What should my next steps be?

I don't know if you have a Social Services equivalent in the US - in the UK we could arrange for a visit from someone who seeing her living conditions would arrange for an assessment and then insist on a care package or a home/hospital as required. From what you say she sounds to be teetering on the edge of sepsis, and each illness lowers her resistance. I don't know how the hospital thinks she will get home - you should refuse to take her (in my opinion) - if they arrange to transport her they should be able to see for themselves it is unsuitable. Good luck.

Everyone has given you very good advise, so I won't reiterate that. However, I do need to tell you that as someone who has gone through a similar situation that you need to prepare for battle.
My elderly mom was also very stubborn, a hoarder, and suffering from dementia. Luckily, she only had one pet which sadly ended up dying from neglect. I lived several states away.
It took many thousands of dollars, several lawyers, and years of my life to get guardianship that enabled me to move her out of her house, to my state, into my home, and ultimately into memory care. Somehow, I managed to clean out and sell the house, which is a whole other dismal story. The agencies that were supposed to help (e.g., APS) acknowledged that she was a danger to herself, but fought for her rights to do so. Worst of all, Mom resisted my every effort to help her and our relationship has suffered for it.
I am not telling you this to dissuade you because from what you wrote you will probably need to act similarly to save your mother and those poor animals. I am telling you so that you will prepare by getting your own moral support for what will likely be a very trying experience.
I suggest that you start by circling the wagon of family, friends and faith groups. Next, you should contact the Alzheimer's Association and your local Agency of Aging since they have a wealth of experience and resources. Also in addition to posting here, consider joining a local support group and if money allows seeing a therapist. Finally, find respite when and where you can.

You need to get authorities involved immediately - on all fronts - as so many of these posts state. In addition, get to an attorney specializing in elder law asap.
Sounds like the Humane Society would take the animals out of the home - not an appropriate or healthy environment for animals, either. Clearly, your mother should not be living alone. Yes, file a self-neglect case with APS. Good advice provided here.

Whoa - you have a multi-faceted problem. Start with her town's elder case worker and social worker. She CANNOT keep the cycle of living in squalor and getting sick and back at it.

MaryKathleen, your post reminds me of several decades ago when I decided to take on leadership of a Girl Scout troup.   I met with various people, including one female doctor to get background information, details, backup and alternate plans. 

I don't recall if she was the existing or former leader, or played some other role.

When visiting at  her at her house, as she was cleaning up after dinner, she took a pot with something in it, spaghetti if I remember correctly, put it on the floor and let the dog finish off the leftovers. 

I was kind of shocked, but didn't say anything, which would have been very rude.   Her house was "lived in", but not anything I would consider close to being undesirable.   And she was a doctor, so I assumed she had a busy schedule and had better things to do than worry about housecleaning.

Sometimes clutter is how it's viewed, and by whom.

I have a thought. Can you get some photos of the inside of the house? If you can, show them to APS, County or City Animal Control, hospital social worker, and anyone else you can think of. You can say her living conditions are awful, but that is just your opinion. Show them. I remember when I had small children with Asthma. I had just finished deep cleaning my house, washed windows, curtains, and all the bedding. Every week I moved out all the furniture and wiped behind the walls and backs. I had no carpets, and had just mopped and waxed all the floors. One of our dogs had come in and left a little bit of sand on the floor. My Sister-in-law asked me how could I live in that filth. I wanted to sit down and cry. My point is, they may need a visual image to take you seriously.

There are several steps you need to take. Talk to an eldercare attorney and get a POA for her. Second, you must immediately find ways to help those poor animals who are no doubt suffering and at risk. This is imperative - they are innocent. Third, sit down with her and try to put sense into her head. I doubt she will listen and then here is my take. If she absolutely refuses to cooperate, and I suspect that will be the case, then either obtain guardianship and take over and make things happen or if she is just stubborn, accept the fact that she has made her bed and now let her lie in it. It will be tough but she deserves what she gets if she is so stupid and stubborn. As to medical appointments, you make them and keep tabs and arrange for transportation and make sure she gets there. Do not let her make the appointments

You are faced with several major issues: 1) Who pays for her care 2) Obtaining a doctor's order that she needs long term care 3) How to deal with her unsanitary living condition. Suggest you contact a family law attorney to find out what the laws are in your state.

Your mother's doctors probably haven't cooperated because it sounds like your mom can perform most of her ADLs and she continues to recover when she gets sick. Our medical system looks at that situation and says "she can take care of herself once we take care of her current physical issue". It doesn't seem to care about prevention at all.

You may need a guardianship to "force" her into a facility. No POA will allow you to force her into a facility. If she qualifies financially and she is unable to perform the majority of her ADLs, Medicaid will likely pay but it's difficult to get and few facilities take Medicaid. While they aren't very good she would be better off than where she is now. Hopefully, she or you have the funds to private pay for her care. Also, you might look into what we call assisted living. In California if someone doesnt make enough to pay for a facility that's a lower level than a nursing home, the state will make up the difference between your mother's social security or disability income and what the facility charges. You have to apply for that waiver. Here the waitlist is 4 to 14 months long.

I would call your local city officials about the filth in her home. That's also a danger to her neighbors and her animals.

Good luck. I faced a similar situation with my brother. Since he can now perform most of his ADLs - but none of his IALs - it has been very difficult to get Medicaid to approve him. One of the biggest hurdles is getting a doctor on board. He's now in a facility - first in rehab paid by his Medicare 100 days after hospitalization and now under his Medicaid. But Medicaid has only been approved for 6 months.

Things are changing but Medicare and Medicaid still look more at the physical abilities rather than the cognitive abilities. While there are a number of older people with dementia in this current facility, they are mostly there because they were no longer able to perform their ADLs.

SimplePancakes, I have read all the comments and I don't see it mentioned if you have durable PoA for your mom or not? If you do, you can and should transition her into a nursing home and not return to the filthy house. If you don't have PoA and she won't assign it to you, your only recourse is to seek guardianship yourself or call social services (APS) and have the county get guardianship. In this scenario, you lose all control over her medically and financially and they get to decide where she is placed (and it won't be in her home). Let us know how it goes.

She needs to be placed in a facility For her safety and well being ..
I did that for my mother against her will but it ended up being the best solution.

I just read a response on this forum last week that fits your situation. The writer stated that you should inform the hospital that this is an “unsafe discharge.” Then refuse to remove her from the hospital. Meet with a social work to discuss the next steps which would include placement in a safe, clean, healthy environment. Question: who feeds the 30 animals when she’s in the hospital? Sounds like the SPCA should be contacted as this constitutes cruelty to animals.

Before She is discharged from the hospital, request a neurological evaluation. This is a first step towards a diagnosis should you need to prove dementia or incapacity. You should also obtain a copy of her hospital records that has the neurologist’s report. Many financial institutions and others require diagnosis from 2 physicians, so you’ll have to follow up with her primary care or get a referral. Definitely stipulate to the hospital social worker that she had unsafe living conditions and lives alone. It’s a rough time, good luck!

She should absolutely not be living alone, esp in the conditions described. Please contact the Bureau of Aging in her area for help & guidance. God bless all of you.

I hate to sound so cynical, but might you get a quick response to the living conditions by calling your local animal welfare inspectors? 30+ what sort of animals?

What have you told anyone at the hospital about your mother's environment?

How long would you say she's been struggling to cope? I assume she's never been a clean freak, but there's a difference between someone who's not interested in housekeeping and someone who can't maintain the routines that she herself considers acceptable.

Don't try to change too much at once. It's partly because she's afraid of losing everything that she won't let you help with anything. Be very careful to pick only the key battles.

Ask for social work to get involved with her case. Take a picture of her living conditions so her doctor and social work can see what she will be released to. Try to talk to social work or doctor about her resistance to help. They will probably send her to a rehab facility... the goal would be for her to go to a permanent residential facility if no family is willing to take her. If this doesn't work, you may have to get Adult Protective Services involved.

This is like a worst case scenario to the point of thinking someone posted to jerk all of us caring people around and see what we would say. Some days back someone was dealing with mom being discharged for the daughter to resume caregiving of this unpleasant and combative/abusive person and there was a child under the roof as well. So the term "unsafe discharge" came up. Surely returning mom and her health issues to her home would be considered that. Does she eat and maintain her personal hygiene? Who takes care of the critters when she is in the hospital for so long? How is she affording food for all of them? She sounds like quite the survivor herself, as well as a potential animal hoarder. Is it possible her house can even be cleaned to a livable standard? I'd be in touch with the hospital social worker, and possibly adult protective services in addition to your local non-kill animal related facility. Are these feral cats? Unspayed and unneutered cats or dogs? This is obviously a very complicated situation and I totally agree the environment could be a contributing factor...

Would it be helpful to take photos of her living conditions to document her living environment?

Many of us have said call APS, I just want to point out when I physically went to Adult Protective Services office and filed a self-neglect case on my sister they told me someone will get by there within two weeks cause they said to me that in California they have two weeks from
time case is opened to their arrival.
Just sayin they can be helpful but maybe not always Johnny on the spot.

I may call the health dept. They will get someone out there to pick up the animals. Also, get Mom out. Hopefully they can take her to the hospital for a full evaluation. Then on to a NH. You may have to allow them guardianship.

Can you explain to the hospital social worker that it is unsafe to discharge her to her home?
I would call animal control for the animals. Very possible that if the employees from animal control see the living conditions they may report to the Health Department. They may take steps to force a clean up. If she is non compliant with that they may force eviction (after a few court dates)
Unfortunately unless she is declared incompetent she can not be forced to do what she does not want to do.
You could try to obtain Guardianship but again you would have to have a doctor confirm that she is not competent.
If you requested "Home Health Visits" for a period of time maybe they could report conditions and that might prove to be more helpful.

Unfortunately it often takes a catastrophic event to get things in motion that can help make her safer.
Also keep in mind Hoarding is a completely different mental condition than is dementia it might be easier to have someone declared incompetent than it is to get a Hoarder to accept help cleaning up their living conditions.

In my state, you call Animal Services on a neglected animal and they are out, Pronto. If you call on humans--you will likely get the runaround and no actual 'help' It's terrible. Animals are more well protected than children or aging people.

The atmosphere of the home MOST DEFINTELY is affecting her health. Full to overflowing litter boxes and poop spread all over the floor--cats are notorious for being on ALL surfaces--I'm gagging a little here.

I just called CPS on a neighbor who is 70 and has had her 3 grandkids dumped on her to raise. Never a 'stellar' housekeeper, she has simply given up and one of the kids' beds is actually a pile of laundry, clean and dirty mixed together. The huge dog runs through the basement apt where they live and spreads the litter box contents all over the place. I can't be in her place for more than like 10 minutes before my eyes are burning from the ammonia and other smells.

Since moving from the upstairs (which was filthy, but had adequate fresh air supply) to the MIL apt in the basement, all 4 of them have had pneumonia, the little girl is covered in eczema so badly she is often bleeding from scratching at herself. I am POSITIVE that the mold, cat feces and such have made all of them sick. It's a 'sick house' that no one should be living in. I have no hope that CPS will really do anything. But I did what I needed to do and stepped back.

Call APS and report her as endangered adult. Give them as many details as you can. They CAN remove her from her home, but most likely they'll do an in home evaluation and try to 'help her'. Really, only in the most dire of situations will they physically remove her.

I am not even going to suggest you try to clean for her. A person who has lived like that cannot and will not change. Her hoard is her hoard and to her, it's probably comforting.

Having her move to some kind of assisted living or NH is what's best--but that's a long shot if she is not declared incompetent.

I'm so sorry for you--I know exactly how you feel (hopeless!) and frustrated and angry all at the same time.

I agree - call the relevant agencies, document her living conditions, her inabilities to look after herself, evidences of her decline and submit them to her doctor and staff at the hospital like the discharge worker. It certainly looks like she is not mentally healthy and may have the beginnings of dementia as well. You are not alone. There are others here with similar stories and difficulties. You don't have any control over her choices, which is difficult when you see the dangers. It's very hard to watching a loved one making decisions which put them at risk. BTDT ((((((((hugs)))))))) Let us know how things work out. It is wise to check out placements for her even if she is not willing to move at the moment.

I think the county she lives in would inspect for the animals. I would start with both APS and call the dept if public health in the county. The animals will no doubt be removed as most counties have limits on pets in the home. Then at least the house could be cleaned. But if the house is determined as not fit for habitation, she can’t live there either. So you will need a plan for that. But in the long run it will be better for her. And the animals

I would try to get her into a nursing home or assisted living. She will need to sell the house and use that for payment.

While mom is still in the hospital, talk to the discharge planners about the conditions they are sending your mother back into. Mention the term "unsafe discharge".

They likely cannot force her into any kind of care immediately, but ask if they will be reporting her self-neglect; they should send someone to the home to check if it is a safe place for her to return to.

Once she is home, call her doctor and ask how to obtain a complete neuropsych workup. This generally consists of a neurologist, a neuropsychologist and a psychiatric nurse. This is a very thorough (6 hour or so) pencil and paper examination that will document her reasoning, insight and thinking skills, as well as memory.

Good luck! And let us know how you make out. We learn from each other.

Having 30+ animals in one's home which is covered with feces and filthy is not acceptable living conditions, as you know. It's likely not a good situation for the poor animals, either, so you should report the situation to the ASPCA. You can also call Adult Protective Services who will investigate the living situation at your mother's home & make a determination based on what they find.

Best of luck!

Oh Lordy when I read filthy conditions and mold then adding 30 animals it all sounds overwhelming to a healthy person, and a dire condition for elderly person with several serious health issues.
Honestly, I have no advice short of filing a self-neglect case with APS, and have them go by and assess the situation.
Good Luck to you