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my mother fired almost every one that home health or area on aging sent out to help her with anything......

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Is she eligible for Medicaid? See if her State participates in Cash and Counseling. Grandma sounds very difficult. Are you sure you want to subject a family member to this?

If not Medicaid, Grandma can (and should) pay for care from her own funds. A caregiving contract should be drawn up by a lawyer.
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bkogirl, in your profile you say you are caring for someone who has Alzheimer's/Dementia.... would that be your Mother? And would that family member be you? Or is someone else willing to help but only if they can be paid [don't blame them].

My Mom [90's] did the same thing, she had caregivers from an Agency that she shooed out the door saying "if I need any help I will call you". Oh dear. Now what? My parents didn't want any help, and only called upon me to be their driver, which became unbelievably stressful. So I had to wait for a crises before I could get outside help.

Plus I had to learn to say to my parents "sorry, I can't possibly do that" when they were starting to be too overwhelming for me to help them. Bkogirl, can you Mom be on her own or does she need help? Or is she in denial that she needs any type of help?
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Your mom has to be on Medicaid and qualify for home care. They can then walk you through choosing your own aide, which of course would be a family member. Or, the sick person can pay you. I hate to recommend this because it's not totally honest, so take it for what it's worth. If the sick person does not have much money to pay, they can supplement by allowing you to use their credit card for some of your expenses. If they will eventually go into a nursing home, they will default on all cards anyway. I'll get pushback on that, but desperate times call for desperate measures.
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When she fires an aide, do not try to do the work they were doing for her. Just say no and alert her social worker. She wants to control you, it's part of the dementia.
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