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From my experience, it's crucial to have someone monitoring them weekly. The dementia may progress gradually or in step downs. Her husband may or may not pick up on this. Is he in denial about her dementia? Does he have it too?
It's very stressful to care for a person with dementia, depending on their symptoms, but once she begins constantly repeating, misplacing things, having delusions, falsely accusing, wandering, etc. her husband may be overwhelmed. I would keep check on that. He may resist help now, but when she is difficult to control, he may feel differently. I'd look into options for placement while you have the time to look around. Just in case.
The problem is that with the dementia, it's difficult to convince the person that they need help. Usually, it has to be done under the guise of something else. There are varying ways to do that. I'd survey the situation, make a plan and then get ideas on how to carry it out. You can get help from her doctors and on sites like this one, where lots of caregivers come to post.
Also track their Rx refills online, although this won't completely tell you if they are messing up the meds. Some MD's have online access to tests and reports, which would keep you up to date on what is changing.
And you do have to get an eyeball on things occasionally. I call every day and Mom wil insist it's all A OK. But when I go down I always find some alarming new developments that must be dealt with.
Others have mentioned POA. Even though there is a trust I would look into a broad DURABLE POWER OF ATTORNEY as well. I was able to get this as well as permission to join the checking and savings accounts just before my Dads dementia got worse. I would have been screwed without this as I'm now taking care of all bills and finances.
And as Blannie says, unfortunately, it usually does take a crisis to make change happen. I've begged and lectured my folks about getting in home help or moving to assisted living to no avail. I've come to realise I can't force the issue. It will take the bad fall, trip to the ER or a major event will force the issue.
Get used to the idea that you can only do so much and that's true whether you live next door or three states away. Good luck.
So stepfather is also resistant to any outside help? If that is the case, sometimes you just have to wait uncomfortably until some kind of emergency (like a fall or hospitalization for example) makes them open to outside help.
How far away are you and do they have decent financial resources?