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Mom’s health recently took a turn, and I know my aunt’s mania is making things worse, but she’s the only family nearby. Mom refuses to put any legal authorities in place, so I am not her POA. Plus, I’m so far away. I knew this day would come, but I’m so unprepared. What can I do?

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Not much you can do if you don't have legal authority to act on her behalf.

I agree you should report her to her county's APS.

You're not unprepared. Your Mom is.
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Beatty Jul 27, 2024
"You're not unprepared. Your Mom is".

THIS.

Unless Mom is deemed unable to make decisions, Mom can change her mind at any time & arrange legal documents to appoint a POA, a Medical POA/decision maker, list Advance Care Directives. Or not. Some never do.
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Call her county's Adult Protective Services and report her as a vulnerable Senior in poor health. You live 2,500 miles away and have to work.
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