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She just got a pacemaker, and he is isolated. They live in Little Egg Harbor, both on Social Security, Medicare and Medicaid.
I live in NYC and cannot get there. Are there programs to help them?

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The advice given is excellent. Do what you can to see what care they have in place and also what is available to them through the programs that they may not know about. So much depends on where people live.

They are fortunate beyond words to have someone like you concerned about them. As samara also said, see how the Power Of Attorney is set up, as well, because likely someone should have POA for both of them.

This could get very time consuming for you, so getting in touch with the appropriate social worker is important. When you have some guidance and a better grasp on what is being done or what can be done you'll know more how to proceed.

Thank you for your good heart and please take care of yourself.
Carol
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Do you know what support your aunt and cousin already have in place? I agree with Samara that your aunt is very fortunate to have you paying attention, even at a distance, but this is just a note of caution to check carefully before you start making new arrangements for her. Perhaps contact her local social services as a first step?
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Thank heavens you are being concerned for your aunt, I good place to start might be to establish yourself to her county social worker as (perhaps) the only sane relative she has....call them, get their email, ask them how you can remain involved and they will recognize what an asset you are. If you have documented somehow your cousin is not capable of providing support/decision-making for your aunt, its possible you could be appointed guardian, but that can be costly if you petition to be that. I'm not positive but if you do stay in touch with county social worker, regularly, perhaps they can recommend you as a guardian, but I will have to allow others on this site share their advice. A few more details about whether your aunt has already set up DPOA, Medical POA, and will/trust would help. Do you know if aunt had an attorney at some point? Is she capable of appointing DPOA/Medical at this point?
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Sorry 50s child, if someone is concerned they should first go and check out the situation whenever possible, unless the OP is in ill health there is no reason not to make a trip that is a straight shot down the Garden State Pkwy....this is a difference between can't and won't. We're not talking thousands of miles. It is an easy day trip. You can leave after rush hour in the morning, and head home before traffic in the evening.

And where do you get that the cousin might be abusing the aunt? Mental issues(because the OP wasn't very detailed) could mean depression. This is why if someone is going to take an interest(doesn't mean you have to do anymore than this) check it out yourself first.

And of course you call first, while most people don't like unannounced visitors the aunt and cousin aren't going to like the state of NJ showing up either. Especially if they're getting by OK.

Also before anyone goes and calls and opens up what could become problematic it is much better to have exact details(by seeing for yourself) what is going on. For example, what is the condition of the house? Is there proper food in the house? Do the aunt and cousin get along? Is there any abuse?

You find this out by going and seeing for yourself. So that if you have to start making some phone calls you have accurate information as to what exactly is going on.
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Basically, I've given up getting involved due to all the nastiness created by my elderly mother (87) and my sister (57) whom my mother begged, whined and manipulated to live with her, despite everyone else in the family saying this was a bad idea and there were other options. This sister has a serious mental health problem (paranoid schizophrenia) and when she takes her medications properly she's fine. However, when she doesn't take them right when she gets anxious (apparently they have to be taken in a particular order), she starts to act bizarrely (food bingeing, glaring, shopping for same things repeatedly -- she now has 50 handbags -- loud voice, refuses to walk anywhere, other). My mother's response is to accuse me or my family members of theft (always something shiny and basically worthless!) and to attack my character and tell other family members how I'm a bitch or whatever. I've tried to help but no one listens or takes up any of my suggestions so I'm just waiting for that call from the hospital or police when it all falls apart, as it surely will.
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You're about 90 miles away from them, I realize that is not around the corner, but that is quite doable for a day trip. Why don't you go down there and check out the situation yourself first than see if a social worker needs to get involved.

You make it sound like they're on the other side of the country, when in reality it would take you less than two hours to drive there, if you don't drive ask someone to take you.
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contact your local area agency on aging or bureau of senior services, they will be able to advise on available services and benefits they may be eligible for.
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As others have suggested, the local county social work office will probably be the best point of initial contact. But I would be VERY wary of taking on personal guardianship, custodianship or conservatorship -- unless you want that kind of involvement, which can be very intense and demanding. I have heard (but do not know) that if family does not step up to legally take responsibility for a family member, then social services will initiate proceedings to make them a ward of the state if they are not of sound mind. The "not of sound mind" is often determined by a doctor and psychologist, or two doctors, a court-appointed guardian ad litum, and a court hearing. If your aunt is doing ok mentally, they will tend to support her wishes to be independent. If your cousin is abusive, negligent or takes advantage of her, social services would likely investigate. If you are the person reporting such concerns to social services, your name may be revealed to your aunt and/or cousin. So when contacting social services, you might request that they keep your name confidential (I don't know if they can). I'd like to believe social services would commend you for your concern. Personally, whether you want to drive the 90 miles or not should not enter into your investigation of what can be done remotely. Not everyone who is concerned about someone wants to, or can, take such a trip and get personally involved.
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Chipping in, I'd add that another point about visiting is that it is usually considered polite to wait for an invitation. Though you can always ask for an invitation! - but of course you wouldn't want just to turn up.
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What is going to happen when aunt is out of the picture - life could be much better for your cousin, but are mental health professionals offering alternatives? Sounds like aunt is "using" cousin to stay afloat herself.
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