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My 93 yr old aunt (no children or spouse)lived alone in NYC. She fell several months ago and suffered a broken hip, brain bleed and concussion. She was not discovered until at least 12 hours after her injury. Had she not been expected in Chicago that day for a visit no one would have found her. My cousin called the doorman after she didn't show up on the airplane and had him break into the apartment where he found her on the floor. My cousin flew in for her surgery and then I came into town from Virginia to get her moved from the hospital to a rehab. After her rehab my brother moved in with her (temporarily) to help her until she was back on her feet. She has home health aides 8 hours a day. Her mental health has continued to deteriorate and we now realize that she will never recover to the point of being able to live alone. My brother needs to go back to his life in Washington State. He is completely burnt out. My cousin and I found a care facility for her near my cousin in Chicago (I live in VA) but she says she would rather die than leave her apartment.
Her closest relatives are her sister's children and the widow of one of her nephews. (My cousin and brother and I are more distantly related although emotionally closer with her). The widow holds POA and Health Proxy but doesn't want to actually be involved with her care. The other 2 argue that we can't force her into care and need to accept her wishes.My cousin and I argue that she is mentally incapable of making decisions regarding her care and that we'd rather she be in a home than suffering a gruesome death at home alone.My aunt is physically incapable of living alone. She requires help using the toilet, dressing, etc. let alone paying her bills and managing her healthcare. She has recently not only had memory loss but full blown hallucinations where she thinks distant relatives have visited her.My brother is on the verge of a nervous breakdown, he is averaging about 4 hours of broken sleep per night because she gets up and forgets to use her walker or starts yelling that there's someone at the door when she hears noise from the street. She insists she doesn't need help but when he left her alone for 1 hour last week (she was angry at him telling her what to do and told him to get out) he came back to find that she had tried to get the mail, wearing only underwear and her robe and a neighbor had found her and helped her get back to the apartment. She was in the hallway, unable to figure out how to unlock the door.My cousin and I are unable to leave our families and obligations to just fly to NYC and take care of her. My brother has lost his job and his apartment back in WA and has blown through his savings caring for her.At this point we don't know what to do.He cannot continue to care for her.We cannot afford for private in home care and even if we could get her approved for 24 hr care through Medicaid, we've been told the aides cannot dispense medication.We've also seen evidence that some of the part time aides have stolen jewelry, cash and clothing from the apartment even with my brother there. We are concerned about what would happen to her without a family member there to watch out for her.The family member with POA and Healthcare Proxy will not take action to be declared guardian.None of us with the willingness to do so can spend that much time in the city (for court) or have the money to pay the court fees.Is there any option to keep her safe other than reporting to APS and getting her made a ward of the state?
Editing to add: The facility we found near my cousin in IL has a MC wing that she would qualify for with her Medicaid. (No private rooms unfortunately, she'd have a roommate) She currently lives off her Social Security and her apartment is both rent controlled and partially paid for through a local Elder Care group.
Please give suggestions. We are out of ideas.
If she is hallucinating I would call 911 and tell them this and that she may have an untreated UTI. They will take her to the ER where your brother will tell them she is an "unsafe discharge" since he must leave to go back to her life and that she cannot manage her affairs anymore. He should then ask to talk to a social worker to discuss having her discharged directly into a facility. Do not believe the hospital if they tell your brother that if he takes her back home they will "help" him. No, this is a lie they tell in order to just get her out. Keep saying "unsafe discharge" and if that doesn't work then "social admit".

The niece who is PoA does not have to be involved in her care but if the Aunt doesn't ever have a formal diagnosis of cognitive incapacity, then the PoA authority is not actually active.

Your Aunt will eventually be assigned a court-appointed guardian who will manage her affairs and make decisions on her behalf. Although this is probably disappointing, it is a still a solution -- and probably the only solution.
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