How do we help belligerent, hermit grandmother?

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My grandmother is 90 years old, lives at home, and no longer drives. Her house is organized, but it is horribly infested with termites and roaches (to the point that the termite wings are gathered along the baseboards, the window sills, etc) but she will not allow the house to be tented or an exterminator to come. We have attempted to reason with her but to no avail. She says it is terrible for her health and that those chemicals can't be sprayed in her house. (A Dr. told her that some 40 years ago and his words are coming back to haunt us)
She is no longer very steady on her feet and falls easily, which is a source of fear for all of us. However, she refuses to use any assistance. There is even a walker that sits in the corner of her living room.
Her eyesight is a mess, and the lenses from her glasses fell out but we cannot get them repaired because she will not come off those d*mn glasses even for a few minutes! She been walking around with only one lense in her glasses for almost a year.
She is fixated on laxatives and is constantly asking for them. She chugs milk of magnesia, prune juice, etc. because she claims she is constantly constipated. however, this has caused her bowels movements to be almost uncontrollable and, dare I say, explosive. She wears depends now, thank goodness, but the laxative abuse is NOT healthy. I've tried to alter her diet so that she is eating things with fiber and healthy stuff, but she turns up her nose at them. Her diet now mostly consists of white bread, some lunch meat, boiled eggs, apple juice, zebra cakes, and oatmeal cream pies.
Almost the entire top row of her teeth is rotted out at the gum line, but she will not seek dental care. They've been like this for years.
My grandmother has some form of dementia, but she is not a wanderer, in fact she refuses to leave her house. It's horrible to watch her fall apart one piece at a time, and refuse to cooperate to get any medical care or additional assistance in the home.
Last Tuesday we hit our breaking point. We had a Dr. Appt. scheduled, which she has known about and we've been discussing for almost two months. She'd been whining about needing to go to the Dr. My mother drove 6 hours to get down here so that we could all go together, and when we get to my grandmothers house, she announces that she is NOT going. She used several different crazy lies, excuses, etc, and when we refused to give in, she flipped her lid. She screamed, hollered, tried to hit me, threatened to throw a TV remote at my face, said she wanted to kill herself, etc. this went on for over an hour. Then a few days later, she whine AGAIN about needing to see a Dr. She fully remembered the hissy fit and cancelled appointments from two days before. What the h*ll????
So what steps do we take (my mother and I) in order to get her what she needs and ease our own peace of mind? After the tantrum last Tuesday, we feel that she is no longer capable of making healthy choices for herself. My Mom would like to see her go somewhere that would monitor her diet and keep a watchful eye on her, considering her lack of balance. Or at the very least, we would be very happy with a home health aide. But how do we get get ball rolling?
There is no POA or legal paperwork that would enable us to force her hand at this point, and deeming her incompetent would be tricky, at best. She still is aware of how much money she has, what bills are due, who we are, etc. etc. She is not completely "out to lunch" And we would like to approach this while preserving as a much of her autonomy as possible.
In a nutshell, we feel that we are being careless by standing by as we are and bearing witness to her self neglect. It's heart breaking. Any ideas or suggestions are much appreciated.

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Hey Everyone- sorry I did not respond sooner- time keeps getting away from me. And I think I mentioned this, but I really appreciate the responses of everyone. And Countrymouse, I am not offended at all and I did not find you unsympathetic. In fact, it is nice to have honest and genuine answers, especially on a topic like this. So many people do not want to have these discussions! At any rate, the extra input from ALL viewpoints is great. And even if it did happen to irritate me, the truth of the matter is that it is NOT ABOUT ME; it's about my grandmother and helping her through this part of her life. So, I have made every effort to "check my feelings at the door".
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GG I didn't mean you wouldn't be right to intervene - there's a tipping point somewhere, at which it becomes irresponsible NOT to, and spotting it at just the right moment is no easy business. What I meant was that when someone has made it very clear what she wants, and she's not yet mentally incapacitated, and you do the opposite, well then she is going to hit the roof and you know it's going to happen - from her point of view, it's logical.

I'm sorry if I sounded unsympathetic, I really am not; and I really respect your carefulness in supporting your mother without getting in her way, too - that's not easy, either.

If it's any consolation - :/ - the time will come before long when frailty will force your grandmother's hand.* I'm sorry for it, it's not the way anyone would want things to go, but knowing there will be a change before long might make it easier to get through this time.

*Given how much effort you and your mother have already made, there is zero chance of a charge of neglect.
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Thank you all so much for your responses. It's nice to know that we aren't the only people having these conflicting feelings about elderly family members. I must reply to Countrymouse's last post, just to make he situation more clear.
My grandmother would not have any justification to feel livid, should we force her hand at this point. For the past 6 months, my mother and I have bent over backwards to accommodate her, respect her independence and authority, etc. etc. Before this, she was primarily depending upon my Uncle, who passed away recently. We've discovered that my Uncle was making cash withdrawals from her account with her ATM card, buying a good deal of his beer and groceries on her ATM card when he would go shopping for hers, and he was also horribly rude and hateful to her. Perhaps some of her defensiveness is due to being around that for so long? I don't know.
She will complain that she can't stay by herself anymore; that she wants to sell her house, etc. however when we ask her to go into detail, she back peddles. We've made it clear that we will do whatever we can to make her happy and keep her safe. Our only prerequisite for her IF she wanted to go to a nursing home/ assisted living is that the facility is a quality place with a great reputation.
It's very hard to not take control when you are watching your loved one neglect themselves and wallow in despair. We are trying, really really, trying, to work WITH her, but she's making it almost impossible. At this point, should something happen to her, I would worry that I would get in trouble for elder neglect.
As far as Baker Acting her, if I would have been there by myself with her when she threw a fit, tried to hit me and throw a tv remote @ my face, and repeatedly threatened to kill herself, h*ll yes I would've baker acted her. I would never have forgiven myself if she actually followed through with it and I chose not to take action. However, with my mother there, I yielded to her choices. I trust Mom's judgement and I also want to not get between her and my grandmother.
Side note- the healthcare facility my uncle had been taking my grandmother to was not a great place, and I would venture to say that the Dr had no relationship with either of them. So getting their assistance would be an exercise in futility.
Once again, I just want to thank you guys for all these valuable responses from other who are also "in the trenches". It really means so much!
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Because her grandmother would be a) miserable and b) incredibly and justifiably livid. As long as she is compos mentis - oriented to time and place, au fait with her finances, generally all there - it is her business how she lives and not anyone else's. And the reason she's being like this - defensive to the point of paranoid - is that she's afraid people will feel entitled to take control of her life. She's not wrong, is she. Still paranoid, maybe, but not wrong.

The message that somehow has to get through is that if everyone works together she can stay SAFELY and healthily independent, in a house that's been de-infested and repaired. At the moment she's scared to give in, so she has to be persuaded that it's not an either/or situation. It's a ticklish diplomatic mission, quite a challenge but worth the effort.
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When mom signed her POA document, there was a third party witness required to sign in addition to mom and the notary, that she was of sound mind and not coerced. It being such a small community, they all knew mom and I guess they knew that this was the right thing to do for her. Good thing we did it then and didn't wait. She would not be able to sign anything at this point in time. She had a medical incident recently that really took her cognitive abilities down a lot.

There are no siblings or family who would dispute anything. I am literally the only person on the planet who is willing to deal with this woman on any level.

Whatever way you get there- with or without an attorney or guardianship- you need to get somebody someway to step in and help. I was just appalled that nobody in mom's circle - family, doctors, pharmacist - saw through her coverups and lies and genius ways of compensating for her debilities, but she used anger and aggression to run people off and out of her business . I want to go back and shake every one of them - especially her sisters - for letting it go. I guess they figured she'd either die and get out of the way, or I'd figure something out, which is what happened.
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OK, I'll bite - why DOESN'T she want the house declared unfit and grandmother carted off to the nearest facility? The house IS unfit. The grandmother is if not cognitively impaired, mentally ill. Most facilities, especially given an involved family member, are better than living in an insect exhibit waiting for the inevitable disaster to happen. A call to APS now, regardless of what they do or fail to do, would at least document you tried to help, in case you do end up in the situation ofr just waiting for the disaster to strike so you can pick up the pieces, if there are any to pick up. Another option is calling the Health Department, another would even be involving police for physical assault -I'm just saying it's an option, not clear whether anything good would come of it or not; maybe they could at least insist she got to the ER. The irrationality of the assault to be almost immediately followed with a repeat request for appointments means something, and it does not mean she has all her marbles, even if she can manage to pay the bills. Others here have mentioned Baker Act - is that an option?
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Phew, she's really pulling up the drawbridge, isn't she? Determined to defend her home from all comers, including those bearing pain relief and some dental treatment. Very hard, especially as you've described someone who is in full possession of her faculties but just going to extremes to stay in her own home and keep everyone else out of it.

Until an accident forces her hand, that is, and sends her willy-nilly into hospital, then rehab, from where she'll have her work cut out to get released back to her own home. And that would be a shame.

Reading between the lines, your grandmother is terrified of admitting to any weakness for fear it'll be the thin end of the wedge, do you agree? So she's ruling out even things she, and any other person, would routinely need like regular medical and dental care. And fewer cockroaches. Shudder.

I agree with Pam S that APS would send a social worker round - just wondering what social workers have ever done to Pam that she'd wish it on them :) They would do that; whether or not they'll get very far when a lucid old lady tells them in regrettable detail what they can do with their kind offers of help is a different question. But, still, worth a try. Good social workers know how to walk softly. Take care, though, because what you don't want is the whole thing getting horribly out of hand and your grandmother's house being declared unfit and her being carted off to the nearest facility… DON'T PANIC. This won't happen as long as you keep communications and aims very clear and focused.

Or, could your mother telephone your grandmother's doctor and explain the situation to him? She could contact him ostensibly to apologise for the cancelled appointments, and take it from there. If he's the kind who'll do home visits, he might be able to slip an initial assessment of competence past your grandmother while he's checking her over physically - that might be worth a try, too. And if he's known her for years and she trusts him, maybe she'll listen to his advice?

Best of luck, keep us posted. You're doing your best in a terribly difficult situation.
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With regard to Sandwich42s freebie POA document: I don't hear anything about a third party witness who would swear before a judge that your mother was "competent" when she signed the POA document. Please be very careful about "do it yourself" legal documents. If a court determines that "mother was incompetent when she signed the POA", power of attorney goes out the window. This is where a qualified attorney will come into play. The attorney I hired, for $300.00, will testify that my mother was of sound mind when she signed the durable POA document in his presence. As he is a representative of the court, she was required to "swear" that she did not sign the document under duress and that she understood what she was signing, and present her driver's license. My mother's health care proxy was invoked two weeks later; and then she was deemed two weeks later incompetent by the family court judge with regard to her guardianship hearing. See the sequence of events. Anyway, my two cents worth.
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GroceryGetter: please keep in mind that Guardianship requirements vary from state-to-state. In Massachusetts for example, a "temporary guardianship" is applied first, and a co-guardian is required. The temp. guardianship lasts for 90 days, and you have to return to court on the 90th day (Family Court) to petition via a hearing for a permanent guardianship. In Mass., a "Notice of Guardianship Hearing" is served by a process server on the person who the guardianship is being established. It is often best to have the notice delivered to a third party, i.e., a social worker, if the person is already in the facility, vs. having the notice dropped in their lap by a sheriff's department deputy. This can scare them and put the "fight or flight" response in motion. My mother started yaking with all kinds of threats after receiving this notice, "I'll get an attorney and sue you; I'm going to fight this guardianship and you'll be sorry; don't get too comfortable with the guardianship; I'll get married and foul up 'your' Medicaid application". All sorts of stuff like that. It isn't fun, and it isn't easy. One thing I have to work on is patience. This is the hard part. Good luck.
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I reported my mom to APS first because of the same type of thing going on. They did an in-home visit and ultimately determined she didn't qualify for services because she wasn't face-down in a pool of her own drool. I still can't fathom how they ended up with that determination after my last visit to her home. It was almost tv-Hoarder level bad. The stink is something I will never forget, and I have worked in a morgue before.

We are poor and did it without any attorneys. I was able to get my mom to sign a free durable POA document ($1 fee for the town hall clerk to notarize) because she had stopped paying bills and didn't seem to mind me taking that part over first. That was the first thing I did to get her money untangled. I got the form online from the state website. Then you file that document at the bank, doctor, pharmacy, hospital, insurance agent, anybody who will listen to you with half an ear needs their copy of that document. I still walk around with it to this day.

Mom was living as a hoarder 1800 miles from me, neglecting her diabetes, with dementia, and had alienated every family member there is. I moved her to my state by just taking charge. She didn't want to move, but it happened and there was literally nothing she could do to stop it. Yelling at me didn't stop anything. Movers came, put all her mess on a truck, and I put her in the backseat of my car and drove her to my state, and set her up in an assisted living facility. I scheduled my time off, the movers, and everything entirely without her because she was not capable or willing to participate.

You are going to have to take charge and make decisions about what is safest for mom, regardless of what she says she wants or likes. When it becomes dangerous for them, it's past time for somebody to step in and take action. It does creep up on family, and it's hard for a lot of family to admit it's "that bad" and really time to get serious.

My plan-B was to hog tie her, stun her with a cattle prod, and throw her in the car with a paper sack of underwear, but fortunately, it didn't come to that.

Guardianship is a lot more strict than durable power of attorney, so I'd recommend reading up on the difference between the two. Guardianship has a lot of requirements.
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