BPDFamily.com

My mother has BPD and dementia and has been very unstable in her independent senior living apartment. I am exploring Assisted living for her so that we can have the support that we need and so that she will be safe. This time in our lives is so challenging for me. I am just looking to learn from others that may have gone through this with their parent so that I do not have to reinvent the wheel and know what questions to ask as we move forward with Assisted Living.

Hey 563501:  
Welcoming to the Community!
Sorry that you mom is unstable in her living situation.  Finding suitable (and agreeable) living situations for people without BPD can be challenging, so you likely have a higher level of challenge.
It might be helpful to check out the link below.  Some guidelines are mentioned, as well as a link to whatever state you live in.  
www.assistedliving.com/laws-by-state/

My mom wasn't the one with BPD/BPD traits, but she spent the last 5 months of her life between hospital stays and skilled nursing facilities.  Nursing facilities have more regulations and oversight, than assisted living facilities.

Your options can vary, in accordance with where you live.  Possible care options can depend on the level of dementia combined with BPD behaviors.  As you do your homework on facilities, might as well document options for different levels of care.  Although, she might currently do well in a less expensive facility, with a lesser level of care, her needs will likely change over the coming years.  Additionally, other aspects of her health may well enter the equation.

Just before my mom passed, we were close to exhausting all Medicare supplementation for extended care options, so we were approaching an "out of pocket" cost situation.  One option we considered, at that time, was a  "Board & Care" facility.  They are not for someone who needs skilled nursing, but can present a home-like environment, while being considerably less expensive than alternatives.  The patients have their own room and then share common areas.  There is usually a nurse's aid, or someone with low level nursing skills in attendance to offer 24/7 help with daily care management and feeding. The situations with medical care would vary by patient and their medical coverage.

There is no easy answer, and it will take some homework.  I made a spreadsheet and rated various aspects of the facilities.  One primary thing for us was to make sure the facility was within a zone for the preferred hospital, where our mom's doctors were on staff.  Some of the aspects to look at are:  cost, location, staffing level, the facility in general, aspects that might suit your mom, activities offered, etc.  If a facility is licensed and rated, you will want to consider ratings, complaints, etc.

When all is said and done, all you can do is make your best effort to choose a facility. I'm in California. Even though we did research, visited facilities, read reviews, evaluated State code violations, etc., we still encountered problems. Institutional-type settings can be environments to catch various infectious medical conditions (staph, MRSA, Influenza, various new superbugs,).  Then, there is a  battle with bed sores.

Staffing was an issue we became very familiar with, particularly after the day shift left.  The standard is to do more with less and to use the lowest skill level possible. The more independent your mom is, the easier the situation is.  We found that, with a rather passive patient, who needed assistance to use the restroom, the nursing facilities (as opposed to hospitals) all wanted to put diapers on the patients.  Once they do that, it becomes a standard and good luck with getting prompt attention for a change.  (then, you have an adult with diaper rash)

I'm sure our situation was unusual. Our mom's original issue was a sudden onset of Pulmonary Fibrosis and a severe UTI.  My mom was septic 3 times in a 5 month period of time (many people don't survive one episode). She contracted MRSA at one skilled nursing facility, then contracted another superbug called VRE, while in different nursing facilities.  The nail in the coffin was when the last skilled nursing facility had an outbreak of Influenza "A".  She was moved to a room with a patient who already had contracted Influenza "A", while recovering from back surgery.  

All you can do is make your best effort to find the best suitable facility, for your situation.  Then, all you can do is monitor and advocate as possible.  Everything is relative to each unique situation and set of circumstances.  We had an awful experience with care facilities (and my uBPD sister made everything more difficult).  I'm sure others, with a different set of circumstances, had different experiences.

Hi 563501,

Just joined when I saw your post. I can't offer help to you but I am in a similar position and will be watching this thread with interest. I only just realised my mother probably has had BPD all her life which has caused incredible disruption to the family and now it is affected by dementia diagnosed a number of years ago. We are in a position where she has to go into a care home but this will be very difficult to achieve due to the BPD. She says she will not go in and has been declined by one so far after an assessment.

The dementia seems to interact with the BPD behaviour in curious ways, some negative some positive. But as you probably know, the BPD sufferer finds it hard to rationalise the extreme emotions and often creates a false scenario to explain them. This is one area that is getting more extreme and is affecting those involved, although it has always existed.

I look forward to reading other posts in this thread and I am happy to compare notes with yourself and others.

 I do have a suggestion for those with elderly family members with BPD who have either cognitive impairment or mobility issues. Look into hiring a Geriatric Case Manager. Some are RN's and others are Social Workers. The private case managers might be more effective but costly, but many medical centers have a Senior Services Department and may be of some help.

Getting an independent case manager sounds like a good suggestion, because they would likely be impartial and looking out for the best interest of the patient.  That isn't necessarily the case, when the service is free. 

I'm thinking that at some point, with the progression of dementia or alzheimer's, that it might be necessary to use a care facility that specializes in those types of disorders. At that point, it's likely that specific BPD behaviors might not be any worse than some behaviors associated with the dementia or alzheimer's.  I think the general physical condition of an individual, their mobility level and control over bodily functions enter the equation.

Anger and aggression can accompany dementia and alzheimer's.  Some facilities either aren't equipped to handle those issue, or choose not to.  I had an elderly uncle who got kicked out of one care facility, because his dementia caused him to get combative. 

The hardest situation could be while a person is still considered legally competent, because they can resist efforts to get them to move.  All you can do is make your best effort to get someone in to a safer situation.  But, you can only do your best. 

Paranoia seems to  commonly go along with mental decline.  Although thefts will occur at care facilities, those with dementia can get very paranoid and constantly accuse others of steeling their things.  Unfortunately, even after you get someone into the best facility possible (for you relative's situation), there is a good chance that there will always be issues to deal with.

I stumbled upon an interesting discussion at a care giving website, at the link below (in case anyone is interested in reading):

How to tell between BPD behaviors and dementia behaviors?    (https://www.agingcare.com/questions/difference-personality-disorder-and-dementia-behaviors-163152.htm)