I'm not sure what to make of the change I see in Mom. Is this the beginning of the end?

I got a ride to visit Mom for the first time since I broke my ankle. I brought her snacks and ensure, milk, etc, as well as clean clothes. I brought my new puppy hoping that would make her smile, peak her interest a little. It didn't. Its been 4 weeks and I can see a big change in her. A good change is the Zoloft appears to be working and she doesn't seem quite so negative, argumentative, or depressed. I found no obsessive notes all over her room like we have seen for the past 2 years. Somehow, she didn't seem as unhappy, but somehow she seems resigned, maybe giving up. Maybe without the obsessions she is facing reality?
She looks terrible, as if she has aged years and acts very tired. She hasn't had her hair done in weeks because she says she doesn't feel well. She said if she doesn't go down for meals they bring them up. It appeared she couldn't hear well out of her new hearing aids. The more I thought about it, the more I believe it wasn't her hearing but more her inability to follow and comprehend what she was hearing. She seemed a little "out of it". A few days ago she called me and my sister, perfectly able to hear on the phone, but the last 3 weeks she has called several times a day and says "I can't hear a thing" and then hung up. What changed, we don't know.
She kept lying down and sitting up, and I only stayed 45 minutes because she seemed exhausted and I noticed she has tremors that are worse. She said her ribs hurt. I asked if she had fallen and she said yes, then she said no. I told her I would talk to the nurse so they can take her to the doctor since I can't drive with my broken ankle. She freaked out, her usual self of refusing any help, saying "they will all come up here and try to take care of me".

We are paying $4200 a month for her to be taken care of, and she isn't getting much of anything because she hides in her room and won't let anyone know her needs. Its her stupid stupid pride and yet she goes around wearing filthy clothes and doesn't shower. I found a stinky used depends in the night stand and dirty dishes under the sink, a huge pile of dirty clothes in the closet (so here I am still washing and ironing her clothes? ) and if the surface looks ok, that's as far as the AL goes? They don't check around, they don't check and clean her hearing aids? They tell me she is ok, but we suspect it is because she lies and pretends she is fine so they will leave her alone, and probably they think we are the problem thinking she isn't fine. I thought this was a great place at first, but I beginning to think they really don't observe her because they know she won't let them help her or maybe at 100, she is just allowed to survive however she chooses. There is no use telling them her ribs hurt or that she might have fallen because she has already rejected their request she use a walker 1) she will lie and tell them they don't hurt any more and refuse to go to the doctor 2) if they took her to the doctor, what could he do - pain pills? any instructions she wouldn't follow and they can't make her 3) she has cried wolf for the past 20 years, we have no idea when she does or doesn't have a serious pain. She has never had even a headache so the slightest splinter she makes a big deal. One minute she says something is wrong, the next she denies it.

But, somehow, something doesn't seem right with her, a change that feels like an omen, and I wonder if she is just letting go at this point. At 100, its possible. I simply don't know if there is anything more I can do or what I can ask them to do in my absence. Maybe AL is just a glorified expensive babysitter unless the person actually lets them help. One good thing, the zoloft at least has relieved some of her anxiety and obsessions so she isn't so unhappy. Maybe I have to just leave it at that.