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Shut door or won't open. Will not let them in, if few times late. Needs someone every day, but refuses. Refuses any eval. Insists she's fine, but forgets to take meds or mixes them up at the times she wants to take them.

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I had a similar situation with my mother. Finally, at a point where she wasn't eating because she didn't have the energy to get to the kitchen I found someone in her neighborhood who had done in-home health care. Luckily, this person was also an avid gardener, as was my Mom in her younger days. This gal called herself a Personal Assistant. She would bring her own breakfast drink and then make Mom what she wanted. She didn't do a lot in the house but did work in the yard. Although part of me was thinking "I don't pay you to be a gardener", I also saw my Mom enjoying the way the garden was looking.

When Mom would protest something I would put it back on me. "Mom, you need to do this for me. I don't live very close (35 miles away) and I know some days you don't eat because you don't feel well. I worry myself sick over it. You need to do this for me".

It is hard to give up your independence, to find someone else organizing things in your house, to have things moved around. Nevertheless, if anything happened to your Mother and someone found her on the floor after a couple of days, or she hadn't eaten, you would feel awful. Tough love. Personal Assistant for just a few hrs a day to tidy up and prepare a meal. It is a start.
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APS is a good last route idea. First maybe try bringing over a caregiver (someone you think would get along with your mother) and introducing the caregiver as a friend. Stay while the caregiver is there and then when the two of you leave, tell your mom the new friend would like to come back and spend more time with her. This was the suggestion of an excellent nurse practitioner who specializes in seeing people with dementia. I never had to try this but it seems like a possible solution.
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Tough one and I've been there. My mom refused her caregivers after 3 woks and called the cops to have them removed. Since I hired them without benefit of POA, legally she didn't have to allow them in the home.

Drs would not sign off to order them.

She has been "maintaining" with no meds for about a year now. Does she need help? In my mind and others yes, but I have been reluctant to call APS.

If she is in imminent danger to herself or absolutely can't manage without in home assistance, then you can call APS. Hopefully, it will be a good experience for you and they can get your mom to agree to reinstate help.
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Is there anything that might encourage her to open the door? A fresh, homemade meal, flowers, a friendly pet she has met before? Sometimes they need a warm connection that is familiar and comforting to respond positively.

And if this doesn't work, I would agree with Pam and call APS.
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Call your county APS (adult protective services) and they will send a social worker who will check on her welfare. If the patient is deemed at considerable risk, the county may get a court-ordered inpatient evaluation. It's better if you call them before they call you.
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