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She refuses to wear medic alert, she falls inside and outside. Neighbors have to help her up. She doesn’t tell me, the neighbors do. She can barely walk, she can barely see. I drive a great distance once a month to grocery shop and take her to doctors' appts. She is berating, nasty, and dismissive. She is chronically depressed, cries, and is beyond sad when I will not do something for her that she feels she needs. She will not hire a housekeeper, so I do all that as well. I’m ready to disappear.

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Some accept this aging stage, this change from *independent* to semi-independance* with grace.

Others fight a good fight til the very end.

Let her know the secret. 'Accepting help' is not weak.
It is BRAVE. It is accepting change. Can she accept this challenge life is throwing at her?

With a few 'tools' (like falls alarm, grab rails, walking aide) & 'staff' to help here & there (cleaner, care assistant) - she just MAY be able to stay in her home a bit longer. If she would like to be involved with how to live safer now, & where to live next, she can be. If not, others will decide for her.
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Yes you can, you can also file a vulnerable adult report on her.
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If her safety is in jeopardy and you have POA, it may be time to take charge over her protests.

Without POA, you both are pretty stuck. You’ve identified the risks, and she is not legally obligated to accept your help.

If you pull away some of the supports you’re currently providing, it may force her to reevaluate her current choices, but it also may precipitate a crisis, but I’m sure you know that.

What sort of services would be available to her through the county health services? Would she accept the efforts of strangers?

Also, if she hasn’t always been “berating, nasty, and dismissive”, might there be some sort of physical issue currently impacting on her demeanor? UTIs, anemia, fluctuating blood sugar levels, just to mention a few, can cause unexpected behaviors in seniors.

Otherwise, her attitudes toward you or others really don’t have much effect on addressing her situation.

My own mother was pretty much the same sort of person. Nothing changed until she fell in her home and broke her hip, causing her to enter a facility at age 89, where she spent the last 5 1/2 joy filled and comfortable years of her life.
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Tell the neighbors to call 911 when she falls.

Call Adult Protective Services in her area and report that she is self-neglecting and refuses care.

Ask the neighbors to do the same.
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