Caring for an elderly couple and wife is deteriorating fast. Should I call APS?

Yes, I think that would be wrong. It doesn't sound like she's being neglected or abused, just sick. And she's being treated. If you think she needs more care, talk to the husband. What extra care have you assessed that she needs, and what are your qualifications to do that? What do you think APS would do, take her away for more care elsewhere or demand some more care where she is? Or say she should only have palliative care? Hoping that some other interventions may help her are a nice thought but don't sound appropriate from your description of the situation.

As a care worker you are considered a mandated reporter. It will be of no harm for you to contact APS. APS will decide based on your report and their interview with the consumer if they need to open a case. They cannot tell the consumer that you are the one that reported. It is always better report and have it screened out than to wait and have something serious happen.

You sound like a caring person. Who is genuinely concerned about the lady you work for.
However, with all due respect, I wonder if you know what "extra care" you think the government is going to provide? And at what cost to the couple...finanically, emotionally and health wise
Everything in life has a price.
Are you aware of what "palliative" care is?
Its bombing people out with a very potent cocktail of narcotic drugs...to the point that they are passed out. This old couple have spent their lives "together"...loving each other. They share a home together.
You say the husband is healthy. And he hired you to help out.
So perhaps a good approach would be to help keep the lady hydrated and healthier
Apply the Golden Rule
Be the change you want to see.
My Grandpa often tells me "Get it done yourself"
There are a couple of simple inexpensive things you can do to help her

a. Distilled Water. Buy some $1 bottles of distilled water. And find out what her favorite fruit is...ask her....or her husband will know. And put a few pieces of the fresh fruit &/or a few sprigs of fresh mint into each mug of water. And keep giving her the fluids. Count the cups the days you are there. At least 6 cups.
This will make her urinate more...of course. However, the body is 98% water and in dehydration the brain shrinks so her problems will be much worse.
B. Herb teas
Corn is in season now. You can buy a few cobs of organic corn for little money.
Im sure the husband will pay for it if you explain
Strip off the silks...(the long hair parts). Bring 2 pints of distilled water to the boil
Add the silks of 3 or 4 corns. Let sit 20mins or more. Strain off. And give to the lady to drink. This taste of almost nothing & is very soothing to the inside of the body. And will soothe the bladder & help prevent & treat bladder infections.
C.
Nutrition is very very important
The key is ORGANIC foods. You will find when you go to the farmers market in your area..especially towards the end of the market day you can get good deals on fresh produce
A CROCK POT is a cheap and wonderful investment. My friend found one at a thrift store for $12. Its just a matter of chopping up lots of fresh vegetables, rice, beans, chicken cover with chicken or vegetable stock (avail at Trader Joes ) Turn on low & leave for 12 to 24 hrs. Then they will have a nutritious and tasty fresh food that will last a few days. Store in fridge or freezer in boxes they can heat up as needed.
These simple inexpensive ideas will improve the quality of life for this dear couple (& yourself if you use the ideas) more than you can imagine.
I work in medicine. Now only practicing holistic medicine

Can a paid caregiver be considered a mandated reporter under the circumstances described above? What are the legal ramifications of doing nothing? 
And is it clear that the health care workers, doctor, hospital staff, are actually aware of the true situation?
When they ask the husband about the situation at home, is he honest and accurate? Wife may not be getting the care she needs - many men of a certain age are clueless about this.

Personally I would never tell anyone not to call APS if they are worried, perhaps with the proviso that at first they do so in confidence and without naming names. The worst that can happen is nothing at all, and it can be helpful in terms of getting advice and putting a potentially vulnerable client on their radar; so why wouldn't you?

That said, it doesn't sound like the right step in this poster's situation. The elderly lady is already under close supervision from healthcare professionals, for one thing; and for another it would be better to think specifically about what additional care is needed.

What is not being done for her at the moment that you would like to see done? What has the husband got against her being assessed for palliative care? A rose by any name would smell as sweet - rather than pushing the whole package, concentrate on particular tasks and see if you can get him to accept more help with those.

You should get their family members involved. It is their decision.

You could call her Doctors office and and inform them of the situation. Suggest the Doctor insist on seeing her within a few days for so. That will get oversight on her when she cannot go to the appointment due to her ill health.

I'd start with talking to family, then doctor, then APS if no action.

But where's the hospital? The woman has been in hospital multiple times in last 2 months. I'm assuming that she's a Medicare patient. Hospitalized are penalized if patients are readmitted within short periods of time with the same diagnoses. She should be getting home health nurse visits at least weekly. Where are those who should be helping this woman?

No You would not be wrong to call for help for this por Elderly Lady Who is obviously suffering. Ring The Adult Protective Services in Your area immediately to get relief for this Lady. As Carer it is Your duty to seek help for the Person or Persons Who You Care if They are suffering or in distress.

Well, first as people have said, involve the family. And the doctor. If she had been taken to the doctor multiple times to try to figure out what is going on, and she has been brought to the ED, then it is not neglect. He may be thinking palliative care is same as hospice and means she will die. So he says no so she does not die? Maybe you tell the husband that you are going to set up a consultation with a palliative care provider so that he can hear about it. He may be competent to make this decision for her but he needs to make it as an informed decision.

Your heart is in the right place. My two cents are that if you are working with an agency, to bring the situation to the attention of your supervisor or manager. However, do not stop there, follow up with your agency staff to make sure steps are being taken to address what you have unearth. On the other hand if you are working privately, I concur with Grandma1954, involving other family member might be very helpful. Be gentle, loving but firm about a course of action you want to see taken. Legally, you are obligated to notify the authority because it can be interpreted as negligence or abuse for failing to report your concerns. Hope this helps

Call your supervisor and tell them what you know. Give it a week and then go above your supervisor. Give it five days. If there is no improvement or logical reason than go to the authorities. If it's a life and death situation call 9-1-1.

Do you work privately or through an agency?
If you work through an agency this should be brought to the attention of your supervisor, manager or other person that can contact the husband and have a "care plan meeting" When I was using an agency for caregiver for my Husband they would come at least 2 times a year to discuss his level of care, how he was doing as well as how the caregivers were doing.
If you are working privately you might want to have a discussion with the husband that you think that more help is necessary. For her safety as well as yours. If things continue the way they are that you will have to submit a resignation. Tell him you will give him time to find another caregiver. I think wording it this way he may realize that you are serious and that it may be a safety issue for his wife.
If you know of a Hospice group tell the husband you can call in a "friend" that will discuss options. Tell him that the service will be free (Hospice would be covered by Medicare) and that the supplies and any equipment would also be covered. Palliative care is not free although some may be covered and not all the supplies and or equipment would be covered.
It sounds like he may be not just overwhelmed but also in denial about how ill his wife is.
If there is family close you might want to talk to them as well or they may be caring for Mom after Dad has died, many statistics show that caregivers die before the person that they are caring for due to stress and not caring for themselves.

Knowing that he is most likely surviving on her SS & his , this is hard but YES , I would call them today . They hopefully will work with you . It is important that they know husband has no interest in working with her and she is definitely in danger of consistent health issues without a proper place to live . It ends up being Neglect because he is not helping her with drinking enough water and without a miracle , she simply will die this way . I would not speak with him about the situation at all . He is going through a hard time but does not understand that she is in dire need of proper care . The understanding you have is something he cannot have without your education in care work . I know you know the right thing to do or this would not even be a question . Neglect is not something always done on purpose . It happens through lack of knowledge on the subject and old habits . Understanding neglect will ease your guilt feeling because you can see it , he cannot . Normal for many in his situation . Please call today .

I am sure that you have talked to husband about the purpose of palliative care, but he probably doesn't get it. That is not 'perfectly normal'. Does he think it would shorten her life? Does he not accept that she is deteriorating and will die eventually? Would he feel he is losing control of the situation? Are there financial issues involved?

It might be helpful to talk to the palliative care agency yourself about the situation - they will surely have had experience in similar situations and may have good suggestions. Even some printed material from them might be a help.

If you think husband is losing patience with you bringing this up, can you find someone else to do it? If finding 'family' is too hard, perhaps a letter to her doctor could explain what you are seeing and the difficulty in dealing with it. The doctor can't talk to you about it, but it could alter what questions they ask and what they actually see. You could even make the letter anonymous if necessary. But Ahmijoy is right - you don't want to appear to be talking about abuse and neglect.

Good luck!

Unless you are witnessing abuse I don't think APS is going to be interested - I imagine the husband has POA for his wife so since you say he is "perfectly normal" it is well within his authority to determine whether or not to choose palliative care or hospice, and she has been seen by doctors and nurses at the hospital who are mandated reporters if they felt there had been a need.

I want to add that people have the right to make medical decisions that you or I wouldn't agree with, even ones that might cause pain or suffering. As a paid caregiver you must be able to go along with those choices, if you can't then it might be better to let someone else step in.

Before you take a very drastic step like this, you need to contact any available family members and tell them what’s going on. Are you aware if anyone has POA or guardianship over either of them? That’s who needs to be contacted before APS. From what you wrote, this woman has health problems. APS deals with abuse and/or neglect. Medical issues aren’t really their concern. I would not hesitate to call 911 when she has a seizure. Don’t let the husband tell you not to call. If you don’t call and something happens, it could not go well for you. At some point, her family will realize they need to do something.

Do you accompany her to the doctor’s? Next time, ask for a family member to go with you. As “just” a caregiver, you do not have the power to make medical decisions. If you aren’t on the HIPPA (privacy act) form, the doctor can’t even discuss her condition with you.

Who pays you? Speak with that person. Or, if you are employed by an agency, go to your supervisor. If you are privately employed and have no luck making voice contact with their family, find an address for the person who pays you and send a registered letter. Tell them your lady is declining rapidly and you feel she either needs Palliative Care or even Hospice. Share this with the doctor as well. Leave it to the doctor to make the first contact, it share everything you’ve observed. If