My aunt seemed to be improving at the AL home with added hospice care. She’s now quickly declining. What’s happening?

As mentioned by other posters, this is common with UTI’s, especially in patients that suffer from dementia. Does your aunt have dementia? How old is she?
my dad was switched to hospice after having had COVID. My guess is your aunt was no longer showing improvement from her PT. Hospice does not pay for PT services - only comfort care related medical needs, in some hospice programs they will provide massage. Dad suffered from dementia and was at times angry, irrational, depressed and unhappy. It made him a difficult patient. He was with hospice for about 1 1/2 years.

on another note, you mentioned feeling financially and emotionally burdened by this job, and that it was affecting your family. I can relate. I was the primary caregiver for my dad (everyone else was over an hour or more away, or out of state). My brother was POA, I was MPOA. I was very uncomfortable doing so, but I did request payment several times when dad was staying at my home prior to finding a good assisted living residence.

It’s difficult enough to care for immediate family, and if you are not being compensated for your time, as kind as it is for you to give back to your aunt in this way, you may want to sit down with your family(husband and children) and decide what you/they think your role should be. Then write a formal letter or email to your aunt’s immediate family members with your decision spelled out - and any requests for monetary compensation for what you’ve done or are willing to do.

Expect a volatile reaction from your pushy cousin, but don’t back down. Bullies can’t bully when you don’t let them. You may have to cut off interaction with that extended family entirely - including your aunt, but remember YOUR own family comes first, as does your own health. Just keep restating your terms as you wrote them. If they refuse, then leave the situation. It will be hard, but you need to show them you’re not a pushover.

It’s possible your aunt is close to the end, and you won’t need to do this. Either way - sending hugs. It’s NEVER easy to be a caregiver for someone who can be challenging to work with, it’s difficult enough when they are sweet!

Symptoms you describe fit delerium: shakey, confused, night screaming. Delirium often caused by bladder infection. Hopefully will settle down with the antibiotics treatment.

If your aunt is on hospice care, she's thought to have 6 months or less left to live. It's not common to see elders improve when on hospice, but continue to decline, unfortunately.

If your aunt has a bladder infection, that can lead to lots of confusion....I've seen it with both of my parents. Almost delirious behavior at times until the antibiotics clear up the infection. That's what you may be seeing with your aunt as she fights the bladder infection off. If she has other health issues combined with the bladder infection, its possible her body isn't capable of fighting all the issues plaguing her, in a weakened state, and that's why she's fading fast.

Speak with her hospice nurse to get their take on what's going on as these nurses are very good at predicting their patients prognosis. If she's approaching the end of her life now, the nurse should be able to prepare you for that.

Best of luck with a difficult situation

A UTI causes this problem. Make sure she is tested to make sure it has cleared up.

Hospice is an end of life thing. Dr feels patient will be gone within 6 months. Not that people haven't lived longer. Some meds are stopped others like morphine introduced for pain and breathing.

You should not be using ur own money for ur Aunt. If she can't afford the AL then u sign her up for Medicaid. Then allow the State to take over her care. Tell ur cousin if he/she does not like it, then she can care for ur Aunt.