My Aunt is competent but she will not be around much longer unless she gets 24 hour care but refuses. Any advice?

Just being recently widowed, she may be reacting to the loss of her probable lifetime partner, and has lost interest in life and therefore refuses to cooperate or take action to help herself.

I think an intervention by the family is appropriate in this situation, but what I don't understand is why someone in ER hasn't already considered or done this.

The children could call APS, but I would also call the hospital administrator where your aunt goes for emergency treatment and alert her/him to the situation, asking with whom someone could speak to add an alert to her electronic chart so that the next time she comes, APS is called to intervene.

How does she get to the hospital? If by EMS, I would alert them as well; I believe they have mandatory reporting obligations and could also contact APS to get intervention.

I don't know if ER physicians prescribe anti-depressants, and I suspect your aunt won't see a doctor, so she may be locked into a downward spiral.

I do think that she's made her decision and isn't going to cooperate even with APS though.

Is there anyone in the family of her age who could speak frankly with her, even if she resists and won't cooperate? Was she religious? Any friends from church or a pastor, priest of other person who could intervene?

I feel for the family; from what you write they're doing their best but your aunt is set on an apparent unchangeable course.

It's understandable wanting to help your aunt and wanting her to have a better quality of life but since she's competent she has the right to make her own decisions about how she wants to live. You can't force her into accepting help. Continue to try and help her but she has the right to refuse the help. I know it's frustrating but there may have to be some kind of major crisis before you and your family are able to step in and help and her.

Snowwhite45, I was dealing with the same thing with my parents refusing to accept outside help [mainly it was Mom refusing the help]. And as Eyerishlass had mentioned above, it usually takes a major crisis before we can get out love ones help.

Sounds like your Aunt's 5 children have tried to take a stand like hiring caregivers to which your Aunt refused. The children probably had tried until they are blue in the face to have your Aunt move some place that has a higher layer of care for her, either with one of them or in a retirement community. Sometimes you can't make a person with a sound mind move anywhere... my parents were that way. Very stubborn.

Who is calling you with the reports that she was in the ER and/or of all the falls? Are your cousins relying this information? It was a major crisis that finally has my Mom living in long term care [not what she had planned] and Dad looking at Assisted Living. But apparently with your Aunt even with all the trips to the ER she still wants to keep independent.

GardenArtist, here in my area, the 911 system keeps records on how many times they have visited a household. And I remember the EMT's asking my parents if they lived alone or had caregivers. How frustrating when I had to say my parents refuse caregivers.

Thank you everyone for your input and good advice. She has been on a low dose of I think paxil which I have recommended to have increased or switched to something else. I recommended a psychiatrist, they made an appointment but then my Aunt cancelled it. My cousins are leery of increasing her antidepressants because obviously your not supposed to drink while taking them and my Aunt will continue to do so. I feel she will have less of an urge to drink if her emotional state improves but I do see there point. My mother and her sister are very very close and my mom was actually with my Aunt when she fell the last time. I even recommended the two sisters to live together along with my mother's 24/hr aide and neither thought that was a good idea. My mother is doing so well now that it probably would be too much for her. I will tell my family to call the hospital (s) to have the alert placed and see if the 911 system has kept records. She also has life line so I'm sure they can contact them as well. We find out about the falls several ways either by life line, she confides in my mom, or unexpected visits usually expose a obvious injury. She is religious and occasionally goes to church. Her favorite priest was transferred soon after she lost her husband so that was another blow to her. It makes me very upset to see my Aunt this way. She misses her husband tremendously and would want nothing more than to be with him and I'm afraid she is trying to expedite this ):