First of all she has been difficult all her life - nothing new. She is almost 20 years older than him, single, and, personally, a very cold person, lacking in empathy, etc. Example she told the dining room manager in a senior hotel not to seat anyone with a walker or memory problems at her table. If you can't discuss the latest news with her she says you are "stupid." That's her favorite word for people she doesn't like and the world is full of them. Second of all she's a total loner - always has been. At this stage in her life she is living in a senior hotel, is almost blind, and due to lack of exercise of even moving about she can barely walk. She has never been one to walk or exercise as much as we and her MD's have encouraged her to do so, she refuses. As a result, she will, sometimes, tumble over and watch out when she does! She will scream her head off. She only wants the paramedics of our city to lift her up but the hotel won't call the paramedics if you aren't injured - they call the Fire Department and she raises such a fuss with them they told the manager they really don't want to deal with her anymore. I'm talking about the Fire Dept in a city of 3 million people!! Anyway, you get the idea. Big problem is she has outlived her money and, is liberally using a $15.00 an hr. home health aide - she winds up in debt every month which we have been covering. She came close to being evicted, that's how we got involved, as the management contacted my husband. He got involved (we have never been close with her) and straightened everything out for her - very difficult to do - what a mess. She puts up a big front so we had no idea she was in dire straights, financially. We are retired ourselves and don't have tons of $$ to pay for her sending her aide to the store for whatever. We told her we will go to the store for her but she prefers using the aide. It has come to the point where, as they raised her rent, she needs to go on Medicaid, which she refuses to do. As much as she complains about her current apt she is horrified by going to a Medicaid home (2 to a room) and un-cooperative when the Medicaid rep came out to try to certify her. We have bought her 4 different style phones and she still refuses to answer so my poor husband (who has already had a serious heart attack and she wouldn't even come to visit him) has to hop in the car and drive 1/2 hour up to visit her to tell her something. He is her only relative except for 2 nieces who aren't involved, and he and she have never been close - he doesn't even like her but does it out of a sense of responsiblity. There's a lot more to this "story" but what I'm wondering is this. She used to be a total Saks 5th Avenue gal but now sits all day in a dirty nightie until the aide comes in to dress and wash her. She was recently given a physical at a top hospital here and they said she is in great shape, except for the vision, and no sign of Alzheimer's yet she acts so oddly. She seems content to sit in her nightie all day, listen to the tv full blast, and eat eat eat. She loves to eat! Her apt smells so bad of urine that her neighbor apts complain. She is in independent living. Now that she has the health aide she refuses to do anything for herself. A senior advisor told us that for some people, getting the aide is the worst thing as the person will sometimes just let the aide do everything for them. Bottom line this can't go on. The manager at her hotel/home says, politely, they want her out of there by March - she causes too many problems. She is refusing to go and she is very articulate -the type of person that can freeze you in your tracks and make you feel like dirt. Always has this superior attitude. My husband is ready to wash his hands of her (finally!) To take her to the MD we now have to rent a medicar ($150. - $200.) and it takes a whole day to go to get her, take her there, wait for her long appts, take her back home, get her settled in, etc. as she raises a fuss going into our sedan. Any advice please? We are at our wits end. Thanks very much. Oh, in case you think I've portrayed her in an overly mean way - I haven't told you half of it, believe me, like how cruel she was to their 100 year old mother and used to make her cry, etc.

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I'd consult with an attorney about the options. Volunteering to be her guardian might be a very daunting task. I'd inquire about what that means and if you want to take it on.

If not, the court can appoint someone, such as the county to be her guardian. Or you can report her to Adult Protective Services as an adult who needs help. They can investigate and apply to the courts, if they think she needs help with medical decisions and/or financial matters. Eventually, as her dementia progresses, she will need more and more help. Whoever is working as her Guardian can assess her financial situation and apply for services that she qualifies for.
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Your husband has a mentally ill older sister who is used to being catered to. You and your husband don't have the means or the inclination to do so.

Step back. Unless you are her guardian, you have no legal obligation. I would not endanger my husband's health dealing with her. Let the facility get the State involved; the State will seek guardianship and she will be cared for.
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