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At what point will city, county and/or state agencies step in and force a single, elderly and medically disabled woman who is not able to care for herself and who is currently displaced due to a building fire that destroyed her apartment building, to either accept to move and live in an available/approved Section 8 HUD apartment that is outside the country where her apartment used to be or move to a nursing home?
In this scenario, the woman is 65 and lives off her social security benefits and Section 8 HUD support to pay for all her expenses including the 55-plus community apartment she had lived in for more than a decade prior to the fire in Nov. 2016. In this scenario, the woman has no friends or family living in the state of NY where she is located. The closest adult child lives more than 3,000 miles away and none of this woman’s children are able to provide her the care she needs in their homes. Additionally, the woman is not medically cleared to travel on an airplane and it is unknown what other form of transportation would be suitable to transport the woman from the East to West Coast given her medical condition and poor health. In this scenario, the woman is very adamant about making 100% of the decisions regarding her health and where she lives, and will not accept any reasonable short or long-term solution that is not 100% what she wants. In this scenario, the woman has consistently refused trusted counsel from family, friends, medical professionals and volunteers from helping agencies, etc., who have all tried an infinite amount of times in-person, on the phone, video webcam, etc., to get her to make the right and best choice for herself and the level of care she needs, but all this communication has proved futile for more than two decades.
Since the fire in Nov. 2016, a person and/or organization stepped up and provided her temporary refuge/shelter at a local religious retreat through Dec. 31, 2016, and went as far to extend her stay a week or two, hoping she would have secured new Section 8 HUD approved/funded living accommodations; however, this did not happen, and when she went back into the hospital for medical treatment, her belongings were boxed up and she was told to have someone come and pick them up as they were not going to allow her to come back. Currently, she was released from the hospital to a rehab center; however, this is not fixing the current ongoing situation for this woman. She needs a new place to live. It sounds like a pretty simple process of submitting necessary Section 8 HUD paperwork and finding an approved apartment that meets her needs; however, nothing when it comes to this woman is every easy. She is adamant about staying in the county where she has lived for the better part of the last two decades and out-right refuses to accept to live outside the county, period dot, or inside the county if it means living in a nursing home of any kind, period dot. She will only accept to move and live in an approved Section 8 HUD apartment if it is located in the county where her hospital is located and services. She has and continues to refuse to accept and move outside the county to an approved Section 8 HUD apartment that meets all her needs. She also refuses, regardless of how short or long her stay might be until a Section 8 HUD approved apartment that meets her needs in the county becomes available, to move to any kind of nursing home as she repeatedly states these kind of places is where people go to die and that the cleanliness and professionalism of some of the people who work in them is unacceptable.
In this scenario, her children have no legal grounds/rights to force her to do anything she doesn’t want to, nor do they have the financial ability to pay for such legal services, nor do they want to take such legal actions either as such a trial would likely cause her to go into cardiac arrest and die during the trial due to her current health condition. What actions can city, county or state agencies or medical professionals take to force her to either move to an approved Section 8 HUD apartment outside the county and/or move to a nursing home until a Section 8 HUD approved apartment opens back up in the county where she wants to live? The word “force” is used because to get her to do anything she does not want or like, will require someone to legally “force” her to do it. Surprising enough, the children of the woman had contacted the area hospital and various family law attorneys in the county or adjacent counties where the woman has lived and none of them will return phone calls. Naturally, this posting is a condensed version of the entire story due to website limitations and am appreciative of any dialog you can provide which may shine a light on how this is likely to play out for this woman.

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The problem with her moving out of state is she has to start all over again. From what I understand, section 8 has a list. If she is on Medicaid, states different and she may have to establish residency before she can get any help. I have a friend who is and will be like this. She has a number of health problems but wants things her way. One thing ur friend needs to realize is she depends on the government. You do it their way.
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What it seems to me is that this aged homeless person has "trained" everyone around her how to cater to her wishes.  As the child of a narcissistic parent, who bad mouthed me plenty to anyone who would listen and who also refused services on anyone else's terms, I've heard this story before.

I think what we would call the original poster who is trying to rescue this lady, is "wonderful stranger." This person is the "only" person who can help, not because of his/her unique qualities, but because the poster has a soft heart and is easily manipulated by the aged lady. The aged lady can only be helped by the unique talents of this one hospital, where she's already trained everyone, because other hospitals won't put up with her garbage. She can't fly, not because of some medical problem, but because she does not want to fly to CA - very ill people can fly across the country and survive.

Her kids have heard this before and set boundaries - that's why they won't rescue her one more time. They've heard it all before, just like I did with mthr. Nope, my best guess is that this is a narcissist with a master's degree in manipulation.

She's a big girl now and she can live as she likes and solve her problems herself. Carmel, you are enabling her mental illness by continuing to help her. Step away and live your own life. She won't accept your help either, just as she has turned away everyone else.
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Well CarmelNY...seems you've come to the answer yourself. What will be will be. You can not help this woman who only wants things on her terms or no terms. You've tried, and Kuddos to you for that, and it's applaudable that you feel so deeply for her. I only hope you can find solice in the fact that you did, indeed, go above and beyond to try to help, and have peace in coming to terms with whatever will be will be. It's all up to her now, sad as that is. But the addage, you made your bed and now you must lie in it, seems to be tailor made for her situation. God bless you...and help you find peace beyond this woman. Live your life now and let her live (or die) hers as she sees fit. Good Luck!
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I would like to thank everyone for his or her thoughts and concerns.
As I mentioned from the beginning, truth be told, no matter what she says, she does not want to leave the county, (not country--this was an earlier misspelling), where she is for any reason, even if it were for her benefit of being able to get an approved Section 8 apartment that meets all her needs, simply because the hospital staff in the county where she has lived for about 25 years knows her entire medical history and all the doctors/nurses there are dialed-in and know how to keep her alive and properly treat all the different things going on in her body. She believes and has said based on her personal experience when she has had to temporarily go into a rehab center or other similar place for several weeks to a month in the past, the level of care and professionalism of the staffs at some/all of these facilities where she has gone in the past, according to her, do not and will not provide the same level of care and professional service and treatment she has always, according to her, received from the hospital she's been going to. Ultimately, when you boil it all down, she does not want to leave the county, period dot, because she believes she is going to die at the hands or care of a medical staff that does not know her medical history like the back of their hands. While there may be some other kind of administrative reason she is not telling me for why she does not want to move out of the county, (even if it meant she could move into an approved Section 8 apartment that meets all her needs), with regards to all her benefits, etc. that she currently receives, if there is, she has not made me aware of it. As stated before, she is adamant about not going to a NH because she wholeheartedly believes this is where people go to die, and she does not want to die.
So, what is a person in her situation to do: her Section 8 apartment building burned down and as best I have been told, is the only tenant who 'did not' have a renter's fire insurance policy, which would've helped pay for a place for her to live for several months or longer; however, this would not have fixed her long-term needs. She has no immediate family living near here--nearest is about 3,000 miles away and she has no friends in the area who are able to take her in either. So... ... ... she is technically a displaced medically disabled senior citizen with no other source of income beyond social security and medical benefits, as well as the support from Section 8, etc., who needs assistance about 8 hours of the day or more to do things such as bath her, cook for her, etc., the list goes on and on. The thing that is exacerbating her situation is the fact that she does not want to move/live outside the county for the medical reasons listed above.
It would seem everyone, for the most part, has come to the same general consensus: she needs to put her fears aside and make a rational decision to move outside the county and stay in the state where is currently living in, or, move all the way to California where her children and grandchildren live, but only if she medically cleared for cross-country travel via auto, plain or train, and all paperwork is ready and approved for the move and that a Section 8 apartment for her to move to is already set up and waiting for her and that there is a medical treatment facility in the area that can properly treat her wide range of medical issues. At this point in her life with all her medical issues, her children are not able to provide the level of care she needs in their homes nor do they have the budget to take on the financial burden this might impose on them as they have their own children they are taking care of and providing for along with all the usual expenses any other family would have. Her children have said it would be great if she moved to California so they could see her regularly, and would go as far as to pay for the needed travel expenses and the cost to set her up in a Section 8 apartment, either where she lives or in California; however, she has to make the decision to do so, complete all required paperwork to do so, and ensure she is medically able to make the trip. Again, she has options, she just doesn't like any of them because none of them entail her staying in the county where her preferred hospital is located. She has been able to beat the system up to this point, but it will come full-circle very soon, and when it does, she will only have herself to blame when a state agency takes matters into their hands and forces her to move and live wherever they tell her she is going.
While this has all been very tough on this woman, it has also weighed heavily upon her children, especially as they tried many times in years past to convince her to move when she was in better health and more able to make such a journey, but she refused for the medical reasons mentioned above. And while their mother will occasionally say she wants to move to California when she feels her back is against the wall and is going to end up in a NH, in the end, she won't take the needed steps on her end to make it happen. Despite her children repeatedly explaining and encouraging her to make the move throughout the years, she continues to not want, in her way of thinking, to concede one once of her civil liberties and rights as an American citizen to live her life the way she wants and to make all her own decisions.
Her children, as some of you have already mentioned, have decided to let her do it her way and just let the chips fall where they may. Yes, they worry she might try to take her own life at some point and they worry about her general health every day, but there is not anything they can do about it. They are not about to try to file some legal guardianship papers with the courts that are likely to take a very long time to be processed and which are likely to be very costly too, especially as they know their mother would not be able to withstand the stress of a court trial, and even if she did, and regardless of the outcome of such a trial, she would likely never want to talk or associate with her children again--so in the end, it would all be for not and not worth the emotional distress such a trail would put on everyone involved.
We've all heard these tragic stories before, and while the storylines may be vastly different, they still bewilder us as to how does a person come so destitute, especially when they surely must have family and friends somewhere who could help them. In this case, she has always had the support she needed, she just did not want it because the ideas, recommendations and/or support offered was not exactly what she wanted and/or on her terms only.
Again, I thank everyone for their thoughts and concerns, and I hope you or anyone else never has to go through something so emotionally draining as this with anyone in your families.
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BarbBrooklyn: Yes, I saw that, but at one point she says "move out of the country" making it a confusing post. Yes, this poor lady is being pushed around by the hospital that you say that you think you know and if she's acrimonious to begin with, it's not going to benefit her goal (should she even have one).
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"Move out of the county", LL. She wants to stay in the county where this hospital is that has a revolving door.

I think I know which hospital, based on remembering the details of the fire. They have a peculiarly ineffective social services unit and simply kept sending my uncle with dementia home without adequate care for years.

Any other hospital would probably apply for emergency guardianship of this poor woman, so that her medical, safety and mental health needs could be addressed.
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This is confusing as you say "she has to move out of the country." And then you say "unable to move from (coast to coast). She's going to have a hard time relocating since she seems to be an acrimonious person.
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As for the professor flipping burgers...I say flip burgers but keep on looking for that better position. Anything can be withstood if you approach it as a stepping stone. Perhaps she can be convinced to apply for medicaid and enter a nursing home as a stepping stone until Section 8 housing in the county of her choice once again becomes available. It's simply not true that all nursing homes are dying centers... there are people in nursing homes in rehabilitation who have ever intention of moving on when the time comes. She can be one of those...
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She may find herself dying on the street before she gives in, sadly. I think this is the plight of many of the homeless. Bless you for caring, but I agree with Churchmouse. This may have to not be your fight to fight, lest you find your energy drained by someone who repeatably rejects your attempts to help.
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If she is in rehab that has long-term nursing attached, she could be evaluated and transferred to the N H section on Medicaid. Her family should make rehab aware that this woman has no place to go. This woman is not thinking clearly. She wants it her way and at this point it's not possible.
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I just had another thought - don't know if it is possible or not - you will need advice on this one. Gather up her stuff and just bring her someplace where she can go on a temporary place. IF ?? she can come home and go to the place she wants to go, and she is able to do so, fine. If not, at least you have her some place for the moment and that gives you time to figure out a solution. Then just take her and if need be, get others to go with you and see she gets there. Good luck.
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With regards to the professor who lost her job, and the only job available was at the local fast food place, I think she should take the job at the fast food place. A girl's gotta do what a girl's gotta do, you have to take what you can get, and flipping burgers beats the home going into foreclosure, starving to death, that sort of thing. Sure, she might have to adapt to an all new lifestyle but those are the breaks
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What an awful situation for all concerned. I always felt the "patient" should be the one to make all decisions - after all, it is the patient who has the problem and they should have a say in their well-being. But this is a tough one. She has to go somewhere - even temporarily. I think I would point blank in no unertain terms tell her that she has choices: a temporary place in another county; she cannot stay with her family; a nursing home - or, worst scenario, she will be dropped off on the street. Yes, that is extreme but sometimes that is what it takes to knock sense into someone. I was in a most difficult situation when my husband became very ill and no one could find out what was wrong. No doctor was able to figure it out and finally I said I was going to take him to a teaching hospital in Philadelphia. He absolutely kept refusing and all other options were gone. I gave him a choice. Come with me peacefully and I'd treat him to lunch - OR, he could come with me but I had hired two strong men to "restrain" him and take him. He was initially shocked but then gave him. (I was just bluffing but it worked.) Sometimes the absolute shock treatment works. Good luck. You may also need the help of the Office on Aging in your county. And find another attorney who WILL help you. No return calls, stay away from them.
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Since my edit button is now gone from the above post, I should add that there's a possibility that maybe she thinks she's being told stuff just to trick her. I myself have faced people telling me what they think I want to hear and I fell for it only to find out they were lying. This wasn't a housing issue but other areas throughout my life and I was gullible enough to believe them until they proved to be liars. When I pursued them about what they said, it seems like they were very elusive, that's when I saw a red flags and maybe she might be thinking the same exact thing. Maybe she thinks someone is trying to trick her? This is just another one of my many thoughts on this issue. 

If it's absolutely impossible to help her and she happens to be of sound mind, you may have to just wash your hands of the ordeal and let her go, even if it means she lives in a  cardboard box under a bridge somewhere. Sometimes this must be the absolute last resort gift someone happens to be competent. If she wants to live in the county then maybe for a while it'll just have to be under a bridge on the street. If people have actually tried to help her and she flat out refused alternate housing, then just let her live in the street. You see this an awful lot with even elders of sound mind living in the street in the big cities (unless it happens to be a town like ours that forbids homelessness and outlaws camping out). This sounds like a situation where you may just have to do just that and let her go and let the cards fall where they will. If the county doesn't outlaw homelessness, then I guess she'll just have to camp out in a cardboard box or even a tent (if she has one).
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If she's just physically disabled but mentally competent than no she can't be forced to do anything against her well or to live where she doesn't want to live, so no, she can't be forced out of her home.

If she's mentally incompetent then a guardian would be required and changes can be made depending on her needs. However, letting them have some say and making decisions together through negotiation is usually better than just overriding what they want as though they were objects. I personally would definitely want some reasonable say if this were me. I wouldn't want someone just having all the say and making decisions regardless of how I felt about those decisions. You always want to hear what the person has to say and give them some reasonable voice in the matter. 

If she still competent, instead of forcing her out of her home, I personally would seriously consider in home care to come in and help her. I've been noticing a move toward keeping seniors at home longer through in-home healthcare. I once had an elderly  friend in his 90s who had in home health care. They came in about twice a day. There was an aid and a nurse. He had an aide twice a day and a nurse once a day who came in with the morning aid. Your can actually consider keeping peace with this poor woman by sending in home health care instead of forcing her out of her home, how would you like it if someone did this to you? I don't think you'd like it too well. No one wants to be forced out of their home, no one, and no one wants to live in an institution. Ever wonder why some people who are institutionalize become negatively affected? For instance, I recall someone who was at a nursing home many years ago who was very bitter and hateful, and I don't blame her! Someone just like you force this poor woman into an institution after ripping her from her home and she didn't want nothing to do with anyone! Put yourself in the shoes of one of these people and ask yourself how you would like it if someone did this to you! The right people out there are finally getting it, which is why there's in home health care to help keep the nursing home admissions at a minimum, especially since insurance companies including Medicaid are trying to stay afloat. There's been word about the government programs having some financial issues, and you can just about bet that one of the very things that's breaking the bank is nursing home placements. That's why in-home healthcare is cheaper and will keep a majority of seniors in their homes as long as possible. There are people out there who really don't want to institutionalize  our seniors. Sometimes placing them in a facility for memory care is necessary. Definitely have those beds open for people who actually need  them. However, I seriously question some of these other wings outside the Alzheimer's unit. I question whether some of those seniors really even need to be there. There used to be a four apartment building nearby, I knew one of the residence and one of the apartments. She really didn't need to be institutionalized but she chose it. She told me from her own mouth that she spoke with the supervisor of our county home and he was willing to reserve a bed for her whenever she was ready and wanted to move in. After she moved in shortly afterward, she started going mentally downhill. She was not the same person I knew in the outside world. It took her two hours of me sitting with her before she finally started to come around mentally because she was losing her mind being in that place. She had no visitors and no stimulation whatsoever. I want to see her once before I found out she was in a nursing home. I'm not sure she was at the county home long before having to move to a nursing home because she became voluntarily non-ambulatory. Stories like this are probably pretty common and exactly why changes are being made to avoid institutionalizing people unless it's absolutely necessary

 Now, as for that burned up apartment building: 

It sounds to me like she wants her original home back. People come and go a lot these days but it's the select few who are longtime homesteaders and will settle for life in a specific area and especially in a specific spot. Yep, she wants her home back the way it was before the fire. If she wants her same apartment back in the same building, she's just going to have to wait until the building is rebuilt  before she can move back in. It sounds like she wants her home back now and she expects everything to be back up and running in the same spot where she lived before the fire. It sounds to me like she's not willing to wait for it, she wants it back now according to what I'm sensing. You mentioned that someone packed up her belongings, this would not make her happy if she's trying to settle back into her original home. I would find out exactly how long it's going to take for this building to be rebuilt for starters.  Be persistent and keep at it and don't back down until you get an honest answer. Don't settle for the runaround, get direct answers and tell them the situation. You might think rebuilding the building will take only six months, but what if it's really  much longer? If this woman is in temporary housing then yes, she must be home to somewhere. If she has a lot of belongings then she needs to be offered a place to keep what won't fit if this is a smaller unit. I'm not sure exactly where this woman is staying right now, I don't recall you saying but it sounds like it's obviously very temporary. I really wouldn't force her into a nursing home if she doesn't want that. I don't think I would even force her out of the county, maybe keep an eye open and watch for something to come open nearby and just take her there and take her into the place, but take an APS social worker with you when you do this. It may be best to move her as close to the building as possible so she herself can keep an eye out on the building's progress if she really likes it that well and wants to move back in when it's done. Hopefully someone can pull some strings and expedite the progress
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If she's still mentally competent people have the right to refuse treatment. Now cops or Social Worker (with a Master's degree) or doctor can Baker Act a person and their competency will be assessed. If a person is mentally competent they still have rights.
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You might consider contacting the local Area Agency on Aging and, if this qualifies as self-neglect, the always overburdened Adult Protective Services.
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This woman needs 8 hours of one-on-one assistance each day, and she stays in bed although she does have an electric wheelchair? That really sounds like nursing home level of care to me. Even aside from the loss of her apartment, I wonder if placement in a care center would have been better than the cycle of hospitals and rehabs and home she experienced.

I really feel sorry for this lady. She did not ask for these problems.

But if there is only spaghetti or roast beef in the kitchen you can't insist on a chicken pot pie. No matter how much people would like to please you they cannot repeal the laws of physical matter.
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Suggest to rehab to discharge her to a hotel/motel that accepts longer term guests until her apartment opens up. A social worker at rehab may be able to arrange for payment of the hotel fees based upon being displaced by the fire. Call the Red Cross and/or United way.
Have all available resources/caregivers, PT, and nurses visit her at the hotel.
Sorry, that's all I got.
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I'd keep trying to find an attorney in the county where she resides. You can check with the state's lawyer referral or even go to the local courthouse and see when Competency cases are heard. There should be a least a couple of them around that you can get a business card and plan a consult. I'd speak with them, because they can explain what is needed in order to prove that she is not competent. Standards vary by state. If she can't run her own household, she may be found incompetent appointed a Guardian. If you don't want to go that route, then, you can report that she needs help to her doctor or Adult Protective Services.
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She sounds like her own worst enemy. In AL, she'd have scheduled transport to shopping, activities and medical appointments. She'd have on site activities. And she'd have someone monitoring her health, instead of reeling from crisis to crisis. She sounds foolish, mentally ill or both. Assisted Living is not prison.

We all have to learn to accept limitations of various sorts. It sounds like this is going to get worse before ot gets better.
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Thank you BB, CM and JG: As best I know from her, is she is not medically cleared to fly on an airplane but I am not aware of the extent of any lengthy travel restrictions. As best I know, she has a pacemaker and has mentioned she is currently waiting for her numbers to be within a certain range before the medical staff will go in and replace the battery. Her numbers are always in a constant state of flux which makes it hard for the medical staff to be able to do certain kinds of procedures on her due to her being such a high risk patient. Her daily health is a bit of a juggling act to keep the various numbers in-check or within the acceptable ranges. As for general quality of life, she goes from (or should I say she went from) her apartment to the hospital and/or rehab and then back to her apartment. She never goes anywhere else because she cannot drive and the cost for a round-trip taxi fare is expensive--especially when you are on a tight budget like she is. Despite everyone seeming to agree on what is best for her, from a legal standpoint, she is still in the driver's seat in determining on where goes next; however, where 'next' is once the rehab center releases her is yet to be determined. If no Section 8 HUD apartments are available in the county she wants to stay in at the time the rehab center releases her in a couple weeks to a month or possibly longer, and she continues to refuse to accept something outside the county, then in my mind, she'll leave the rehab center staff no other choice but send her to a place like an assisted living or NH that accepts Section 8 HUD as payment for the room she'll be occupying. The only other options would be to park her outside the rehab center facility in her wheelchair and let her deal with the situation, or if/when it is getting closer she comes down sick again and is sent back to the hospital. I've seen this process play out several times now where she just goes back and forth, never staying in rehab or the hospital too long to possibly be committed but long enough where she can take advantage of the system for as long as she can to avoid the inevitable of having to go to and permanently live in an assisted living or NH environment. Although her children, do not want for her to have to live our her days in an assisted living or NH; they also know this is the best option for the level of care she needs. As it stands now, prior to her apartment building burning down, she had a health aide spending 8 hours a day with her between the morning and afternoon hours and when the aide was not around, she basically was stuck in her bed until the aide came back the next day for assistance. In an emergency, she had a battery powered wheelchair next to her bed which is what she used to get out of her apartment during the building fire. Everything points to the inevitable only she will not accept it. And again, moving out of the county where she has lived for so long and having to go a different medical treatment facility or hospital is, I believe, the two primary driving forces behind her fighting the inevitable so much. No one wants to say she is a lost cause; however, after decades of standing her ground on what she will or will not do, has basically tied everyone's hands, some to the point where they just want to wash their hands entirely of trying to help someone like her who wants and needs help, but whom only wants the help so long as she gets it 100% exactly the way she wants it. A classic example of this is telling someone with a PhD who loses their job with a university and who needs a job to pay their bills and provide daily sustenance for themselves that the only job in town currently available is at the local fast food restaurant. Does the PhD professor go flip burgers to make ends meet or will the PhD professor say, I would lose my home, car and starve to death before I go and work at a fast food place that I feel is beneath me? In this example: she would rather starve to death and lose her home before accepting to do something she doesn't want. Fortunately for her, things have managed to work themselves out in the past due in-part to people bending over backwards and jumping through hoops for her--until now that is. Now, she is either going to have to accept and embrace the change and choices available or force someone else, i.e. the state to make them for her. I hope for her sake she makes the right choice.
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If she accepts a nh or all placement voluntarily, she can leave when she wants. If she's placed by the courts, under guardianship, then she won't have a say-so.
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It sounds as though she has significant heart pathology (is that what you mean when you say that she would go into cardiac arrest if she were subjected to a "trial"? Is she really that medically fragile? It sounds as though her medical needs would really best be met in an Assisted Living or even NH environment.
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I like CMs thought. Another is, you (or whoever has taken on the thankless task of dealing with her) can give a forced choice. I.e.," Sadie, there are two alternatives, you can go to HUD senior housing in Columbia county or you can be declared a ward of Putnam county and they will have right to decide where you live." And id Sadie says, oh, but I want to live only in Putnam county, the answer is "that's not one of the choices, Sadie". Make sure that the choices are viable, available and doable. If she can't or won't make this kind of clearcut choice that you can help her with, then she's probably beyond your ability to help.
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Extremely frustrating, yes!

As a calming exercise, try this thought. This lady is exercising her autonomy. Fine. The flip side of that for her is that she is insisting that her problems are her problems. Fine. Then let her propose, identify and implement the solutions. All you can do is point out to her the jeopardy: if she fails to do so by the deadlines which exist in this cruel material world, and still declines to choose from the range of valid options offered to her by others, then on her legitimate eviction from rehab she will bodily be carried to whichever location the state deems most appropriate, and tough.

Essentially, it's this. The lady is insisting that this is her problem. So let it be her problem.
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She is currently in a rehab center, right? That will not last forever, as you know. When they say, "We will be discharging you by the end of the week. We'll arrange transportation. Where will you be going?" What will she say?

She might say "I'll just stay here until an apartment opens up." And of course the insurance won't allow that.

If she really does not understand her situation, then I really think she is not competent to make that decision. (My opinion and $2.79 will get you nice coffee at Starbucks.)

This must be extremely frustrating for everyone who is trying to help her!
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I think that you are correct, that the county or the state will try to find her incompetent, assume guardianship and make a forced placement.
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JG: Thank you for your initial response.

To further exacerbate her situation, she never had a renter's fire insurance policy nor did she tell her family she didn't have one, not to mention an employee who works for the owners of the apartment complex said that Section 8 HUD policies dictates they cannot mandate someone in her specific financial situation as a renter to carry a fire insurance policy. Unlike most of the 30-plus residents who were displaced by the fire, she is one of about 12 who didn't have immediate family/friends living in the area who could take them in temporarily, and she was the only one, as I've been told who did not have an insurance policy. She said she was informed by the owners of the property that she, as well as the others who were displaced, would have first priority to move into one of their other apartments if/when they become available, but as it stands now, the demolition and rebuild of the apartment building is likely to take a minimum of 6 months to complete, if not longer. Her children, as have others, have pretty much summed up her options for her, and as you'd expect from someone trying to hold on to their independence and the ability to make their own decisions and control the way they live out the rest of his/her life, she doesn't like any of them because it means she has to move out of the county to a Section 8 HUD apartment where she doesn't want to move to and/or because it is to a nursing or assisted living home in or out of the county--a place she unequivocally refuses to go to if she has anything to say about it. Her children, as have others, have told her that while they understand where she is at in her life and the enormity of her current situation and where she is coming from, to a certain extent, with her way of thinking and wanting to remain on her own, where she wants to live, etc., that by being unrealistic and unwilling to accept other short/long-term solutions that are all for her benefit, she is sending the wrong message to those at the city, county and state level about her mental state of mind and her ability to make sound decisions on her own behalf with regards to her health and wellbeing. While anyone who knows her can see she has passion and fire in her belly so-to-speak, which in and of itself is a good thing, it is to the point of it being her Achilles heel as she will not consider any solution that is not 100% what she wants. This same school of thought applies to everything else in her life too, not just this specific situation, and she's been this way for as long as anyone can remember. She is afraid that if she agrees to and goes into a nursing or assisted living home, even if it was intended to be a short stay until a Section 8 HUD opened up in the county, that they would try and keep her and not let her leave whenever she wanted, such as when a place became available in the area she wanted to live--i.e. the apartment building that burned down was rebuilt and she was contacted to move back in.

Yes, it is true that this is unfortunate, and sad too, for any person to be in the pickle she is in. She did not ask to be bitten by ticks and contract Lyme disease and for all the follow on domino effect of health issues which stemmed from in-part or whole from long-term medicine usage, etc. to the point to where her health is today; however, no one is trying to penalize her or hold it against her either. On the flip side, she has refused multiple opportunities the past 20-plus years, when her family was better able to assist her, when she was better able to travel and when her health was not as bad as it is now, to come and live with them, and she refused. Now that she is in such dire straits and her back is against the wall, she talks a good game and says she wants to go live with or close to where her children are living; however, she doesn't really want this, nor is she ready and able to make such a journey. She wants what she wants--her independence, freedom and living by her own rules, and being able to have her cake and eat it too. And while those who know her entire life story would say she deserves to have her cake and eat it too, they would also agree that her demands and refusal to compromise at this stage in her life with all she has going on medically, is unacceptable. No one more than her children want what is best for her; however, as with everything in life, there are limitations as to how much any person can do or give of themselves for someone else, especially if the person you want to help is unwilling to help themselves due to stubbornness and being intransigent.

As sweet and loving a person as she is/can be, I hope for everyone's sake who has assisted her through the past 10 to 20 years and since the Nov. 2016 apartment building fire which displaced her and more than 30 others, is that she comes to her senses and makes a fundamentally sound and wise choice for herself, versus dragging things out the way she has and potentially forcing someone at the city, county or state level to intervene and make those choices for her. I'm not sure how elder laws differ from state to state, but I have to believe it is only a matter of time before someone deems her unable to make sound/safe decisions on her behalf and files the legal/medical paperwork to make those choices for her.

Again, if anyone has any insight on situations like this, please share.
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Oh dear. This is a painful situation, isn't it? I can't speak to the legal question; I hope others here can.

How are her cognitive abilities, besides being stubborn and unrealistic?

Does anyone have healthcare POA?

Her apartment burned down. Did the other residents all find new places? Do you know if they had to go out of the county?

How long are the waiting lists for the HUD apartments in her county. Obviously no one can predict that exactly, but do the administrators say "a list this size usually takes about 6 months to clear" or a year or two years, etc.

Even if she were paying for this out of her own pocket, if there are no suitable apartments available, there are non available. Does she expect them to evict someone so she can have their apartment? What is her idea for making what she wants happen (aside from demanding it)? This kind of reasoning process may get to the question of her competence to make decisions for herself.

Competent adults are allowed to make decisions for themselves, even very bad decisions. But making impossible decisions makes one question her competence. When only two choices are possible, insisting on a third choice does not sound like a decision coming from a sound mind. Has she shown other signs of cognitive problems over the years?

This is so sad. She is so young to have such problems! Please keep us updated on how this works out.
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