How can I broach the subject about my aunts accidents that she does NOT remember and insists she doesn't need any help?

Does she wear Depends or something similar?

I doubt you can convince her that she needs the aid. Could you try something like, "The ALF insists that when their residents leave the grounds they need to be accompanied by a licensed assistant" ? Or "Of course you would be OK without the aide, but I'm getting a little worried about my balance and I want to make sure someone else could help you if I have to sit down."

Agree with her that she doesn't "need" the aide but try to convince her that the aide needs to come with you anyway.

I like jeannegibbs and AmyGraces ideas and approach. Once upon a time I was able to take my mother out with my adult disabled son coming along. Now I could no more do that than I could fly. In fact, now I can't even take my mom out - just the two of us. One of those little mysteries in life is why my mother will do things - like bear weight and help get herself in and out of a car for her hired "companion" but for no one else. Sorry, I digress- given your mothers age I'm guessing you're getting up there in years yourself - sorry, no offense intended. So put it on you - you hurt your back, your knee, whatever - and just tell your mom if she going to go out with you, you have to have the help of the caregiver or the outing will be impossible. Then just do it. If mom kicks up a fuss, skip an outing or two and re-explain why.

Jeanne has a good idea. There is no way to convince someone that age that they even have accidents, or to convince them they need help. My mother was in her late 90's when she did the same. Arguing and resisting is the only tool left in the box for them since they are powerless and physically weak and mentally confused. Mom refused help up until the age of 100 and only accepted it then because she was wheelchair/bedridden. When Mom got stubborn and argued, we found the best thing to do was not even ask her if she wanted help, we just did it whether she liked it or not (and she soon forgot what she was fighting with us over)

How does she go on an outing without her caregiver? Is she still driving?

Besides incontinence, what are her impairments? Why does she need a caregiver?

Remove all her regular underwear and replace it with Depends or whatever brand you are going to use. Many of them are colored pink for women so it will still look like "pretty underwear"
If she asks about her other underwear just tell her it is in the laundry.
Keep her drawer or wherever she keeps her underwear filled with the incontinence product. I would put enough for using one or two a day in the drawer so you can monitor that she is in fact changing them daily.

Mthr's home said it was time for Depends, and to simply take the other undies away. My DIL recently had a baby and had some left from the post-partum time, so I brought those in to show mthr. I told her these were a gift from xx, because all the young girls are wearing these now so they don't have to do laundry and we all know how much she dislikes to do her laundry. I explained that if they get wet or dirty, you just throw them away because it's cheaper (little fib: the home does not let them do laundry, but not about the price of depends - they are cheaper than her breaking a hip doing laundry). I took the undies to "donate to charity." No argument, and she's been on a subscription to Sam's brand ever since.

Sunnygirl, I really like the idea about telling mom that the aide needs the work! That is one thing that really will affect many old folks, and that is giving work to those in need.

Is she only having accidents when on outings? I would think that they would put her in Depends in the AL for everyday use if she's incontinent. That's what happened with my cousin. After repeated inability to notify someone she had to use the bathroom, they had the doctor write a script for them.

Also, we learned to double the Depends when she left the facility and take extras and a change of clothing, along with wipes, plastic bag, etc. We had a huge accident at the dentist office. I had to go next door and purchase Depends, clean up supplies and a pair of pants for her to put on. Lesson learned on that one.

While I certainly understand 1RareFind's suggestion and I have received similar suggestions on disciplining compliance, stating that she will have to go into a NH if she does not comply is taken as a threat by seniors who are struggling to maintain their independence and dignity. Threats increase fear which increases resistance, agitation and lack of trust in someone who is already feeling very vulnerable. Plus if she does eventually have to go into a NH it will have vestiges of punishment not a positive thing. If the senior has dementia it is hard to reason logically since dementia impedes reasoning and short term memory does not allow for retained explanations. When my mother acts out I do stay away, but without threats and she gets to missing me and then behaves better so that I won't mysteriously go away. Threats backfire when used on my mom, she digs her heals in deeper. I find the gentler approaches to the situation as given by jeannegibbs, AmyGraces, murphyclm, Hugemom, and Grandma1954 work best for me. I explain I can't manage on my own (bad shoulder), and just slip things in that she needs (like exchanging the undies for pretty adult depends and such. We don't want to treat them like children who are dominated- they resent that and after living 90+ years, they have earned whatever respect and dignity that can be given.

1rarefind, I just want to point out that Lacypeach's Mom is already at a facility. Lacypeach covered those questions a few messages down from her original post. She writes:"She is 99 years old and living in an assisted living facility with a full time aid."