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There needs to be someone close by who is the back up for these services - who can go check on the elder if she doesn't answer the door, or go to the ER to meet her if the aide arrives and she has fallen....but it can be a way to help someone 'age in place' a bit longer. The assessment from the area on aging can help access these services for her.
She may refuse, and they can't force her to accept. Start slow...maybe a homemaker weekly to do the laundry and change the bed linen....
you and your cousin may need to coax her to accept service slowly....
good luck.
So she does not have siblings or her own children and there is no DPOA and MPOa existing, right? Your the only extended family somewhat nearby correct and your sibling is couple of hours away, right? I think you are going to have to take a hard look at if you want to take on the responsibility of becoming her POA.
The default mode by social service agencies is to encourage or heavily press any family they can identify to become the POA, assuming that the elder appears to be even somewhat competent and cognitive to do a POA document. But you do not have to. If you or your sibling were to decline - for whatever reasons - becoming Aunts POA and it’s pretty obvious that she cannot do on her own what is needed for her own safety / health / security, she would likely become a ward of the state and a court appointed guardian then takes over dealing with her living situation and placement in a facility if that’s what’s needed.
My mother could turn herself around on a dime when it suited her, even if only for a moment, to try and appear like she didn't help. The social worker working with me knew this, so she coached me, and stressed that any detail, no matter how small, needs to be shared and/or left untouched.
My mother was sly. Everyone, health care pro's included, knew she needed to move out of her house for her own safety, but they can only do so much if certain conditions aren't seen. Mom kept up the act, there was nothing they could do...
...until a neighbor, who I'd invited over for when an agency was there, told the worker my mother had left a little "stain" on her chair cushion. My mother wasn't bowel incontinent--she just passed a bit when she passed gas. That little detail cinched the deal. Normally, it would have meant nothing, but it was used to keep her safe.
When I decided my father could use some assistance, I contacted their newly created program which expanded their services for seniors to stay in their homes. I think it was called Safe Home, but I couldn't verify whether or not it's still in existence. I had 2 bad experiences with AAA reps for this service.
The visit occurred at my father's house. The nurse said she was an RN, we began with good discussions. Then she (accidentally?) revealed she wasn't familiar with psychotropic drugs. This shocked me, especially since they're used in seniors' medical treatment. I began to wonder if her she kept up with nursing updates and was still a registered RN.
She seemed to become more confident and stronger in her presentation as we discussed needs. Then she began to integrate the program's aspect of home upgrades, not just minor ones, but expensive ones. She felt the living room needed a new ceiling, this needed to be replaced, etc., etc. She ended up stating that she thought Dad's house needed about $50K (!!!) in repairs and upgrades.
That's when I really became irritated. Beyond the safety issues, which we had already addressed, she had absolutely no foundation for assessing other issues. I politely closed the conversation, she was upset that I wasn't going to discuss home remodeling with her, and to me that was the end of it.
I don't know if she got credit for identifying and securing home upgrades, or what the deal was. But my father had built things all his life, designed and built beautiful butcher block cabinets, built a woodworking shed, did his own electrical work, and much more. The concept of a nurse who didn't even know what psychotropics were now telling us how the house needed to be remodeled was absurd.
The other experience with them was when I needed some work done in my large garden (about 1/3 of an acre). I explained what I wanted done: some weed whacking, and removal of junk trees started from neighboring junk trees (there are 7 properties bordering mine, most of which have overgrown junk trees which spread and started easily b/c of my large garden and improved soil).
The rep added to that list what HE thought should be done: he wanted to stump grind the trees (these were still large saplings of no more than perhaps 6" in diameter), cut down ALL the trees (including my evergreens) and other tasks which I can no longer remember. Charge would be $800, more than I had ever paid for comparable work.
When I stood my ground on what I (not he) wanted done, he became angry, then belligerent and then hostile. Fortunately, we were discussing this on the sidewalk and I knew neighbors would become involved if he became violent. But I closed the conversation and went inside the house.
I share all this b/c I hope it prepares you in the event someone similar shows up recommending a lot of upgrades to the apartment, or recommends something way beyond what you might feel is necessary.
I do not think she is even competent at this time to make any decisions on her own and am sure the case worker will be able to assess that. She has no one to stay with her all day everyday. We tried a visiting nurse for a short while but she refused to let her in when she showed up so she stopped coming which I totally get. I give anyone who does this caregiving a lot of credit since it seems like we are just going in circles
She should be grateful for the help you’ve given her, but this is really cousins problem. Don’t be spending on her aides yourself or doing the aide work yourself. In fact tell aoa that the actual child lives two hours away and you won’t be there to stay with her to cook meals, put her on the toilet, give her a shower, do her shopping or pick up prescriptions or shuttle her to the doctors and so forth. Because it’s the truth. She’s not your parent.
At any needs assessment be honest.
As a matter of fact try to pretend you are not even there, let your Aunt answer questions and give your input when asked by the person doing the assessment.
I am not 100% sure but if the person that is doing the assessment feels that your Aunt is not safe to remain in her home they may contact APS to follow up. Now if someone is with her all the time then that is different and would be taken into consideration and she would be determined to be safe.
If no one is POA she may need a Guardian, is there a family member that would take that on or would she become a Ward of the State and the Court would appoint a Guardian.