My 78 year old obese sister (lives alone in another state) obsesses with her health but does nothing to make it better. She has pains and falls and calls her friends and EMS to take her to emergency care. When they find nothing seriously wrong, she seeks pity from me, in another state, but makes no changes to her life style.

Should she go to Assisted Living?

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My sister, who was 85 when she died this last January, was very much like your sister. She, too, would go to the doctor, but not follow his advice. She has fallen once, and called on neighbors to get her up. They couldn't, she had the chain across her door and couldn't get in. EMS broke down her door and got her up; she had a sprained wrist. Strangely, the sprained wrist turned into her sitting for MONTHS, except to go to bed or bathroom, until she basically could not walk anymore except with a walker. She ate cookies and deli sandwiches that neighbors would shop and get her. As far as I know, that was her diet. (I am not exaggerating; I saw her kitchen.) My brother and I tried very hard to talk her into improving her entire situation by going to AL, but she NEVER have agreed to AL, She knew she couldn't live her life like she wanted, which evidently was sitting on the couch eating cookies, watching TV and manipulating her neighbors to get her food and drive her to doctors' appointments and the hairdresser. Brother and I live in different towns and are aged ourselves. I think we both felt like we had to do something, but she just ignored our concerns. Finally, her sacrum broke. Dr. said it was from osteoperosis or old age. She didn't fall, it just broke. That led from one thing to another, and we had to go to her, call an ambulance, and she ended up dying in a skilled nursing facility a few months later. This is a long story, but my point is, there is not much you can do unless she is cooperative. I think my sister craved attention and pity, and if she did something for her well-being, that type of attention might end. Hate to say that because I loved my sister, of course, but she put up barriers to any kind of help we offered or suggested. You have to refuse to be made to feel guilty. Do what you can, and then let her live as she is choosing to.
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Don’t let this stress you out. Unless you are her POA - focus your energy elsewhere. You live far away, have different lives and you don’t need to get involved.

At some point, if she continues to call paramedics to help her with normal activities of daily living (getting up), she will probably wind up in some type of nursing care whether she likes it or not.
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Many people behave like your sister. It’s certainly frustrating. I don’t feel like you are fat shaming your sister at all. You are merely pointing out that her weight is contributing to her health issues.

Let’s face facts, obesity is a common situation and some people struggle to lose weight, others are plain uninterested in losing weight. You know your sister and her background story.

If you have repeatedly offered your sister feasible suggestions of ways to help her improve her life, and she has constantly ignored you, or disbelieves your ideas, then I wouldn’t even bother to suggest any possible solutions to her.

Yes, your sister may be seeking attention. She may want you to feel sorry for her. It may work on your nerves. Limit the amount of time that you listen to her. What else can you do?

As far as assisted living goes, I seriously doubt that she would change her habits if she isn’t interested in doing so. You can’t force her to change her ways. Maybe she is a food addict.

Best wishes to you.
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A couple things pop to mind. True she has attention seeking behaviors. She is getting a lot of secondary gain by not adhering to a treatment plan, enlisting friends to take her to the ER (dangerous liability by the way), and the sympathy of an ER visit. EMS may start charging for these visits if they become too frequent.

Not to make light of it, but I had a senior who used to be 'found' on the floor and be taken to the ER, get a hot meal, warm bed for the day shift. His dentist daughter worked all day and refused to come get him. We discovered he put himself on the floor and never once actually fell!

I'd start with asking PCP for a home health evaluation including PT. Let them assess her and the home for safety and her mobility and strength. A plan could be made after that.

Good luck
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If your sister is of sound mind, then it doesn't matter where you think she should live, as she will and can do whatever she darn well pleases. Unfortunately it will probably take a crisis or catastrophe before she will allow any changes in her life.
Thankfully you live in a different state, so you have the option of not answering your phone when she calls, and letting her calls go to your voicemail. It will then be up to you whether or not you want to return her call.
Have you tried telling her that you're tired of her calls for pity, and until she makes some changes you really don't want to hear about her woes? If not, you may need to do just that. Good luck.
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What she 'should' do & what she 'will' do are two entirely different matters, as you've witnessed with your sister, since she is not following doctor's orders. It's also easy for a doctor to say, "lose weight & exercise" to an obese elder when they've been eating a certain way & living a sedentary lifestyle for decades. Then it all catches up with them but it's not so easy to make the required 'lifestyle changes'. Your sister likely needs support more than anything else. Maybe that's what she's looking for when she calls you seeking 'pity' may be understanding she's looking for more than anything else. Have you asked her what you can do to help her? There may be nothing you CAN do but listen to her, which also gets old if she refuses to help herself.

My sister in law is 64. She's been heavy her whole life and then became diabetic as a result. She did change her lifestyle, lost about 100 lbs and it still wasn't enough; she had her foot amputated to the knee a few months ago from a persistent infection in the bone and is now trying to walk with a prosthetic. Fortunately, her upbeat attitude is what helps her immensely. It blows my mind that she never complains or feels sorry for herself!

Anyway, if your sister moves into Assisted Living, nobody there is going to 'make' her eat right or exercise or do anything else to improve her health, either. That is something that she herself must want to do. When my mother lived in AL, she fell 40x because the staff can't prevent falls either! It's really a big fat mess when elders lose coordination and start down the 'falling' path, it really is.

Wishing you the best of luck.
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She sounds like she needs to see a psychiatrist for mental-health evaluation and treatment if deemed necessary.

Ask her if she feels like harming herself, or wishes she were dead. If she threatens to do self-harm or is suicidal, you need to call 911 and get her hospitalized for a psychiatric evaluation.

Otherwise you cannot tell her what to do or how to live.
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Contrary to what others are saying AL might be beneficial to your sister. Many seniors are lacking social interaction, especially since Covid. If sis moves into AL she might make friends and get involved in some of the social activities and find something else to do other than eat. Of course it is up to the AL to assess her and decide if she is physically a fit for them. Mom's AL would send any resident who fell unattended to the ER, and if she is really obese the staff may not be able to help her and would call the EMS anyway.
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Beatty Jul 2021
I agree with you. The social life in AL is beneficial to many.

Especially if it is becoming hard to access social activities in the community, due to health issues, mobility etc.

More company, with less personal space VS own home but less company.

What she 'should do'.. let's say *could do* is decide for herself. Being a sister who suggests it many not work (hasn't for me anyway). But no harm in planting the idea 😉
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Has your sister expressed any interest in moving to Assisted Living?

If she asks for your opinion or your advice, you can be as frank as you like; but unless she does the kind thing to do is try to curb your (very understandable, if you ask me) irritation and frustration and voice what you know what she wants to hear - ideally without undermining any authoritative advice she has been given.

E.g, "oh dear, poor you. Didn't your PCP recommend you join that weight loss program to help relieve the knee pain? Do you think that might be a good idea? Maybe Marcia would take you and you could try it together." [Cue: 101 reasons why this would be much too difficult]. "Oh dear, poor you. Well, you be sure to good care of yourself now you're home again."

If you find her as irritating as I find my similar very much loved one at times, my tip would be to time your phone calls and cut them short - just make any unrelated excuse - when you've had as much as you can take. Otherwise you might become reluctant to talk to her at all and that would be a pity.

How kindly you feel towards her of course I don't know! But absolve yourself of any responsibility. You have no moral obligation to guide her choices.
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What she *should* do is listen to her doctor(s), but she doesn't. There really isn't anything you can do to change her situation. Assisted living won't change her issues, other than there might be someone available to help her up if she falls. Otherwise, AL isn't going to solve anything for her and it would be up to her whether she wanted to live there or not.

Attention seeking? Sounds like it. She goes to doc, gets advice, but ignores it. Until she decides to change her life circumstances, this will go on until she has a serious medical issue and then she may end up in a NH.

If you feel you can't really help her and don't want to be interrupted so much, let her calls go to voicemail. You can take her calls when you want to take them. You can call her back later, if you choose to after she leaves a message. Listen with half an ear, mumble some "comforting" or sympathizing words along the way, but find a way to cut the conversation short - ring your doorbell or set the oven or microwave timer and beg off the call.

You can make suggestions for ways she can improve herself, but she is the one who needs to make a decision to improve her life. It doesn't sound like she's willing to put in the effort and would prefer to get sympathy from others. Encourage her to consider taking her doc's advise and say you'd be willing to be more supportive IF she makes the effort to change.
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