Great topic. I'm glad there are people out there who value those who are struggling through their later years. I like how you tell a story with this poem. The short, succinct lines draw the reader in for the meat of the story.

she demanded the girl be brought down from the 'tree'

I like this line a lot. It makes the scene come to life. I can imagine how a delusional person would say this remembering something from the past. It also makes me wonder who's in the tree and why. I like how you show us the difficult reality that relatives often abandon these vulnerable people and the brunt of the task gets pushed entirely onto just a few of the family members.

they who want only her wealth and nothing more
karma is a reality
wish they realized it before it is too late

These lines make me realise that the person giving the care is concerned about how the discarding of the elder will effect everyone.

I liked this piece. 😎