What can be done to help a patient with severe COPD and heart failure?

Could you clarify something for me? You wrote that her oxygen levels (SAT Rate) get low b/c of oxygen deficit.

Is she on oxygen 24/7 at home? If not, why not? Medicare will pay for it although there will be a co-pay for the 20% that Medicare doesn't pay.

Your friend can go to county court and fill out a form petitioning the court to appoint someone else as guardian. In our county the filing fee is waived if you are referring an at-risk adult. The court in turn will wake up the out of state family. If they do not respond, they are out of the decision process.

Next time she goes to the ER and friend and does not have any kind of authority to make decisions but is no longer able to provide the 24 hour care she needs and needs to be permanently place in a nursing home and apply for Medicaid.
Hospice might also be a consideration because of the number of ER visits and admissions. The severe heart failure and COPD would also qualify her. She may not want to do any of those things but really she has no choice. I am afraid there will be no choice of facility, it will be the first bed available in a facility that accepts Medicare patients. The next time she goes to the ER contact her family and tell them that they will be responsible for her future care, as it is not safe for her to be alone during the day and there is no question of you not working. I can only wish the best for her but really this is the only alternative in this case. Explain to her when she is lucid that you wish it could be different but if the family won't step up this is what has to happen. I hope she gets a nice place and does not take it too hard. Of course the friend can still visit and take her out for meal if she is well enough but realistically she is entering or has entered the last phase of her life.

Your friend can tell the discharge planner at the hospital or rehab that she will not take the person home. Is friend prepared to pay rent alone? Without power of attorney, I would not take responsibility for a frail elder left alone when I worked. It sounds like time for the social worker at hospital to begin looking a Medicaid facility with emergency guardianship by the state she lives in. Just be sure that no joint bank accounts or assets exist that will need to be turned over for her care. Send a notice to the kids by certified mail that their parent will not be discharged to friend's care as the living arrangements do not provide safe 24 hour care. Some folks are happy to let it be your burden forever. Your friend has all the work and no protection. Sorry it has gotten so bad.