Not at all - it can be extremely frustrating to deal with elderly who refuse to acknowledge their growing limitations. And frankly, it can be extremely hard to diagnosis dementia - which has many, many causes and at least 15 of which are nutritional - when one isn't living day-to-day with the elderly person in question. We would probably not be so aware of my MIL's issues, for instance, except that she has been now been living with us for 3 yrs and the decline is starting to pick up.

The most difficult issue for your family is the legal one. If this person has not signed a Power of Attorney document it is going to be costly and difficult (e.g., possibly incurring much bitterness/resentment) to go to court to get the POA over her objections.

Without the POA and a durable healthcare POA, the family has no right to talk to her doctor(s) or the retirement association. Assuming one of the family is willing to go the extra lengths to become her agent as verified by the court system and her doctor, then the issue of choosing the correct care for her can be settled.

I place this problem in a legal context because you have indicated there are numerous family members who might wish to become involved, one way or another. Any time you have multiple people to satisfy that 'XX is being properly taken care but not taken advantage of', I strongly feel one's position as agent should be verifiably legal and clear-cut to avoid any future accusations of breaching fiduciary duty. Many families have quarreled bitterly over elderly care; it's a difficult and emotional issue.

JKOM is so right about having the legalities in order before trying to set things up for your wife's relative. Otherwise, with such a large extended family, you'll encounter all sort of conflicts and complaints. However, it sounds as though the relative herself is unwilling to let go of any of her independence and power. If that's the case, then you & your wife need to step back, take a deep breath, and caution yourselves before you jump in to take any action.

No matter what you think (or know), as long as the relative makes decisions for herself, you don't have many options. Cajoling, lecturing, advising probably won't make a difference. If other family members jump in to try and help or rescue her from herself, you may be able to dissuade them. But that's about it.

Honestly, it's important now, before the real crises have started, that you & your wife are in agreement about what you will and will not do for the relative. You need to set some boundaries and limitations now, before you get dragged too deeply into the situation. It wouldn't hurt to talk honestly and openly about your fears with the sister and your wife's mother. They need to understand the ramifications if they try to help the relative. They may end up taking on more of a challenge than they can handle -- financially, emotionally, and physically.

As difficult as it may be to accept, the relative has a right to live the way she wants. As JKOM mentioned, trying to gain guardianship, etc. is a long, costly, & difficult procedure. It would be wise to find out about it before proceeding.

In reality, in the absence of written POA, the hospital and doctors can and will talk to immediate family about planning care etc.--each state has rules about who can give consent for procedures in the absence of POA (ie here it is next of kin in this order--adult child, parent, sibling, and so on) but usually in practice not so strict about discussing discharge planning. Of course the person can always give verbal consent to include or allow someone to be involved.

Even if they feel that they can't give you information, there is no restriction upon *you* giving *them* information--like her apt. is unsuitable for her convalescence and why, lack of family resources etc. They have a duty to take those factors into consideration with discharge planning, no matter what the patient may say, especially if they suspect that the patient is not fully in touch with reality.

Unfortunately, I can't assure you that the hospital will actually send her to an extended care in the end--but without your information, they might when they wouldn't if they knew what you are telling us.

Other than that, jkom and shambo are sooo right about the issues and pitfalls. The time to talk--to the whole family--is now.

DH had a similar situation with his uncle who was a multimillionaire but didn't want to pay for a retirement facility where he would be well taken care of so he stayed in his home.

Three times he fell in his house and was taken to a facility where he had physical therapy and regained his physical mobility. But would he stay there? Oh, no, he insisted in going back to his house where he lived in squalor (it was never cleaned, papers were everywhere and there was an aisle between the furniture to get around. Kitchen had a one-burner gas stove which he lit with a match. House was a fire hazard)

The doctors and occupational therapists at the various facilities stressed the fact that he should stay there and not go home. The OT even went to his house and checked it out. She was appalled at the condition, as were we all.

So he lived there in the dirty house until finally he had to go to a nursing home where he died. I feel that he would have lived longer if he had stayed at the retirement facility where he would have had good meals, companionship and health care. But since he was compos mentis, he couldn't be forced to move.