This is my first post in this particular corner of MN (I've been on here since 2006 but name-changed in case my mother finds it, as I suspect she knows my regular username) and to my shame I had no idea there was even an 'Elderly Parents' board. Hello. 
Well, I suspect my post isn't going to be particularly unusual. To cut it short, both parents are hoarders. They live in gradually decaying houses and when something stops working that's it. No repairs. They tend not to let anyone in because 'of the state of the house' so it's a vicious circle.
Because of somewhat unusual circs, my mother lives half the year in the UK in their jointly owned house (which is a right state) and my father lives in an EU country about 2 hours' flight away. He holds dual nationality and his original nationality is of that country. Because of Brexit and my parents' joint dislike of engaging with complicated paperwork/stress/bureaucracy, they have never sorted out paperwork to allow my British mother to stay over there longer than 90 days in 180. (Despite being married - UK wedding cert - to my father for well over 50 years!) So, back and forth she goes. She is 78 now 
and dad is 82. They are both extremely resistant to facing up to the state things are now in and accepting any sort of help. Either from my brother and me, or from any outside agency.
It's my father I'm most concerned about. He's getting very vague and mum and I suspect losing his marbles. (His parents both had some sort of dementia by the time they died.) For half the year, he's living on his own in a fairly large house in a residential area of the city. There are stairs. He absolutely does not look after himself. Every time my mother returns there's a hell of a mess to clear up - kitchen in utter squalor, maggots in the rubbish bin in the kitchen, cat litter trays overflowing, fridge full of rotten food. He tends to buy ready meals (they're much nicer than in the UK!) and takeaway cooked food from supermarket and eat that, plus goes out to lunch a couple of times a week (it's very reasonable there). He has two friends left alive really, one is housebound, the other he sees once a week. I honestly think it's all that keeps him going - being able to talk to an old friend in his original language and get out and about in a very minor way.
But the house is an almighty state. A couple of weeks ago, my father had a fall outside. (He was feeding the feral cats that my parents have taken it upon themselves to feed and get neutered, and again while this creates its own problems, I think it keeps him going. They are nice friendly cats!) He lay outside on the concrete for maybe 3 hours and nobody could get hold of him. Could have killed him. Eventually he managed to crawl back inside. By the time I got hold of him, I'd decided we had to ring a cousin (my age) to check him over, as he was refusing to call for medical help. My cousins came over the next morning and took him to A&E where he was patched up, scanned etc. (Great service, far better than current A&E in the UK!) They obviously saw inside the house and what they saw horrified them. They said dad desperately needs a cleaner.
Initially I thought maybe they were being overly squeamish. I would LOVE someone to come over to him once a day, just drop in for an hour, chat, make sure he wasn't lying on the floor, and that he was ok, taking his pills, maybe do some washing up... But my mother has just now travelled over there and by her reports, things are far, far worse than they've ever been. I won't go into details but it's essentially a health hazard. Not just a bit of washing up.
Dad had been very compliant with my cousins and nodded and made the right noises when they told him he needed someone to come in, but deferred the decision and said he'd have to talk to my mother.
My mother safeguards this topic of conversation and I have to tread very carefully, to avoid upsetting her/triggering hysterics. She was at first saying 'well maybe, but it'll be very expensive' (cleaner my cousin found for us charges Euro 10 an hour!! Bargain) but after she told me, at length, everything she found on this trip over (the maggots, the filth, the untouched food on the hob from her last visit...) and I said 'look, I know you don't want to hear this, but he needs someone coming in' she just flatly said 'we can't afford it'.
I have no idea of their finances. They're not great with money (nor am I) and there used to be plenty and now there isn't. 
There is no way on earth they are going to sit down with my brother and me and have a grown-up conversation about this. They don't open envelopes (well my dad doesn't) and while a rental property is being 'managed' by a cousin of his, we suspect it's being mismanaged and something untoward may be going on there. (She's a lawyer, she does take a fee for property managing. We are not convinced it's all being done fairly though.)
I am at one remove from this and am 'not allowed' to just fly over and help. If he were living in this state in the UK I'd have some idea of where to start in terms of accessing a home help, and I could book a private cleaner. I know it's a horrible system in the UK, we'd probably have to sell their house and move him somewhere smaller with no stairs. But in the EU country he lives in - I don't even have enough language to be able to deal with the system! I am already in a debt of gratitude to my cousins who stepped in, and maybe we'll just have to ask them to help us again.
If you were in my position, what would you do? I have no idea where to turn, and I feel so useless as a daughter. My poor dad lives in squalor, he can't look after himself, he won't let anyone from the outside try, and my mother is driving herself crazy doing what she can, at 78.