I'm out of options for this woman

The dog thread inspired the title, but totally different situation. 
Click for The Full Backstory (Mostly)
TLDR from the above link: Mom has Alzheimer's and dementia. She is in an assisted living facility (ALF) now. I have two mentally-disabled sisters that lived with my mom (I have tried to get my mom to allow me to find a place for them for 30 years, mom stubbornly refuses help at every turn). Those two sisters are now living in my moms home with myself, my wife, friends, and home healthcare visits to act as supervision. They are still alive and have not burned the house down yet.

So, my sisters have been living in my mom's home (where they were before my mom went into an ALF) since March 10. It's been difficult because they both have mental disabilities and should NOT be on their own. My wife and I have been trying to find an ALF for them that is affordable and doesn't smell like an outhouse. It seems like those two are mutually exclusive. We are having a hard time  finding any info about group homes. They don't really need the A part of ALF, just LF haha. 
We talked with my sisters and together we set minimum expectations that need to be met to ensure they are safe and healthy. They are not meeting them. I would say they are batting .250. My younger sister (44) is morbidly obese and doesn't take care of herself in any way. There is a medical concern that we took her to her doctor (a major feat in itself!) and the doc was prepped that we are really hoping that the concern would lead to being admitted to the hospital, that would in turn lead to a rehab facility, and we would transition her into an ALF (see the above part about not being able to find an affordable one). That visit to the doctor didn’t warrant a hospital stay, unfortunately.
Anyway, skipping a lot of (probably pertinent) info, today her BP is 201 over 110. Her home health care nurse says "you gotta go to the ER if the meds don't reduce this in 30 minutes." 60 mins later it was higher. We got her to the ER and the ER doc says "go home and take your meds twice a day." I told the doc that she doesn't take her meds, she refuses. She threw away a 90-day supply of all of her meds simply because she didn't want to take them. Didn’t matter. This is TWO visits to the doc/ER in one week that resulted in not a freaking thing. The ripping and running of trying to take care of my mom with Alzheimers in one facility, and my two sisters at the house is taking a serious toll on me, and most importantly my wife. 
30 years ago when we were dating and it was serious I sat my wife-to-be down and explained to her that my sisters would one day be my responsibility. Nothing was set in stone yet, but I knew my two brothers would bolt (they did) and I wouldn't (I haven't). My wife said she would help take care of my sisters when the time came. Amazing woman.
So we're at a crossroads. We need to put my sisters in a facility of some sort, or maybe just a shed on another piece of property lol. There's NO WAY my younger sister will do that voluntarily. We know that the Sheriff won't help as this is out of their spectrum. 
That leaves us with the only option I can come up with, and that's calling Adult Protective Services. She does fit within the tenant; it's not just specifically for abused adults. But I don't know if I can pull the pin on that grenade yet. If I call APS and they also do nothing except say "go home and take your meds" it will cause my sister to withdraw from us more, and probably shut us out. The other issue is that she can’t go to an ALF or group home at this time because she has open wounds (diabetic ulcers) that need to be healed before anyone will take her. She’s doing nothing to heal them, and home healthcare isn’t there frequently enough. My wife and/or I doing it isn’t a viable long-term solution.
I’m not expecting answers here, just venting. Sorry but man, I need to vent to someone. I have decided that I am going to put my sister in the ALF that she can afford, even though it smells quite bad. If we find something better that is affordable, we’ll move her. When I walked into the house yesterday (my wife had just called 911 to force my sister to go to the hospital per nurse’s instructions) my wife looked beaten down, emotionally exhausted, and sad. I have to put a stop to that. I have an obligation to my mom and sisters, but my family has to come first.

APS is the way.

Had something similar with my mom. Her liver was failing, she refused to take medicine or change her diet.

She got herself kicked out of two group homes. It was more than my wife and I could handle, but the only remaining options were $10,000/mo. 

When she wound up in the hospital for the umpeenth time, we called APS, they found her hospice care for the rest of her days.

What did the Vet say?

Kidding, just dark humor.  Seriously my wife and her sisters cared for both of her parents as their health failed, it was an enormous give of time and emotions.  I will likely be there with my Mom some day.   I feel for you and hope you find a solution soon.

In reply to DrBoost :

I have nothing constructive to add, and I am deeply sorry for that.  Luckily my mother had instructions in place (not Alzheimer's, but a series of strokes left her mentally deficient) so all we really had to do was execute them.  Lost my FIL to dementia, but he remained surprisingly cooperative until the end.

I am truly sorry that you're having to deal with all of this.  I'm proud of you for being the adult in the room.  Hopefully APS can give you some real support.

In reply to akylekoz :

LOL. I'm in complete agreement with the vet on this one.

 

In reply to everyone else :
Thanks for the support. It would be hard if all three were cooperative. But one is mostly cooperative, one is combative horrible to be around, the other is manipulative and not nice. That makes it really hard.

Do you have guardianship of your two sisters?  If so, then you can move them as you see fit.   If you don't, then you need to try and get it asap. 

docwyte said:

Do you have guardianship of your two sisters?  If so, then you can move them as you see fit.   If you don't, then you need to try and get it asap. 

This is the lynchpin in my humble opinion.  Unless you have guardianship, I don't think you can involuntarily move anyone anywhere, which leaves you trapped.  It seems as if your sisters, for all of their disabilities, have their mental faculties in order and will fight to be removed from the home they've presumably spent their entire lives in. 

This is a terrible situation and I feel for you, but as you know- your wife takes priority here.  Family is family, but there's still a line to be drawn. I feel like you have found said line.  Kudos to you for sticking it out for so long. 

We don't have guardianship. We looked into it and it's thousands of dollars up front, then hundreds a year to maintain. But more than that, the lawyer said a number of months to get it done. We need them out of the house in less than a number of months. We're hoping that adult protective services can get it done. There are a number of documented canceled appointments, refusal to accept home health care, refusal to care for wounds, diabetes, throwing medication in the garbage, etc. that we're hoping that's enough to get things done. 
If she is admitted to the hospital then we would just have her taken to a facility. The house will be sold, and she'll be where she is. 
If we have to get guardianship, we will. 
It sounds cold, but I don't see any options. Her refusal to do anything is costing time and money, and creating an unsafe environment. We have a call with a social worker to explore the APS avenue this afternoon. 

There is no perfect answer for this, sorry but that is life.  Seek professional help, with legal and state offered services, maybe some counseling for you and the wife in making a decision.  If you look forward 10 years the outcome is sort of inevitable, but the scars from dealing with this will last longer.  Being able to look back and think you did your best and looked at all the alternatives may be comforting a little.

This is incredibly insensitive, but with her health issues, current open (and septic) wounds, diabetic history and BP higher than Willie Nelson... the problem will likely sort itself out sooner than later:/

Some people just don't care enough to keep themselves alive.  That's not on you.  You need to know that. 

Next time one ends up in the ER, just don't pick her up.  A home will be found for her, hospitals refuse to keep beds full.

i don't have anything new or unique to offer, but I would just encourage you to do what you know you need to do and not feel too badly. If someone is resisting help to the extent of throwing medicine away, they've made their bed and need to lay in it. You can't make them want to survive. Protect your family and your mental health.

golfduke said:

This is incredibly insensitive, but with her health issues, current open (and septic) wounds, diabetic history and BP higher than Willie Nelson... the problem will likely sort itself out sooner than later:/

 

Some people just don't care enough to keep themselves alive.  That's not on you.  You need to know that. 

 

I  have to agree with this.  Nature will take its course on untreated blood pressure that high.  One of my cousins, who was  fully alert and functional but had serious high blood pressure issues,  gave up one day and stopped taking her meds.   I think she lasted about a week before a massive stoke happened.  

golfduke said:

This is incredibly insensitive, but with her health issues, current open (and septic) wounds, diabetic history and BP higher than Willie Nelson... the problem will likely sort itself out sooner than later:/

 

Some people just don't care enough to keep themselves alive.  That's not on you.  You need to know that. 

 

I'm very practical, so I have already thought about this. After watching my dad slowly die (multiple sclerosis) over the course of 20 years, I'm all for Kevorkian. That being said, my mom has diabetes and doesn't have the same health issues as my sister, but she doesn't do anything to take care of it. She just turned 77. Of my 4 grandparents, there were 2 alcoholics, 3 diabetics, and 4 very obese people. All lived into their 80's. The outlook is grim lol.  This chick will be the only 100-year old diabetic with a body full of ulcers and blood sugar in the 1,000.


We just talked to the social worker. We have a plan to get her into a hospital, then a rehab facility. From there, home will be a ALF. It all hinges on getting a decent nurse when we call APS.

"Nature will take its course on untreated blood pressure that high"

With blood pressure that high a stroke is pretty inevitable; what isn't inevitable is that she won't survive it. Then there's a likely chance she will be in much worse condition than she was previously and now even more of a problem than she was. Getting her stable is a huge priority, but if she won't comply no one including the doctors can force her to take care of herself/take meds/eat or not/etc. It's her choice, even as a mentally disabled adult, to live or not and the law is pretty clear on it. The doctors hands are tied. I'm going through something somewhat similar with my father who has severe dementia.

I've worked with Adult Protective Services on several occasions professionally and it is a good option. If it were me I would call them today and explain the situation. As much as I'm sure you have done all you can do, you are not a professional equipped to handle this and it will drain the life from your family. I truly wish you good luck!

Oooof, I don't envy anyone in these situations.

Just yesterday I was talking with a co-worker about his situation.  A 26 year old son with severe autism who has zero impulse control (all food has to be locked up 24/7, thinks any woman who makes eye contact wants "it" and acts on that urge inappropriately), but apparently has an IQ just 2 points too high to get state aid in his care.  He and his wife are exhausted and know that their situation won't change as long as their son is with them.

akylekoz said:

Next time one ends up in the ER, just don't pick her up. 

Last winter the father-in-law called 911 and went to the ER 5x over a weeks period.  Twice we didn't know cause he left his phone at home. 

The ER called us out of the blue and asked us if we'd come get him or they can send him home in an Uber.  

We considered not going........

I really feel for you, since I've been through a similar situation with my dad and brother. I know it isn't appropriate to respond by describing my own experience, but after reading this I really need to unload. Please forgive me, your situation sounds even more difficult.

Brother was an alcoholic and drug user, self medicating for his bipolar/delusional mental illness. My dad had dementia. The last straw was when I got blamed for stealing $40,000 that I spent on upkeep on the house where they lived (finding things to blame on me was part of a lifetime pattern), and walked away.

After a few years, the sheriff's department called to have me pick up my dad after my brother got so paranoid that he was locking him in one end of the house. By then, the well no longer worked, so no running water, and my brother had parked cars on both of the septic systems, so no sewage.

I stepped up yet again (the other part of the lifetime pattern), and picked up my dad, paid to get him into an ALF, and left my brother in the house. Dad died in 2019, brother lasted two more years. After he died, the house was trashed, needed a new well, new septics (two of them, I paid for the last pair), a roof (I had paid for th last one), and gutted to the studs. It wasn't worth as much as the liens, so I had to quit claim it and walk away. My inheritance was gone, they had blown through about $800k.

I didn't see my brother for the last ten years of his life, but that allowed me to keep my sanity and my family intact.

I'm always amazed to hear peoples life stories. People are so much more resilient than they give themselves credit for. You have all been through a lot, and have come out the other side alive. You can do this, you've made it this far.

What a horror story.  I have exactly no answers, but know you have my sympathy.

Family is the best thing in the world, unless it's the worst.

Everything I could think of you have already tried or ruled out as not applicable.

Makes what I went through with my late wife look like a walk in the park.

You have my heartfelt sympathy.

In reply to DrBoost :

Hey Doc, thanks for being open about all of this. I know it means a lot to.

Speaking as a nurse, I'm very happy you called and began working with APS. I know exactly what you're going through with people who just refuse to get better- I right now, have 2 patients I care for in my ICU like this, one of whom I have to punctuate everything (like a toddler, you do either A or B) to get better with "You need to do this, or you do not get a liver transplant". I've learned in healthcare that actual internal strength and resilience is a rare trait regardless of mental acuity- one of them is even a doctor!

In reply to GIRTHQUAKE :

Thanks for the perspective of a nurse. 
I called APS yesterday. They have 24 hours to respond, and the person on the phone said that she expects it will be a home visit as opposed to a phone call due to the mental disabilities. 
Life gets interesting now.....

Still following, and had this thought: 

she's allowed to give up, but you're not required to go down with her. Good luck, and please keep us posted, because we care.

Ouch.  I feel for your situation.  One of my cousins was comitted as a ward of the state decades ago when he became too much for my aunt and uncle to deal with.  

+1 on a surviving a stroke. The same aunt had one back in 2019 and she has been in an ALF since.  She is somewhat cognitive, but is non-verbal, so communication is difficult.  Since the stroke, my mother was made her POA as apparently my aunt didn't trust either of her other two adult children to take care of things in an unbiased manner (no small amount of money is involved).  At first we thought she would be gone in a year, but 5 years later she's still going. 

Thinking about it... I need to schedule a trip down there with my mother to visit her.   It's been a while.   On the plus side, she's a little over an hour from the Dragon, so I can usually spend a day over there when we go down to visit.