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I have a particularly difficult situation regarding my 65 year old mother. She lives in Texas and I'm out of state and am her only living family. Her current living situation is harmful for both her mental and physical health, yet she refuses to change (won't sell home, won't allow people to clean, demands independence). Hoarder to the extreme, failing hygiene, and smokes more than anyone on the planet.

She is battling with mental illness such as PTSD and severe anxiety and has bouts of altered reality but is incredibly articulate and bright. I don't believe that I'll be able to force her into making any changes from a legal standpoint. So far, no lawyer will even have a meeting with me, as there is no way a judge would ever consider to not understand what is going on. She knows exactly what she is doing.

I'm unsure if anyone can improve her situation but I would appreciate any opinions. I just know that if I don't act in some way now, she will die in this huge falling down house... I'm open to any suggestions / resources, especially if you are familiar with Texas (Houston area).

Warm regards,
Jennie
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((((((hugs)))))) jennie. You are in a very tough situation. Can you contact APS in her area and see what they say, or the police for a wellness check? Could you contact her doctor and detail your concerns? You might go to your local agency for aging and/or social services and discuss your mum's problems with them.

Hoarding is increasing as a problem and gets worse as people age. Your mother has significant mental health issues. Concern for and research about hoarding is growing these days. No matter how articulate she is she has mental illness. It would be a good idea to document what is happening.

Hoarders are generally treated with cognitive behavioural therapy (CBT) and antidepressants. If your mum is having times of altered reality she likely needs something like an anti psychotic too. Do you think there is any chance that she is developing dementia? To me this is far more a medical issue than a legal one though applying for guardianship may be advisable at some point. It sounds like she is unable to make wise or even safe decisions for her own care.

You don't say how old she is. She needs a thorough, possibly, geriatric neuropsych evaluation and then the recommended treatment. She probably needs hospitalization for that to occur, then follow up out in the community. Does anyone have POA for her? If she falls or has any episode that requires a trip to the ER you can intervene then, talk to the doctors and ask for an eval. Have your documentation ready for that. If she is having an episode of altered reality I suspect you could call the paramedics to take her to the ER. It would be a good idea to find out under what conditions you can call for her to be taken to the ER.

Likely eventually some health problem will result in her going to hospital. It is better if you are prepared for that. A doctor may say she is not safe too be released to go home alone. If this happens do not take her from the hospital. As I understand it, if there is no one to care for her they then are obliged to find her a placement. Hope you can put a plan together. My mother was out of control with a personality disorder and dementia. The right things started happening once the proper professionals were involved, in particular, a geriatric psychiatrist. Up until that, things were pretty crazy.

Good luck to you. You are not alone.
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I now see that she is 65, so she qualifies as a senior and in need of a doctor with geriatric training.
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"Bouts of altered reality" suggest psychosis. An actual formal examination might help determine if the "articulate, verbal" part is just semi-oriented banter and bluster versus really being sharp and able to stay on top of anything. And if she is truly legally competent, such that APS can't do anything and you can't get guardianship, you'd have the option of calling the Health Department for hazardous and unsanitary conditions.
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