I have an adult sister sister who suffered a traumatic brain injury in 1981. I don't know where to start to deal with issues that have gotten worse as time passes. Any suggestions?

What a very sad situation. I don't know if I could just give up on my sister, but that really seems to be what is needed here, don't you think? She doesn't want your help, stop trying to impose it on her.

Subsidized housing is physically inspected at least once a year in my state. They look at everything, including the oven, the inside of the fridge, the floors, etc. They are checking for damage to the property, of course, but also for the safety of the residents. Does this happen where you sister lives? When was the most recent inspection?

While I would try to remove myself from the direct line of help, I think I would try to bring the problem to the attention of someone who might be able to so something. Maybe I'd find out how to request an inspection. And/or I'd contact Adult Protection Services, and report that a vulnerable adult is living in an unsanitary situation.

This is really hard! I'm sure you love your sister and have done your best to help her over the years. Maybe it is now time for tough love.

Even if you could get your husband to change his mind, please do not even consider bringing your sister into your home. That way lies madness for all concerned.

Your sister hasn't bathed in over a month. She is living in an unsanitary home that smells of urine and is so unswept that setting foot in the place brings on your asthma symptoms. She is morbidly obese. She is verbally abusive. She is in worsening health.

I am sure you have been doing your best - these 37 years, what's more - to support your sister and maximise her independence. But looking at how you describe her living situation...

How would you say that's working out for her?

I respect what you say about not wanting to jeopardise your sister's independence. But you are not alone in this: professional social workers won't want to do that either, any more than is necessary to her wellbeing. Let them get her living situation back on track while you develop a new kind of relationship with her. You've surely more than done your bit.

My suggestions might be "long shots", but it sounds as if you're in a very difficult situation and your sister is unable or unwilling to cooperate, so "a long shot" might be worth a try.

You might want to contact your county and state to see if there are any services for individuals with TBI. I don't know if 57 would be considered "senior" in your area or state, but check that out as there may be additional levels of service for seniors with TBI.

A county health department might be able to institute a cleanup, or work with the governmental agency that manages the subsidized living.

I would also do some research and find out if there are any rehab facilities for individuals with TBI. One of the local hospital chains in Michigan had a TBI rehab center, and if I recall correctly, there was a social worker affiliated with it.

If you're in an area with teaching hospitals, contact its Neurology Department - it may have some information to share.

You might even want to contact neurology clinics, big ones, with a multitude of medical pros. Another thing I vaguely recall is that when I was researching to find a neurologist, I came across one which if I remember correctly had a social worker on staff. (I recall being a bit annoyed that I only wanted post stroke treatment and didn't a SW to get involved and try to dissect my concerns).

This is a big research project, to identify and research whether or not there are clinical social workers who specifically address TBI injuries, but it might open some avenues for you in finding help for your sister.

You might also contact local hospitals to find out if any sponsor or are aware of TBI support groups.

Good luck on this challenging venture, and remember that you're doing what's best for your sister while trying to preserve your own family's well being. These are not easy situations to manage.

Dnibbelin, what ever you do, DO NOT move your sister into your home. You will loose your home, your marriage and your sanity to name a few things. Her behavior will not improve, her personal hygiene will not improve and you would have no escape from the verbal abuse. You did not do this to her, so please do not give her your life to ruin.

I am sorry for your sister, it must have been hard to loose herself through injury. However, I am concerned that she has just sat around manipulating others to do for her instead of adapting to the new normal and living her life. People are injured in traumatic ways everyday, some choose to feel sorry for themselves, destroying themselves and all around them, others choose to find a way to live on their new path with joy and happiness, embracing what and who they have with love and gratitude.

You have done all you can for her, it sounds like you need to contact Adult Protective Services, they can assess her situation and determine if it is in need of intervention. This can be done anonymously so as not to cause more strain in the relationship. You should not feel guilty if they determine that she needs more help than a home situation can provide and you should not feel obligated to intervene if they say, no worries, people can live like hogs if the want. Filth is not a big concern as long as there is no danger in it. Let the professionals make that determination and you live with it. It can be hard if it's not what you think should happen. Also, do not let them guilt you into being a solution, tell them under no uncertain terms that she can not move into your home. They try to guilt families and it is so unacceptable, your sisters situation is the exact purpose social services was created, so stay firm in NO I am not a safe release option.

As a caregiver of a selfish, manipulating, narcissistic dad I understand how hard it is to want to help and to be attacked because he wants what he wants, not what he needs and nobody can tell him different, he has a broken brain and body as well. I have been learning to walk away, my help does not extend to being his scratching post. You have to learn that you and you alone have the choice, stand here and take it or walk away. I personally have a hard time with his lack of gratitude, I can never dance fast enough to satisfy him, never have been able, so I choose to not dance. I do what I can, when I can, I so wanted his acceptance and I sooo wanted to be good enough and I realized years ago that I am not the problem. His choices have consequences that he does not want to face, so I should be responsible for them. Sorry dad, that is not how it works. Yes some people will think they're responsible because of fear, obligation and guilt and manipulating people can work those like nobodies business.

Love your sister and keep yourself safe from her choices, sometimes people need to hit rock bottom (I personally need to drag bottom after I hit it) to wake up and make changes. She has been getting her way for 30+ years, if she wants change it may take a long while to see it, she has a lot of things going on.

God bless you and your family on this difficult journey and may your sister find the help to set her on a new path. May you have the strength to say no and to not let her move into your home.

If she wants to live and be in filth that is her choice. The dog should definitely be removed from there, since he/she does not have a voice and needs someone to speak for him/her.

You said she suffered a traumatic brain injury. Was your sister always like this or just recently. Brain injuries contribute to Dementia. She may be showing signs. I agree that you may have to back off. I would call APS or Office of Aging asking them to check sister out. Let them do what they can if she resists oh well. I am getting this way with a nephew. I am so tired of telling him over and over what I expect (he lives in my Moms home for now). He has physical and neurological disorders. He hygene is awful. He is a slob. And he is almost 100 lbs overweight, which effects his physical problems and rods. At 68 I don't feel like babysitting a 28yr old. Yes, some of his problem is his maturity which is probably 18 but even an 18 yr old understands what I need done in Moms house. I am trying to sell it. I can't have living with me. In the process of finding him help long-term. I won't always be here.

I also believe that God helps those who helps themselves. I am willing to help a person find resources. Even drive them there to sign up. But why should I do this if the person doesn't follow thru. I have a friend who loves to say "poor me" but doesn't do anything for herself. She has tons of medical problems, maybe. She is known for telling lies. When she told me she was diagnosed with Parkinson's I asked her what he future plans were. She said to stay in her apartment the office lady said she would help her stay there. Right, is this lady going to bathe her, dress her, cook for her...this friend will not use the Senior bus or call Medicaid for help. She is estranged from her boys and as an only child no siblings. Her parents were 40 when she was born so no Aunts or cousins. She expects too much out of people and gets upset when they don't come up to her expectations. She was complaining on FB and a lady commented that she has offered help but K has not excepted it.

God helps those that can not help themselves. That scripture is often misquoted and used to make people wrong. The sister obviously needs intervention and from my experience that is not something that family or friends have much luck with, strangers with authority get way more compliance and willingness.