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Her Long Term care insurance will pay for cleaning service. She refuses to use them. Her house is filthy.

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It would seem she has made a choice here. I don't quite see what you can possibly do about it. If you do not have POA for health and for ability to handle finances for future needs that should now be done on your next visit to her. These may be crucial in the future. You do not say anything about her current health, other than her risk for falls which would of course be the case in almost any 90 year old. You don't mention if she has any support or other relatives within or without her community. But as to the cleaning service I guess you have to take a "no" for the answer. If you visit and find her living conditions unsafe you may need to apply for guardianship and placement, but it is now up to yours and her choices according to her wishes and the laws.
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blanca, your Mom may have to do what my Dad did when he was in his 90's, living alone in his house, and also a fall risk....

Dad needed to hire agency caregivers to help him out, and that was expensive. But it was worth every penny knowing that Dad was safe and had help if he should fall. There were 3-shifts of caregivers each day which cost him $20k per month, yes per month. And the house always looked neat and clean as the caregivers would do light housekeeping.

Then Dad decided it was time to sell the house as it was becoming way too much for him to handle, even with hiring tradesmen to come over to do work. Dad used the equity in his house to help pay for Independent Living facility which was costing him $5k per month. Huge savings. Plus no more house expenses to worry about, especially real estate taxes and homeowner's insurance. And never to worry what will need repair next. Dad loved living at the senior facility, it was like living in a hotel :)

Many of us here had to wait until there was a medical emergency where 911 is called, hospital, rehab, then being placed in a senior facility. Elders can be very stubborn and want to show the world they are still 40 again... [sigh].
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