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The dog is creating unsanitary conditions its time for dog to go. It is deficating and urinating inside the house so bad that its causing a bad smell that means it is no longer a clean inviroment for the sick lady and unclean for the care workers this is time for the dog to go, if someone were to call adult abuse the dog would probably be removed the sick lady needs care for herself its time to get rid of dog.
They don't always work for most dogs though. We tried that, and it never worked to stop the barking. The only method that worked for us was the spray and shock collar, and we only needed to use it for about a week. It isn't something you leave on afterwards. The shock is annoying as hell, but causes no harm. The spray is for when it happens after the collar, and we used that for about another week until the problem stopped.
Doggy door advice sounds like a good idea, as long as the lady can manage that, making sure her dog does return.
Chances are you probably thought of this already, mentioned that you've worked with animals, as I do but just in case! I'm concerned because you mentioned the dog being older(older than 6/7?)-depending on breed... What kind of diet is she on, has she had her nails trimmed, is she at as proper weight, has she been de wormed, fleas...ticks..., etc? Would bring that up with your friend. With that of course if you know a clinic that can help out low income, if that's the case with the women, would have the dog examined, which might tie into an unseen cause for the dog's behavior-such as an infection or incontinence due to age, beyond what has been discussed already.