BPDFamily.com

I desperately need guidance before potentially doing something that could severely upend many people’s lives.

The crux of my question is this: Can a person with BPD live in an assisted living environment? If so, what additional resources do they need? If not, what is the appropriate setting for them?

Here are the (mostly) germane details. Please ask if more clarification would be helpful:

My elderly mother’s income has been reduced from $3,000/month to $800/month, and her mortgage is $900/month. This is obviously an untenable situation, so I’m trying to help her move to the “next stage of life.” She owes ~$70,000 on the house and the house is worth ~250,000-$300,000 in its current condition.

And its current condition is horrid. The roof is falling off, the furnace only runs half the time, there are holes in the walls and plaster falling off, and the yard is completely overgrown. She has stopped doing real housework; I have been vacuuming for her when I visit once a week.

In addition, her health has deteriorated to the point that she has to go down the basement stairs backwards to do laundry and clean the litter box. She is chronically dizzy, which is ostensibly why she doesn’t clean her house like she should. She fell in her yard four years ago and landed on her face, knocking out all but one of her teeth. But she has refused to go to a dentist to get dentures because she wants a $40,000 dental rebuild (I should note, however, that when we looked into that she was such a difficult patient that the company ended up refunding her $4,000 prepayment and asked her to go elsewhere). She also has refused to see a doctor for the past 11+ years, aside from a doctor she sees who prescribes her Adderall and Xanax. Mercifully, she doesn’t drive anymore, following a series of minor hit-and-run collisions.

I could go on and on; suffice it to say, as she’s gotten older she’s become less and less capable of taking care of herself. I won’t even go into the financial messes she’s made, largely because I don’t know any more than what I’ve actually witnessed, but in a nutshell there are judgments and liens and credit cards being declined.

So it seems clear to me that, at this point, she legitimately needs help with her life. She needs a place without stairs where she can get some help with housework and meals and a driver.

I’ve been working with a local service that has helped me find several communities more than capable of taking care of her needs. Apparently, as I think I understand it, if she can live in one of these communities for a certain period of time (one to two years?) she can transition to Medicaid support when her finances are exhausted. Given her financial situation, that would work out about perfectly, with maybe enough money left over to finally fix her mouth.

The problem, as I'm sure you can imagine, is the resistance my mother is putting up. I don’t have any idea what her long-term plan is, but on her good days she’ll go see a place with me and spend the whole time talking to the staff about how much people love her artwork, all the ways she knows she has psychic powers, and the plots of several books she wants to write; and on her bad days she just sits and pouts and says it’s not fair and she won’t move and she just wants to die.

And, mixed into those extremes are healthy doses of shaming and belittling she tries to leverage over me, I assume to try to manipulate me into doing her bidding, whatever that may be at any given moment.

So, now, I’ve only just realized a major problem that could ruin everything: At all the places we’ve visited, all the staff and other residents have been so kind and gracious and patient, and the facilities seem so wonderful and peaceful… What would happen if she moved into one of these places? Would she treat the staff and residents like she treats me (I know who she is, so I can put it in context, but I don’t expect a stranger to do the same)? Would she end up just getting asked to leave? And if so, what then?

My mother obviously isn’t the first BPD to need assisted living, so how does this ordinarily play out? Could she mellow out once she’s living in an environment where the walls aren’t falling in around her and her mouth is fixed, etc.? I honestly cannot see her for one moment joining social activities or eating with strangers, so will she ever adapt, and is that even important?

Or is there something else that happens with BPDs when they get to this stage of life? Is there a better place she can go?

I should say that I’ve been sorting out my relationship with my mother for an entire lifetime and I genuinely don’t feel I need help setting boundaries. I know she’s cruel and vindictive and insensitive and malicious, but I do love her and I’m concerned for her. I refuse to let her live with me and I absolutely will not financially support her, but I also don’t want to see her become penniless or end up in a women’s shelter if there’s anything I can do to help her avert that.

I’m just more and more wondering what that means.

My BPD mother just entered an assisted living facility. That story is in my recent posts. Yes, she was resistant but finances pushed her. It was the only decision she could do as she leveraged her home equity.

I had similar concerns and so my best answer is- it depends. The home health nurse coordinator who assisted with this is aware of BPD mother's behaviors and chose a facility that she felt could handle someone with BPD. My mother was assessed at one level according to her physical needs but when the staff saw she emotionally needed more attention, they raised it. This came at a higher cost but was still within her monthly income and less than she was spending with home help.

One difference with my BPD mother is that my father left a pension and her monthly income is higher than what would qualify for Medicaid but it did not cover her use of home health care and so, she took a home equity loan to cover that and was at the point of the bank repossessing it. As you can imagine, she's accusing everyone of rushing her to move out of her home but the alternative would have been the bank doing it and the bank is less invested in her well being than her family who pushed the move.

Of course she doesn't like it and thinks the staff is inadequate but she said the same thing about her home health workers and complained about them too. Bottom line- she doesn't seem to be content with any situation but there's not really any alternative. I will update here on how she does there. I think your mother's best chance at being able to stay at an assisted living is to choose one that can handle her behavior if possible. Your mother's choices are limited due to finances and so were mine but just try to find the best fit possible for her. It's not as if she has any other choice if her monthly income is not enough for her to stay where she is.

 :hi: Phineas,
It sounds like you have great boundaries and a good handle on what needs to be done. 

Every facility is different.   I think you can get a really good feel, by just spending a day or several hours there as an observer. Most welcome you doing that, and it would be a red flag, if they only want you to “ go on a tour”.   If you have narrowed it down, that could help you decide.  My mom is in an assisted living, and though she does not have BPD, there are definitely people there with BPD, NPD, dementia and deliurm.  My sister has BPD and they have to deal with her and lots of difficult family members.  My observation is they are very skilled at training the staff, to not react, enable or indulge.   They are so busy with the care duties that they seemingly know how to distract, redirect, or isolate the residents who are acting out until they self soothe.   I am not sure, but  it seems as people age, their PD is more obvious as they aren’t as skilled at masking it. It becomes very clear very quickly, as they “live there”. 

Unfortunately many facilities are very understaffed and may not spend as much time as my mothers facility in staff training and development.  I have visited many places and some of the time you can see right away, that they wouldn’t do well with an intense or emotionally needy patient. 

You have a good plan, and it sounds like you have options.  good luck. Your mother will resist for sure, but stay focused on the plan and expect/prepare for her resistance.   You might consider, spending significant time with your mother in the first week, weaning the time down as she adapts.   The transition is hard, but once she makes it, it will be such a relief for you.   

On top of having to deal with all the mistreatment from your mother, it seems you have two key challenges here: 1) How to get her to agree to go to an assisted living facility. 2) Finding an assisted living facility that would be able to deal with your mother's challenges with BPD. Number two may not be as difficult as you imagine. There are many disordered elderly peope in my family including my mother with BPD who is deceased. My experiences have been that there are many people who work with the elderly who get how to work with challenging clients, including ones with BPD. Getting your mother to go to assisted living may involve obtaining a mental health assessent to find out if she is legally competent to make decisions for herself, and unfortunately/fortunately the bar is extremely high to get a person to be ruled incompetent. It sounds like a medical emergency may be your best hope in which the hospital staff could refuse to release her back to her own home and insist she go to a rehabilitation center or assisted living. My heart goes out to you, knowing you want to do what is in your mother's best interests and how she is making it as hard as possible for you to do so.