To start, I am currently out of state from this grandparent. The person in question has been hoarding for a very long time. This began, from what I was told, when her mother died. I have ignored it for a very long time as it may have been a level 2 or 3 in moderate control. Now, since her husband (my grandfather), her son, as well as two of her sisters passed away. Her hoarding may be at level 5. Several alarming things have brought to my attention by her and others which suggests this. Firstly, her fridge, washer and dryer and car are current broken or need repair but she won't allow anyone in the house to replace or help. This is mostly due to the fact that she doesn't want to get rid of or change anything that was purchased with her husband. She now also has her son's house which lived on the same block and it also is in the same condition as her house. To add, she also is paying for a storage he had because he to, hoarded items. She is in her 70's and sleeps in a chair in the living room to make matters worse. Year after year I am met with the typical excuses of "If I find a good place to donate the items of your grandfather's I will take them there, i'll need to throw away his underwear because that can't be donated" or "I will get around to it when I have the time/energy". My sister got into contact with me at told me she doesn't allow anyone into the house anymore and that the glimpse she had of it was that areas that where never blocked now are. My sister also want's to get into contact with the SPCA and APS to get assistance for her and her animals. One of which, a dog, just died recently. Finally, I confronted her outright yesterday because now it seems she is need me to pay for her car, her sons taxes as well as other things that she can no longer afford, her credit being maxed. I had to help with the expenses of the dog that passed. She seems very aware that the extra house and everything is sapping her fiances (extra water bill, electric, taxes, lawn care, ect.). I was very stern (not mean or yelling), and asked her what it will take to get her son's house taken care of and sold. She at least seems honest and wants to meet partially with me about doing something and even admitted the reason why she never wanted me to fly down to see her that last few years was because she is ashamed of her current situation. But on the other hand I was being met with resistance and misdirection's (attempting to change the topic). Essentially, I told her if I would like to fly down and fix the situation before I am going to be forced to sever my relationship with her. In that, it is hurtful to watch her on a sinking ship such as this. I told her to call me back when she has a decision ready. What she doesn't know is that if I am not successful in any means, my sister will call in officials. What I fear is that she may not be capable of cleaning the house herself and she may be sent to a home and her houses condemned. What that said, in the past she has threatened several times that if she was sent to a home she would "off herself" or down a bottle of pills because her mother was abused in a retirement home. The most I have been able to do up until this point was to convince her to speak with a consular, but this has not put a dent in the issue by any means. She also seems to be suffering from dementia, repeating stories, not remember what she told to people, consistently cutting you off mid sentence, and changing topics completely ect. I think this a serious form of self neglect and I have no idea what to do after the general resources are exhausted "APS, police/fire, ect." A lot of people have given up on her and I seem to be her last hope at any from of a normal life. I'm really trying to get a plan of attack together, and any advice will be greatly appreciated. This person lives in New York. Also, sorry if the details seem a bit disorganized, I'm a little bit scatterbrained with everything that is going on.