I just finished reading "Being Mortal" by Atul Gawande...very insightful into just these kinds of questions about safety vs independence trade offs, what's critical to the quality of life of the person vs. what others want for them, etc. I suggest picking up the book to gain some insight into this very difficult subject that impacts us all one way or another.

Can your parents select an assisted living place that has room and then get her to go for a visit to actually see it?

I think raven might be on to something. I would have your mother or father take some photos (without her knowledge) of her living conditions, just to be on the safe side. You could send a few to her doctor. And if they can convince her to let your father be her power of attorney in case of any emergencies, that would be great. It will be a process for sure.

The one right I hold most dear is the right to self-determination.

I lived this, with my dad. My mom passed away first, and my dad's slow decline into Alzheimer's started within a few months of her passing.

Part of the answer to your question will depend upon the laws of your particular state. I'm in New York, and worked with an attorney to understand from a legal perspective how and when I could become my father's guardian. The legal process isn't particularly easy, nor is it cheap (in NY I guess nothing is ever cheap anyway) - and in the end I managed to handle this without having to go to this most drastic route.

What Cooper wrote above is gold. "The hardest thing....is accepting that what people choose for themselves is not what I would choose for them."

I am concerned that some people are a little too quick to want to force someone, who isn't hurting anyone else, into a group living situation.

I would start with a call to their local Office for the Aging. They can help line up local resources.

Everyone in this situation is a grown up. Your parents are not her parents. She can and should be allowed to choose to live and die as she pleases, not as suits others. We all die. I would never want someone to take my autonomy away. That is so incredibly basic.

So she has diabetes, and her house is messy. Leave her alone.

Thank you all. I understand the right of freedom to choose......but I hate to see her like this. I don't want to force anything against her will, but wonder if she is still in a right mind to make such decisions. If police or whomever came for a wellness check, she would not answer the door. I mention the diabetes only because she is not, or no longer, monitoring it etc. and she doesn't feel good, in part because of this. The diabetes, the home, etc. all seem overwhelming to her, but she is not able to anything about it. The way she is living is not healthy for her....the messiness is way beyond a little clutter, from what I hear. Sigh. It is frustrating only because we care for her well being.

"The hardest thing....is accepting that what people choose for themselves is not what I would choose for them."

"I am concerned that some people are a little too quick to want to force someone, who isn't hurting anyone else, into a group living situation. "

I understand the above, but I don't think it is so much she likes living like she is, but is afraid of change and doing anything about it. Also although I too would hate to force someone out of their home, I think she is beyond taking care of herself at this point. She was my favorite aunt as a kid, and even when I last saw her a few years ago she would laugh and was enjoying life, now not so sure. My parents have brought her some brochures etc. for homes, she seemed to like the idea, maybe, but not really interested in moving forward. Annie I will have to check out that book.

Thank you all for your inputs/perspectives.

Thank You Annie for the book title. I checked it out to my ipad, and will read it. I will someday be that kind of a person, as the aunt.

In this time and age, when you can get almost everything delivered... I could be here for a long long time... not that I am in need of help at this point of my life... but I am not getting any younger.

I hope, the original poster can find a way to get her aunt some help without taking her independence.

Moni

woodnative, you also said that you are 90 min away so I'm guessing you are getting all 2nd hand info. Her sibs who feel responsible for her care may want what they view is easiest for them and safest for her, but safest and easiest for them isn't always best for the person. There are a lot of interim steps between being alone at home and being in a nursing home that may be worthwhile investigating that she is probably not aware of. Getting a social worker involved who may be able to come up with some services such as VNA or home health aide may be able to improve her living conditions and health without depriving her of her home.

Why don't you take some time and go visit her, and make a determination for yourself? You say she was your favorite aunt, yet you haven't seen her for years and are just relying on what a court of law would say is hearsay. How old is she? There's a difference between 75 and 85. Also, if she is not in the throes of dementia or alzheimer's she has the right to determine where and how she lives. You have no right to contact her doctor, and said doctor has no right to talk to you about her. There are privacy laws.

We went through something like this with my Mother. Her situation was not as dire sounding as your Aunt's is, but she neglected her home and was a pack rat but absolutely refused to consider a nursing home. She became ill, and was forced into a temporary nursing home, which became permanent as she passed away there.

I forgot to mention that there is home nursing care available, which might be a first step to look into. Having a nurse make recommendations as to the best thing for your Aunt might be a start. Someone who comes in 3 days a week and helps her bathe and monitors her meds and blood sugars.

I know how difficult this situation is because we lived it with my FIL. Wouldn't accept help from the kids, refused to even consider living with one of them or in a senior community of any kind. And since his mind was still sharp until his passing at 93, there wasn't much that his kids could do about it. Whenever they tried to approach him about accepting help he became so angry they couldn't reason with him. When his physical health got to be pretty feeble, they would go in and try to clean up and he would rail at them, and they had always been pretty scared of his temper all their lives. I can say "it's their choice, you should just accept it and leave it be" but I know how difficult it is to not keep trying. It also causes a lot of guilt on the part of the loved ones and that's a shame, it's not something that you can cast off easily even though it's not your fault. The only thing you can do is try to talk them into help and if they refuse just chalk it up to the fact that you tried your best. You can't force them unless they are deemed incompetent by the court.

Groceries can be delivered these days by a grocery store. If family members do not want to run errands they can say no. My half brother Tom had a temporary physical illness that affected his behavior and was appointed a guardian who charged $50,000 while his illness was treated, a few months.(That fee was just her fee, the total was way more than that after the facility, the lawyers, etc.). He was forced into being boarded in an expensive facility instead of staying with his SO.

I think people have the right to make their own choices, even if the choice involves turning down care that could keep them alive, as long as they can show that they have their wits about them. I'm horrified at family members who force other family members into care situations they do not want.

My father was a doctor, and I remember him talking about an older woman who had just been diagnosed with breast cancer at a more advanced stage. He said that she chose not to be treated at all, that she said that she had lived a good life and did not want to go through the pain and so on that her treatment would entail. He said that for her was a reasonable choice. That conversation has stuck with me for many decades.

Lucille, I agree with you. I think sometimes people force relatives into inpatient care situations because it's easier on everyone else.

Caring for my dad in his own home was so stinking hard on me. But you know what? No one was forcing me to help. I could have walked away at any time. (And there were many times when I did walk away - albeit briefly - for my own mental health.)

When he finally got so bad he truly needed 24/7 care, it was a thousand times easier on me. And yet it was a million times harder on him. He broke my heart.

Aging can be a messy, unpleasant ride. Things that once mattered so much to you can become unimportant. It's hard to watch, but it's not our "job" to force someone into different living situation just because it's uncomfortable to us.

Contact adult protective services, in your state. Most seniors and adults with disabilities live independently without assistance, however, some face abuse or neglect by others and need trained professionals to advocate on their behalf. Others may simply be struggling with routine activities and benefit from in-home support services to maintain their health and independence. APS helps by assessing each individual’s unique needs, then developing a service plan to maintain his/her safety, health and independence. Adult Protective Services

Be sure you know what you are inviting into your aunt’s life. As Lucille stated, outsiders can become involved and charge money for making decisions on your aunt’s behalf. It happens to people with children who live close by. Imagine an orphaned elder. There was an article in the New Yorker last year about oldsters losing their independence and money, all with the approval of the state.

Does she get meals on wheels?

https://www.newyorker.com/magazine/2017/10/09/how-the-elderly-lose-their-rights

I have another viewpoint for your consideration. You mention that she is very reclusive (as I am). The idea of being forced into a facility where my privacy and space are forfeited would make me lose all will to live. Can she afford a personal shopping service ( Favor, Shipt) to bring her groceries and supplies in and take some of the pressure off of your parents?

Your aunt sounds depressed. She is probably too discouraged to tackle the mountain of things (that she has been too discouraged to tackle). She's *embarrassed* about the state of her house. She's not seeing 'a way out', but something could be presented to her as 'already in motion'.

Would your parents supervise a Super Cleaning Team of the sort that tackles home disasters? Your parents could supervise to soothe any fears that things she values would be lost. If all goes well, the cleaning continues another day until the 'mountain' is gone. I think she'd be *relieved*. She might then agree to have a cleaner on a regular basis to maintain order.

She is not going to initiate this. Could your dad find cleaners and present the plan to her as already arranged, deposit paid, and scheduled to commence 'next Wednesday'.

While the team cleans, could someone take her to see a few suitable places for Assisted Living. Does your dad have an idea what she could afford? I would NOT bring up selling her house; let her figure out that part *IF* she becomes interested in moving.

Unless she resists violently, I'd persist in at least getting her house in order. Sometimes, all it takes is making a start.

Would she go out with your parents? Most of the senior facilities, whether independent or assisted will have tours with a meal provided so potential residents get a feel for the atmosphere, food, care and activities. When my mother was slowly inching towards selling her home, we visited and had lunch at more than one. It's a step towards accepting more help when and if she does make a move - while giving her more of a sense of choice and control.

In the meantime, getting her to accept a part-time housekeeper and caregiver a few hours a week could be an alternative family could explore.

Does she have documents appointing someone to act for her if necessary? If not, I think all states have a procedure where a court can grant guardianship/conservatorship for an oldster who is incapable in whatever ways of taking care of themselves. If there is no paperwork and the problems are personality rather than medical, there may be nothing that can be done.

You haven't seen your aunt "in years" and she lives only 90 minutes away? That says more than you might have intended, unless you yourself are disabled in such a way or for another reason that you are unable to drive.

Lucille, that New Yorker article covers a sensationalized scam in in one particular jurisdiction, Las Vegas. It's worthy of the National Enquirer, it's neither news nor information of broad applicability.

Elmer, I assure you that you are wrong. The NYT has similar articles about the issue. Here. you are pontificating in error.

"If police or whomever came for a wellness check, she would not answer the door."

If the police came for a wellness check and she didn't answer the door, they might very well break down the door to get in to ensure she's ok. After all, that's what a wellness check is for.

I think people have a total right to self determination - until their survival is no longer possible without the help and intervention of others, like depending on your parents for groceries, maybe medications, etc. It's not fair to your parents or others to have to choose to give up their retirement plans to care for her, or in the alternative, refuse to help her knowing she's suffering from lack of food, etc.

I would see if they can talk her into visiting (insist on it) assisted living facility, with the caveat that she try it for a month and if she doesn't care for it, they will try to make other arrangements for her. I would bet $$$ that once there, receiving medications and food and comfort, she wouldn't want to move home again. Nor could she probably figure out how to do that on her own.

If that doesn't work, contact Adult Protective Services in her area. They will assess whether she needs to be involuntarily relocated, or can arrange for in home care for her. Your parents don't need to be her case manager. There are people whose job it is to do that for those unable to do for themselves.

lucille, does it happen frequently, infrequently, or rarely? Everywhere or in limited places? Do you know anyone who has been such a victim? Is this a useful caution or a sensationalized article?

Sure, people have a right to live as they wish, so long as they're mentally capable of doing so and demonstrate such by making reasonable decisions. When either stops, family or friends often feel the need to get involved to protect the person.

elmer, you are using basic debate tricks, something you often do when you pontificate in ignorance. Playing debate games with you is not worth my time, I know you are not familiar with this subject and are simply pontificating.

I suggest to those who are curious, that you do a search, there are plenty of examples/articles.

lucille, I don't read the National Enquirer or other tabloid rags. Address my questions to explain your point or not, your choice, but I don't think you do anyone a favor by citing out of context extreme sensationalized pieces.

Having been a guardian and conservator for my husband and knowing each state has their own laws in many states a family member can be appointed as either one or both guardian and conservator. The $50,000 mentioned above may be a state thing or could also mean that the family's attorney if the consulted one either did not advise them of this or the family elected not to do it.

Here even if you are mentally capable if you are physically incapable of caring for yourself a guardian can be appointed by the court. I saw this happen the day I received my court order. One was appointed only until the person was capable in their doctor's opinion. The other one did not have this provision.

Good luck to the families that are undergoing this. A POA prevents many problems and they can be for the person's care and for financial or both. In some states a POA can be written to go into effect only if the person becomes unable to care for themselves. This type has several names so you may have to explain what you want to whoever is writing it.

Lucille, that article just boggles my mind. It almost doesn't seem possible that there are people that evil in the world.

Sadly, Professional Guardians for the Elderly have become a big business here in Florida. Most are ok, many are not. I suggest everyone look into your own state’s situation.

Current Florida investigation of Professional Guardians

governor wants guardians to be held accountable

There was a scandal in my area also about lawyers being appointed as guardians who siphoned of the ward's funds, forbade family to have contact, weren't available in emergencies and so forth. It truly was just another source of income to too many of them, and a pot of gold to a few. Of course, some were conscientious and ethical, but they didn't seem to be the majority (or at least, have the majority of the caseloads). This was my opinion not just from the newspaper's investigative report, but also from my experience interacting with them in the hospital.

A step before contacting APS or law enforcement might be to find out what senior services are offered in her county (every county has some federally funded, and probably state and county funded, services) such as housekeeping assistance, low cost home repairs, and so forth. Then let her know what is available and encourage her to take advantage, emphasizing that everybody understands that things often get harder to deal with so that is why the services exist and people need to use them.

Sometimes people who have been loners, or comfortable or content, or get their self esteem, with only a small social circle and their career can get to a point where those things are gone and they don't cope well. The answer isn't necessarily to get them into a senior facility, and pushing to do that can backfire. Sometimes they just need some time, attention and assistance to get themselves upright again.

Maddie, a friends's mother is in a care facility. It has become obvious to her that the psychiatrist was billing visits and not treating her mom.

He assumed that her mom was like most, rare to no visitors, little to no family. She set him straight.

I just finished reading "Being Mortal" by Atul Gawande.

Annie, I"m glad you read the book. I've recommended it quite a few times.

Anyone over 55 should read it.

Our book club read it and it made for a really interesting and thought provoking discussion. We are all in our early to mid-60's and most of us still have one aging parent some who are still living at home by themselves, one living with their child and a couple, my mom included, living in various types of care.

Dr Gawande is an exceptionally smart person and has produced a lot of thought provoking work. But I've come to think of him in a similar way as I think about Malcolm Gladwell, another exceptionally smart person, in that I think both of them seem to produce work that isn't simply from intellectual application of their vast abilities but also being very mindful of the sales and marketing consequences of what they do. In other words, their output strikes me as not just the result of innovative thinking from being extremely bright but it seems to be directed to coming up with those ideas, the communication of which in book or speaking formats will be commercially successful. Maybe I'm cynical to think so.

Thomas Friedman, another "innovative thinker", also seems to work that way.

She sounds overwhelmed and quite possibly dealing with dementia/Alzheimer’s. She can’t keep up the house, she’s not calling services to repair things, she can’t handle her meds, she’s possibly afraid to drive now thus having family deliver them. Is she handling her bills? Whoever she is closest to should offer to bring her to her dr since she isn’t feeling well. They can either call ahead and explain the situation or slip a note to the receptionist with their observations and concerns. Drs do a mini mental health exam ( who is the president, what’s the date, what’s happening in the news, etc) there’s 30 questions. If she can’t pass , the dr can refer her to a neurologist for further testing. If they suspect dementia, she shouldn’t be living alone period! This is something that should wait until she leaves something on the stove burning. Something wou,d have to be done. If she’s mentally sharp at the exam than a Granny Nanny ( or other services) would be ideal fir light housekeeping taking her out for errands, reminders to take meds, help with laundry etc. They are pretty pricey -$17/hour here. It’s a great solution if she can afford it. Have your parents google The 7 Stages of Alzheimer’s. There are descriptions of each stage. It’s not what most people think, at least not in the earlier stages.

Elmer? Cynical?

Lol!!

:)

Just because she makes choices you feel are "bad ones", does not mean that she is mentally incapacitated.

PLEASE do not bring in outside "services". Once one gets on that road, it's very difficult to get off it. She is making her own choices, whatever her reasons. We have no possible way of knowing if she's "overwhelmed, depressed, or losing it". Many elderly people become just as she is and it's their right.

As soon as my old friend Sally had to have a medical procedure, and had a bad reaction to the anaesthetic, her nearest and dearest put her away in a nursing home. Piously claimed it was for her own good. Let me tell you something, friends, when someone tells you it's for your own good, it is not. They wanted her out of their way, they wanted someone else responsible.

I disagree, Sylvia. Maybe your friend's family had ill intent.

But most family members suggesting alternate housing have very real fears of someone lying at the bottom of the stairs unable to get up.

I'm with Sylvia. They don't want to have to check as often as they should, so a nursing home/assisted living means a once a week check-in max. I'm old and I've seen this happen with many people I know. Most did not last long in that "retirement" home as they were deeply unhappy there. They missed their own furniture (no need to take it - we'll take it FOR you!), they hate the food, they hate being surrounded by nothing but old people. An hour in one makes me want to go find a bridge and jump. Please, no....

Well, hopefully, those of you who would rather die than go to a place where you can be cared for have made explicit arrangements for what you DO want and how that can be accomplished when the time comes. Just wishing to stay with your furniture, yet expecting others to be responsible to check on you daily, or do whatever else might be necessary for you to live at home, is really not a good plan. Nor is it fair to your children who have their own busy lives and responsibilities to become the problem solvers/caregivers. No children? No children near you? Then chose a place you want to live when you can no longer be at home and make a plan for how you're going to get there when it's time. Or find an agency that can provide in-home care for you and figure out how you're going to pay for it. Make the arrangements while you are able or live with the consequences of not having done that and are at the mercy of other making those decisions for you.

When someone is no longer able to manage food/medications/personal sanitation, what are the choices besides outside help? An alternative living situation or outside help, or starve to death?

Unfortunately, Olychick, they prefer to stick their heads in the sand, make no plans, change nothing in their lives or their houses, and pretend they are not growing weaker by the day.

I am glad that in my family oldsters move in with youngsters. I could not imagine having my grandmother live alone. She was perfectly capable of taking care of herself and had the means to farm out anything that she did not care to do, but living alone without her husband and no children near by, what kind of a life would that have been? I know to some living independently like that may sound ideal, not to me. Of course if she had needed memory care or some serious medical attention, then we may have needed to have made different arrangements. She helped my kiddos with homework and I chauffeured her to medical appointments. It was heavenly having her a part of my children’s upbringing.

Olychick, since when is expecting adult children to check on an elderly parent such a burden to the children? When were they at one time not a "burden" to the parent, too? For many, many years! In fact, no mother on earth ever quits worrying about her children, regardless of their age. I am speechless.

I'm not talking about coming daily to give meds or baths or other personal care (although I have had many friends who did do this for a parent in the past). A daily check-in phone call will take far less time than these same adult children undoubtedly spend on social media.

It's a very strange world to me where children feel they should be relieved of all responsibility for an aging parent short of putting them in a home or hiring outside help. I am quite capable of taking my many meds, bathing myself and getting dressed. I also pay my bills - nothing wrong with my brain at all.

But it would be nice to be checked on regularly to be sure I'm okay. Frankly, I'm far less worried about falling and dying than I am about how long it might be before it's realized I'm MIA and someone needs to check...for the sake of my TWO DOGS!

Having dealt with a MIL with mild-to-moderate dementia, the problem is that a "phone call once a week" - or even, in our case, a VISIT once a week - didn't fully reveal the extent of her problems.

There are no easy answers to dealing with elderly relatives. Each situation is unique. There are excellent senior and Asst Lvg facilities, but many of them are expensive.

I will say I'd be very, very careful of getting involved in the legal/financial affairs of an elderly relative without the protection of a properly drawn-up PoA. It's one thing to want the best possible outcome for an elderly relative.

It's a whole different can of worms to be held liable financially for their care.

I think talking to your Area Agency on Aging [county name] as a first step, perhaps with you and your parents, is a good idea. Then I'd find a good local eldercare attorney - meaning one who specializes specifically in this field - and talk to them to find out what you can and more importantly, should not do to conform to your state laws.

It would be worth paying a modest price to get sound legal advice, rather than asking on a Net forum. Just MHO.

I second Jakkom's advice about only dealing legal/financial affairs if you have the proper POA. There is also the small thing of being careful what you sign even with it. If you sign paperwork such as hospital admissions with only your name you can be held liable for the bills. Each state has its own rules as to what is and is not allowed.

I would like to think that all attorney's that say they are eldercare attorneys actually are but some like my first attorney for my husband said they had years of experience in that field and did not so be careful.