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BPD mother has been unstable at assisted living (physically and emotionally. She has not been able to do anything for herself (emotionally- and now physically). The AL has not been neglegent- she doesn't cooperate with staff in her own care. Since being in AL she has been hospilalized and sent to rehab 3 times and had several ER visits for evaluation after falling, or other reasons such as a suspected UTI. She won't let staff assist her and gets up on her own and slips at night. I would estimate since going to AL she has spent about half that time in the skilled nursing facility.

I am now at the point where it's necessary to tell the skilled nursing home to keep her. She has bedsores now. Again not neglect. She refuses the air mattresses they offer her. She got them during her last hospitalization when she was so sick, they considered Hospice ( she refused ). If they put compression socks on her she takes them off. The bedsores are too serious for the level of care an AL is licensed for.

I also have to now conserve what is left of her money so she has it to pay for this and tell AL she isn't coming back. She is insisting she can go back and people how well she is doing. Listening to staff- she's very physically dependent and still needs treatment for the bedsores which technically, the AL doesn't have the resources to treat.

She's fortunate in the sense that this is the best of the facilities in her area and if we conserve her money now - she can stay there. She won't agree though. But I have seen the cycle- she stays there- where she gets better, goes back to AL and then gets sick again with something and it back in this facility. The only times she has been stable have been in this facility. She complains about it but when she's at the AL, she stays in her room, doesn't participate in any activities, or go to meals, so all she does is stay in her room, albeit it's more private there. But privacy means she's alone and she can't be left alone.

Since she's had this recent illness, I have had her mail forwarded to pay bills from her bank account. She has not previously allowed me to have involvment like this. She's had late fees on credit cards, a payment to AAA- for an ongoing membership she had- she doesn't drive or have the car anymore. Got a bill for homeowners insurance and cancelled it- the house isn't hers anymore. While she isn't technically "mentally incompetent" the staff at the nursing home says they don't think she fully understands all they tell her. She sounds reasonable at first but if they keep talking to her, she seems to unravel. She's financially irresponsible. On the basis of her being a financial and physical danger to herself- I will need to push for her staying there and take more action with her finances.

The facility also knows her "issues" and is willing to have her there.

Her family backs me up on this. They have seen this pattern too. This is the best thing for her but it's going to be difficult. It's impossible to reason with her. Although there may be some age related cognitive issues going on, this is mostly BPD. It's been impossible to reason with her or get her to cooperate - like a toddler, she digs her heels in at attempts to do this, even if it's for her own good.

I am so sorry NW.  I get it.

It’s hard to know what to say.

I’m just so sad, and sorry for you that you are left to deal with your mom who is so unreasonable, and irrational that she refuses help.

Yes, it sounds like you have waited as long as you can. It sounds like it can’t wait any longer. 

Is the “skilled nursing care” you are referring to a residential long term care facility, or a “home” for more complex care needs?

I’m no nurse, but my understanding of bedsores is that they are serious, and can lead to complications. It also means she is lying in bed a lot, and not moving.  Then she gets up without calling for assistance, and falls. She clearly sounds weak.

I don’t understand  how the  system can claim she is still mentally competent with all these behaviors. Our moms share a lot of similarities although yours is more progressed than mine.  They choose the path of extreme resistance which results in the worst case scenario.  You are left to bear witness to this.

It strikes me that BPD is this kind of grey zone or undefined border between sanity and insanity.  It’s like there’s no legal plan for what to do with these people so they are deemed competent, when to the families and people responsible for them, they really aren’t because their decisions are so irrational, and self-harmful.

I know she must have had a recent assessment.  There just seems to be so much evidence in your story for a higher more complex level of care needed.

These are her choices (eg not to accept help getting out of bed).  Her choices, her consequences. It is incredibly difficult to observe all this and feel powerless to do anything to make it better.  Again, These are her choices.  It doesn’t seem fair to you.

Where is your sister with all this?  Is she on the same page as you?

As parents we have to make decisions our toddlers don’t like.  But the decision to not eat candy before supper still needs to be made.  Your mom has reverted to being the toddler.  It happens.  It’s a difficult place for you to be.  It’s ok for you to do what you have to do in the best interests of your mom.

The situation with your mother is extremely sad. You are doing what is best for her, and of course, you wish she would cooperate in doing what is in her best interests and those of other people as well, which she can't do. BPD is such a destructive condition. My mother's doctor put in her in a nursing home for a couple of weeks so she would not lose her leg which she refused to elevate and she would not allow a hospital bed in her home.

As sad and stressful as it is, you'll do the right thing for her as she isn't capable of doing it for herself.

NW,

   You have stated what needs to be done.  Why aren't you doing it?  If the POA says you have full authority, 'just do it'. 

   If you don't have full authority, then you will need to consult with an attorney, and find out the laws to have her declared legally incompetent.  Get the doctor or doctors (depending on local regulations you may need more than one) to declare she is legally incompetent and have the attorney present it to a judge, and have the judge make a ruling on it.  This is an extra time consuming step - and then 'just do it'.  Be sure to explain the financial situation with the doctor(s), so they are informed to make a good decision.

   Take a page out of the pwBPD playbook, and blame-shift, 'they' have imposed this as a requirement for you to stay here, whether this is the facility or the judge - both are aware of the dynamic, just make sure it isn't someone who she regularly interacts with you or the staff, it could be the management with whom she doesn't interact with - just some thoughts.

    My step-B is doing this for my step-M who has dementia.  My step-B has no problems telling my step-M "no". 

   I don't know how not to be blunt, so I am going to be blunt.  It sounds like you don't want to say "no" to your mom.  Since you have mentioned you attended CoDA meetings, not being able to say "no" when it needs to be done is a trait of codependency - according to Google over 90% of all persons are codependent, and Ms. Beatty, an expert has mentioned 45% in her book, so it is nothing to be ashamed of.  This "no" is a boundary, a necessary one so your mom can be properly cared for.

   I am going to quote a portion of the serenity prayer "God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.".

   This is a super hard thing that you are doing, but it is something that must be done for your mothers wellbeing.  You are stuck between a rock and a hard place, and you are paralyzed in your decision making process.  I am offering a 3rd person perspective from my own step mom.

   I have done similar stuff with my wife, she hates it; however, there has been tremendous improvement (comparable to DBT therapy, but not DBT therapy, but she still doesn't know she is BPD or OCPD, but by making her therapists aware of it, through prompting my wife to describe specific symptoms she has, she is being treated.  Yes, it is manipulative, and that is where the 'wisdom to know the difference' comes in.  It was at a CoDA meeting when someone who has been there for 40 years (no kidding) shared this insight with me when I was struggling with a similar dilemma of doing this uncomfortable manipulation with my wife that was so out of character for me.  Now I am sharing it with you, even though I am a 6 month CoDA noob, it is not eloquent, but it gets the point across.

   When I did NOT say "no" to my wife, it enabled her bad behaviors, which lead to all 9 symptoms.  Now her bad behaviors have consequences, so she does less of them, and has stopped others.  I'd say in another year she will be in complete remission.

   So you can use Nancy Regan's slogan of "Just say, 'no'" to letting your mom spend the way she wants to.  Or if you want a positive connotation, use Nike's slogan "Just do it", and do the right thing for your mother.

    Don't be impulsive, reflect on this, get others' opinions, and take positive action once you have come to a decision and have slept on it.

Hi All- and thanks for your responses and advice-

Why haven't I done it already? She's not completely mentally incompetent. She's in that "in between" borderline state of "legally competent" to make her own bad decisions. Although I have POA, many banks and credit cards don't honor them. I have consulted an elder lawyer and a legal pursuit would likely have failed as the courts in her region protect the elderly from financial abuse. She has been subjected to that - from other people, not me, but when I go into her bank, even with a POA and my name on her account- they are on high alert with anyone who does that. As per the lawyer, I had to wait until there was enough evidence- physically and financially to intervene.

As with BPD - her making me POA has resulted in constant drama with her resisting any advice or attempts to intervene, and not just me, her family too. I guess it was wishful thinking that she also would be concerned about her finances but she isn't.

Methuen asked- I do have evaluations now and the advice from the social worker who is at the facility. My entire family backs me up.

And SawltyDawg- I don't logically fear saying "no" to her but the emotional and physical aspect of it - the one from childhood - that experienced her ability to raise utter Hell for anyone who does say "no" to her remains, and we, her children, are terrified of her. Not our adult selves but this is such a learned response. One thing we got punished for is if we touched anything of hers. Now, even opening her mail invokes a chill of fear.

I think this is one continum of "hope" for some kind of relationship with our BPD parent - something we have had since we were small children, that if only we are good enough, do enough, are reasonable enough, BPD mother will "come around". I have given up on any kind of reciprocal companion type relationship with her but hoped she would have enough sense to cooperate with her own medical care and people who are assisting her. She doesn't and she doesn't care. Another reason is that I don't want to do this- I think it's important to allow an elderly person as much autonomy as possible. But she's at the point of being a danger to herself. I think I have enough proof of this if my actions are questioned.

It's also that I want to be careful to not let any emotions get in the way of my decisions. 12 steps has helped me to let go of resentments so they don't get in the way. Fear though- you are correct. I tried to intervene with her on behalf of my father- for his own best interests-  and the two of them aligned in their anger at me. She has no boundaries when it comes to her retaliation.

But I don't think there's much choice here now as to what is the best situation for her.

This is such a difficult period. I'm sure your mother is working through the realization that she is reaching her end-time, and she is fighting it.

In the meantime, you need to make decisions that keep her safe.

The bedsores are problematic. Once they start, and her skin becomes that sensitive, much care must be taken to prevent infection. My mother was bedridden for a bit over six months  -- hospital, rehab/skilled nursing facility, then home health and finally home hospice -- and we were able to minimize any skin problems/bedsores. The other issues that arise are UTIs and cellulitis -- we dealt with both of those several times.

 I had a caregiver come in four hours a day who was a CNA. She bathed my mom,  put her through recommended PT movements, and ensured she changed positions and had pillows propped. I'm not confident that residents even in skilled nursing facilities get four hours of personal attention a day -- I realize we were fortunate.

So...having been through this in very personal and close-up detail, I would say that the recommendations of the social worker is on target. I can't see AL being appropriate anymore for her level of care. One way or another, she needs the oversight of a skilled nursing facility.

Thank you- Yes, she needs this. It's maddening. We are on vacation and she just called me to tell me she activated her ATM card. She has no need for one. She also can't do this without assistance which means that she got someone to assist her and now her information is not secure.

I have emailed the bank manager. I did take the opportunity to meet with him, give him a copy of my POA, show him my ID. This is a bank that is known to not accept them but he also has met my mother and is concerned about fraud with her and tends to assist me. I hope he will. I appreciate that the bank is so careful about protecting her account but this also includes me and I am the one who is trying to protect her while she doesn't protect herself.

I also believe her intent was to create drama while I am on vacation. But I am already upset over her behavior.

You agree her intent was to create drama while you are on vacation. You are upset. It is unbearable to be the constant target of a close family member. Is there someone who could take over, be POA who would be less of a target? With my NPD sister,  I had my lawyer take over all communications by communicating directly with her lawyer and by making everything all about the business that needed to be taken care of. I am not suggesting that you hire a lawyer, only that you could possibly look at ways to have someone else be the POA that your mother would not be so vested in targeting.

Legally, I can't appoint someone else as a POA. Truly, I think this is the inevitable situation for anyone in this position. I do have support from social work who also says she needs to be in long term care. Nobody is disputing this --- except she will resist it. I can do it but I know she will make it difficult.

In a way, it's been a learning experience. It was a similar situation with my father as she was in control and trying to help him was chaotic. I didn't understand BPD at the time and so the behavior seemed personal to me and it was hurtful. Now, it's not. It's like deja vu over again with her.

Taking the perspective that these are learning experiences, maybe there's some silver lining to this in that, I see now that it isn't me. I was emotionally bonded to my father in a way I am not with her. What he said and thought about me mattered. When she say things, it's about her, not me. I also see how much my parents were enmeshed. She is acting so much like he did but I think this is her influence on him.

I think this is one more example of how BPD affects families. It's understandable that one struggles with the decline of old age. Her behaviors escalated when this happened to my father, and so not a surprise she is also acting out. Not that it's OK - it just is what it is.

That a bank wouldn't honor a POA blows me away.  What's the point, then? At least they work with you.

Legally, you can't appoint someone else as POA, though the social workers at the assisted living might help you to get another family member to have the right paperwork signed so they can make decisions for your mother. Your mother's relatives got your mother to move to assisted living, and they are much less of a target for your mother's dysregulated emotions than you are because you are her daughter. I have often thought that your mother must be extremely jealous of you, as you are everything she isn't and surely she is angry that she can't control you.

It's shocking but true. Many banks and credit cards don't honor a POA.

https://www.nytimes.com/2016/05/10/health/finding-out-your-power-of-attorney-is-powerless.html.

The only reason this manager is willing to work with me is that he has seen my mother come into the bank and she has been confused. I don't know why she isn't deemed incompetent but I think it's because she can answer basic questions and appears intact in brief conversation. It's also because she wrote a very large check to an unlicensed care giver she likes and we had it blocked. He knows she's at risk for fraud. However, once I went to the bank and he wasn't there and the manager there at the time refused my POA and they treated me as if I was the criminal.

Likewise one of the credit cards she has limits my POA.

It's insane as they all want their own forms but this came after she did the POA. Fortunately I had my parents put my name on her remaining account when my father was ill. She had other accounts that I didn't have access to but she spent them. So I have access to whatever money she has now.

Something for us to think about when we appoint someone as POA. Whatever bank or credit cards we have- we need to get their own forms signed too.

Also neither social security or the IRS allow a POA. They have their own forms too. Fortunately my mother's accountant has a IRS POA to file her taxes for her. I have a refund check from the IRS in her name and I am not allowed to sign it and deposit it into my mother's account, but her accountant can do it.

It's an eye opener just how hard it is to act on someone's behalf. Undesrandably this is to protect someone from fraud but it makes it difficult for family members to act on behalf of someone.

Good grief.  Good to be aware of and thanks for sharing.

Well. The longer this drags on, the worse it could become for her if she's not getting the level of care she needs.  If everybody (including the assessment team docs I'm assuming?) agrees she needs to be in long term care, are the wheels being put in motion to make that happen?

I agree with GaGrl about those bedsores.  And she's such a fall risk that she probably would benefit from a bed that has rails maybe? 

Where I live, there's a waiting list of 3 years for AL, and there are cases where people wait 1 yr for LTC (often in hospitals!).  I don't know what it's like where you live, but it might be helpful to everyone to put the wheels in motion sooner rather than later.

I guess one silver lining is your full appreciation that none of this is personal.  It's the disease, which can be hard to separate from the person.  I tend to use imagery to help me cope with this.

This is why I have to act now. She currently is in a skilled nursing facility after being hospilalized for an infection. They have told me she can stay there long term. She won't agree to that but I can override her and this is the opinion of the staff there as well- that she needs this level care. It's a good facility.

I know it's the right thing for her. It brings up a lot of feelings because the dynamics in the family, you must obey mother ( and do what she wants) is the message I grew up with. This is also the "family rule" that enabled her behaviors.

In terms of our relationship, I don't feel there's much to lose. I think there's still a sense of wanting to make things "right" with my parents. When I tried to act in my father's best interest when he got ill, my parents resisted and got angry at me. It's a similar pattern with my mother. There's no mutual cooperation. I think a part of this is having the radical acceptance that - this is how she is. Gaining any understanding on her part is not possible.

This is remarkable! It is time.  Get it done.  And be kinder to yourself than you have ever been.

With regards to saying "no" issue.  Please use DBT "Wise Mind" (top of the 'tools' menu on this site).

You know what needs to be done.  However your mother has not been declared incompetent.

This is the tough part...  Use your POA and talk to her doctors, go in stating specific examples of why you think she is incompetent, be sure to state that "she's at the point of being a danger to herself" (these are 'magic' words to empower the doctors to do the right thing - that she is a danger to herself!) and passionately ask them to declare her 'incompetent' and have a court then declare that she is 'incompetent' and this will make your ability to do what is right for her so much easier.  This is pretty much the only way that you can gain the necessary control of your mother's life to ensure that she is well looked after and not taken advantage of.  Be sure to mention the limited amount of finances she has for her end of life care, and the consequences (real or potential) of not being able to manage it.

Most doctors will be reasonable, and work with you to accommodate a ruling sooner rather than later within the framework of truths that you wish to highlight.

Think of her finances as a 'boundary' that must be imposed.  However do let her have autonomy of what friends she makes in the home, and non-critical care decisions - I do this with my wife - if she makes good decisions there, I will encourage those behaviors.  The cold hard truth of the matter is that you are now the parentified child caretaker of your mother, and as such, you have been groomed to be AND you have also elected (chosen) to be the parent to your mother.  As such, you need to treat your mother with appropriate boundaries for her own good.  You would let a child touch a hot pan on the stove, likewise, you would let a child spend all their remaining money on junk purchases, do the same for your mother.

While I do not want to be the parentified caretaker of my wife; however, it is the only way to handle my situation if I want to have a sane relationship with my wife - I too have chosen to become the parentified caretaker of my wife.  Before I became a parentified caretaker for my wife, my wife was out of control when I did not setup boundaries on her bad choices.  My wife even recognizes it, and asks me "why are you treating me like a child?".  Most of the time I don't answer, as that will tick her off more but I am thinking "...because you are behaving like a spoiled little brat with your tantrum" or whatever prompted me to enforce a boundary.

My step brother has done this with his mother (my step mother).  You need and have chosen to do this with your mother to ensure her end of life care is the best it can be.  I know how tough it can be, and I know my step brother did a tremendous job with my dad on his end of life care, much better than I could have done. 

Do you have any siblings that can be supportive in making this happen?  I think you would since they helped move your mother out of her home.  If so, ask them to help you out - you don't have to take the entire burden on by yourself (another codependent trait - don't be the martyr if you don't have to), ask for their help in this matter.

Good luck, and I will be praying for you.  :hug:

As I always remind everyone who is in crisis, be sure to do some self-care for yourself.  Take time to do some self-care.

Why do you feel you have to be the person in charge of your mother's care and why do you think you have to do it alone without the support of family and other people?

Zachira- I do have support from extended family. It's that she named me POA so I am the only one who can override her. Sawlty Dawg- there are two kinds of POA- one is "springing" only when the person can not make their own decisions. Mine is "durable"- I can do it at any time. The reason I didn't do it sooner is out of respect for her autonomy - but her health has gotten worse and she's more dependent and so someone has to step in for her own best interest. Also we didn't know anything about her finances until recently- she kept that information from us. She was running out of money and took out a home equity loan and didn't tell us. We- her family- found out about it when she'd already spent about half the equity in her home. Then we stepped in.

It's an odd situation (as BPD families are). I was parentified. My golden child sibling was coddled and enmeshed with BPD mother. Although I was the scapegoat child- she emotionally abused everyone in the family. I became the most responsible child- had to be in this situation. GC does not have BPD but has had the worst of the emotional issues.

My mother has helped out GC financially. I became financially independent of my parents early on when I went to college. I have always expected that my parents would name GC in their will and not me. After my father passed away, my mother appointed ohe of my cousins as POA.

Several years later, new legal papers were sent to me by her new attorney. The person working at the attorney's office is a friend of hers. I was appointed POA. The will had a 50-50 split between me and GC. My best guess is that her friend advised her to do it this way. I thought about refusing it but then realized that of all the people in her circle ,I was the best person to make decisions in her interest and agreed.

I can't change the will but it is possible to refuse an inheritance. There won't be much of any of it left- but I plan to refuse my part. I told her that I will refuse it. I don't want anyone to question my motives or to believe her if she makes it sound like I do.

Are you going to have your mother remain in the skilled nursing facility? It sounds like you are legally able to do so, and that the skilled nursing facility would not likely release her to an assisted living nor would the assisted living take her back.

Yes that is the plan.

The assisted living can not ( according to state law) take her back with the bedsores. She also has a higher level of care need than they can provide.

You might consider telling your mother she will be in the skilled nursing facility until she gets well enough to go back to assisted living. Sometimes this type of lie is a favor to a senior who will be more unhappy knowing the truth and never accept it. My cousin's wife told my cousin who was in memory care that he could go home when he got better. It was a genuine act of kindness on her part and made his last few months more bearable and him easier to deal with.

NW, is this what your dad would want you to do?

Reading between the lines, what I'm hearing is the hurt, and determination you have to demonstrate you are not the person you believe your mom painted you as to others.  You do not "want her money".  Have I got that right?  

I think your deep motivations for doing this are key.  As long as it's not out of vengeance, or hurt, or stubbornness or some other negative emotion.

If I remember right, your mother didn't hold a job when you lived at home.  She stayed at home, queen style, and had you kids do all the responsibilities at home, or hired help to do it.  She didn't do it.

I think you treasured your relationship with your dad growing up, even if he surprised and disappointed you at the end, and defended her behaviors due to enmeshment.  During his family time as a father, he was the wage earner and provider in the home.  So this is his money too.  Would he be ok with you refusing his money? Thoughts?

Just another perspective.  

My mom only worked about 2 years out of my "growing up" years so she was a stay at home mom too. I genuinely think of her money now as dad's money.  I too had a dad I cherished.  He wouldn't want me to refuse inheritance.  So I guess that's where I am coming from.  Mom threatened a few years ago to take me out of the Will (when I got home care involved after her first fall, and after I burned out of caring for her for 4++ weeks after said fall).

I have never met you, and only know snippets from a few years on this forum.  But I think we get a bit of a feel for each other as people on this forum.  You are authentic.  You matter.  You are worthy of this inheritance, even if there is only $2 left after all her spending ($1 for each of you and your sibling).  

I don't know all your reasons for refusing inheritance.  If you decide refusing it is the best decision for you, could you do something else with it?  Donate it to a charity either you or your father would support?

Or use it in a way that is dedicated to your own self care?  You are certainly deserving after this lifetime journey.

If anyone questions your motives, that is truly their problem.  They know nothing.  

I think of it as my father's money too. Would he want me to have it? I don't know the answer to that question. I did treasure my relationship with him and know he cared about us but I am not sure how he felt about the relationship. I wonder if - since this was the only parental attention I got, then to me it was wonderful but his focus seemed to be directed by BPD mother.

I became aware of money issues when I was a teen. If I asked him for something, he'd snap at me. Yet, he wouldn't ever say no to BPD mother. So the finances were lopsided- we had our needs met but money was directed to her.

I think my father would want me to protect her money like I plan to do, but I also think he only is concerned about it going to her, not anyone else.

I think my refusal to take it is about making this my choice now.

Notwendy, I'm wondering the same thing as Methuen... you've had a mother mischaracterize you for most of your life. Worse, she says untrue things to people. It's awful that you have POA and are made to feel like a criminal for trying to do what needs to be done. This can't help the feelings that go along with managing your difficult relationship with her, at a time when you probably have more power over her than you've ever had, flipping the dynamic.

What seems tricky to navigate is that you have no intention to abuse that power, whereas your mother will see nothing but ill intent, and she'll say so, to you and anyone who will listen.

My uBPD hermit/waif grandmother was like this too. Though she was losing her mind when she went to AL, the move seemed to compound her issues. She became worse. Oddly, with her becoming worse, at least emotionally and psychologically, it became easier for family to get her the care she required. On the family law board, we talk about it as shining sunlight on the situation. Sometimes the best thing we can do is let that sunshine in so others can see it. At times, we have to stop protecting them so there is something to see.

I wonder if something similar might be around the corner for you.

When my ex husband had a psychotic break and implied he was going to kill himself and our son who was with him at the time, it was the worst night of my life. Yet, I remember ForeverDad writing on the Family Law board that it was an opportunity. I couldn't see it at the time but he was correct. My ex demonstrated in no uncertain terms that he was not up to the responsibility required to take care of a child. He was too ill for that privilege and measures had to be taken.

What might happen if you took a step into the sunlight?

I understand when someone with BPD accuses you of being x, and you are nothing like x, it still feels like you have to defend yourself and make sure no one even thinks you are x.

Sometimes, though, we swing so far in the other direction to compensate, when the original allegation was baseless. If there are legal concerns, there are ways to protect yourself, including getting third-party professionals involved to witness and help document. Although it seems in your situation that the concern is more about what your mother will do and say as she becomes more compromised.

You know your mother best. You know her better than her caregivers.

What steps would make you feel like you dotted all your i's and crossed all your t's? Not that you need that, but in the jury of public opinion, which is not nothing with BPD family members, how would you feel protected in making these decisions for your mom?

And I agree with zachira that sometimes a white lie is an act of compassion. With dementia patients it is encouraged to go along with them, and while we may call it validation, it is essentially giving them a bit of peace believing what they want. I can see why this might feel insane to someone who grew up with a BPD parent, when believing in false realities was tied to abuse.

I am watching a small sliver of this with my mother, who isn't BPD but is an adult child. We are letting her believe she might drive again, which is absurd. Previously, my father supported her in getting her license and two days later she hit both the front bumper and back bumper on two separate occasions during the same trip.

Four days later she got confused about which way to turn in an intersection and created a traffic jam in both directions for miles. On another trip she couldn't remember where she parked and had to call my father to help her find the car, but first she had to get into her phone and couldn't remember her passcode. She asked someone to help her, then got frustrated when they couldn't help her unlock her own phone. She made such a scene a security guard got involved, who contacted law enforcement, and that's how she got home.

I don't agree with decisions my father makes, but I know they are hard decisions and there is no true right or wrong. She is his to manage, and there but for the grace of god go I. It's unlikely I would do better because what he is also managing is her crying fits at home from being cooped up and feeling controlled. In managing her, he is trying to manage his own experience, which no one but he has to endure.

Mostly, I think that's what others think when they see difficult family members become more difficult with age. "Yeesh, glad that's not my problem to handle." Or, "Am I going to have to do that with my mother?"

It's the greyest area and anyone who goes through is by definition brave.

 :hug:

NW, it may be that the social worker(s) at the AL and the skilled care can be your New Best Friends as you navigate this situation. They have seen and heard it all when it comes to difficult, recalcitrant elders.

Perhaps they can both be with you when you discuss with your mother what is and is not possible. They have the info on state guidelines, which is invaluable in having a hard boundary between AL and skilled care.

NotWendy, this is a very distressing situation and I am so sorry it has devolved to this. You have received great insights and advice, so I will try to amplify/add and hope not to duplicate.

We all know you on this forum to have clear and positive intent to support your mother ( and protect her from herself).

It sounds like you know what to do. Just do it. There was a point where my mothers doctor said exactly that to me, when I was trying to appease my uBPD sisters concerns/avoid her wrath by not increasing my moms level of care. I moved forward against my sisters wishes because I was HC POA, and incurred my sisters wrath but it was the right thing to do. I wish I had done it sooner.

You have the right focus, spending the money to benefit your mom, and not worrying about what’s left of the  inheritance. At the same time, whatever is left, you deserve your 50% that was outlined by the will. Help me understand why you think you should refuse your inheritance. Do you want GC to get 100%?

Lastly, please check on her SNF costs/benefit coverage. When I put my dad in a SNF (and things might have changed), Medicare only paid 100% of the first 20 days of a Qualifying illness. When  he was admitted I had to sign that I would be financially responsible for the balance of what Medicare didn’t cover beyond 20 days, and  100% once he ran out of lifetime days or if his condition no longer qualified. I think Medicare only provides partial coverage day 21-100.

Your mom clearly needs Skilled care today, but if that clears up and hopefully it does, they may try to place her back in an AL or lower level of care. You might need to be prepared for that.

Sometimes a home health care or hospice program can provide skilled nursing care in an AL. (My mom recently had a very serious pressure ulcer over the last few months before she passed, the AL wanted her to go to a SNF, but we were able to arrange skilled wound care via hospice/ a would care Nurse practitioner. she received excellent care for her wound and passed from other causes)

Thinking of you and wishing you the best. The current situation isn’t sustainable so something must change.

I am taking this opportunity to remind you of F.O.G. -  you may be in FOG right now.

I see you questioning yourself if you need to 'step in' even further.  You have the durable POA, out of Obligation, you should coordinate with her doctors for the best course of action in order to reduce your own level of Fear and follow through with it.

With regards to the will, and it is your dad's money too.  It sounds like you are experiencing Guilt if accept any of the money remaining.  I like what Methuen says about the will money, very well throught out, so I won't expand on it any more.

You have helped me realize my role, as a father, with a uBPDw how it affects my children.  Things have improved for them.  If I were to pass first, and my wife had my life insurance money, I would want both of my children to receive these residual funds 50/50 if my wife were to pass after me - even though I didn't know your dad, but if he is anything like me (other than lack of apparent self awareness for your and your sibling's needs), he probably would want you to have it in this manner.  I also understand your father's perspective putting his uBPDw's (your mother's) needs over that of his children's, as she required more emotional attention from him, especially as you kids moved out of the home.


I agree with Zachira, telling a person who will never get better (barring a true miracle) this type of 'white' lie - it will encourage better behavior, give them a better outlook.  Please consider it.


LnL has some wonderful advice, I agree with her.  I also agree with GaGrl regarding the legal concerns, this is where your POA comes in with the meetings with her doctors and the AL's social workers.  The doctors and social workers have dealt with this, a lot with their other patients as well.  Use their years of experience.  Have a list of questions (I am sure they already will have answers for you), and use their guidance to guide you for your mother's health care.  You are not alone, and you have a team of professionals who have 'been there, done that' with other clients.

I know that there is a lot of 'Guilt' in doing this, especially if your mom becomes verbally combative towards you - even though this is hard to hear - they lash out most at the one that they love the most.  This is true for Dementia, this is also true for pwBPD - unfortunately you are on the receiving end of the worst of both directed towards you - this can be mentally very hard on you - it is important to do self-care, do extra self-care if need be.  Lean in to those around you for help, who have your back.  Everyone posting on your thread cares about you, as we have our own stories on this.  It is painful, it is tricky, but this too shall (eventually) pass.


MommyDoc has good advice too.  Unlike her, I am repeating her as well as others, as it is worth repeating.

You know what needs to be done.  You are conflicted.  I, like others, will encourage you to 'just do it' especially if you have the [apparent] unanimous support of the health care providers and the law regarding her bed sores.

Take care with self-care and do the right thing for your mom.

Take care with self-care.

Thank you. She has some funds that would cover her costs if she stops her excessive spending at this point and so my first goal is to try to get them into a more secure situation.

I mostly wanted some sentimental items from my father. so I feel that I have what my father would have wanted me to have. But I also know he was worried about GC- who has some financial concerns- and with a small (maybe nothing) estate, I think he'd want GC to have what is left if there's anything left. GC doesn't expect it though and is in agreement that the funds are for my mother's needs first.

I am reluctant to accept any money from my parents because it was such a difficult issue in the family. It's also a way for me to keep an emotional distance from the dynamics. If there was a mutually considerate relationship- this would be different. Her immediate family has tried to reason with her too and she won't cooperate with them. They are still involved but also she has strained their good intentions as well.

I agree with the "white lie" idea. She would want for us to hold her room at the AL for when she gets out of the nursing home. To do this- pay for both, would quickly drain her savings.

My plan is to move her belongings into storage- and let her know they are there when she may need them.

I don't think anyone can predict the future. She may improve physically and if so, it will be considered. Emotionally, mentally, I don't think she can function in AL. AL is a social construct- allowing seniors to be as independent as possible and providing social and recreational activities. She has not done any of them. She doesn't even go to meals. This isn't new behavior although before Covid- she did socialize some. It's her inability to function socially as an adult with other adults. She did this when we were kids as well- stay in the house, in her pajamas, for most of the day, socializing once in a while when accompanied by my father but most of the time, she avoided it. She can hold it together for brief interactions but not a long term relationship.

It's sad to see this. The AL she has been in is not a depressing situation. It's like a college dorm for seniors. When I visit- there are people sitting on the porch, socializing together. On the wall are posters listing the days activities. I stop and talk to the residents on the porch and they ask if we are going to any of them but no, my mother won't do that.

She also has a lot of medical needs and even in AL is in the ER frequently. So truly, the nursing home situation is more supportive for her. There are activities there too. I see residents who have the ability to socialize get together on the patio and they can go to meals in a dining room. She can do this if she wants to but it's the same thing- I don't think she's capable of having reciprocal relationships. So while she may prefer to not be in the skilled nursing situation- she's not going to take part in the social aspect and she's safer where she is.

Salty-Dawg- I am glad that my situation has helped you with your own family. I do agree that children need to be considered equally in these documents and this is probably why my mother's friend advised her to do this in hers. As to FOG- yes and the biggest one for me is Fear- we grew up terrified of my mother. She can be vengeful.

NW,

   I can see your perspective of the inheritance going to the Golden Child.  I am glad that the GC is in agreement.

   It sounds like you have a good head on your shoulders and your ideas are sound - I believe and feel that you are doing the right thing with your stated intentions.

   Hugs :hug: and good luck.

SD

One of the biggest challenges in your situation is some people, mainly your mother, are going to be extremely critical of what you do, no matter if it is in your mother's best interests and done with a lot of time, efforts on your part in figuring out what is best for your mother. At some point, we have to mitigate living in fear of how people like our disordered family members are going to react and take revenge on us for not getting their way. It does not mean we can totally let our guard down. You have a lot of people who respect you and understand how you are doing what is in your mother's best interests and despite how badly your mother treats you, are still helping her. Can you tell us who are the people who do support you and are there to help you? There are probably a lot more people than you think and realizing who those people are and focusing on them and reaching out to them in the difficult moments may make this easier to bear. Sometimes I wonder if you feel you are all alone and nobody quite gets it, and you are right about this to a certain point. We are unique and nobody will every fully get us, though there are always people who get important parts of us, and those are the people who become our allies and sometimes our closest friends, though no individual will ever be fully understood by anybody. The aloneness is compounded by being a family scapegoat, especially one of a BPD mother, always being told that our point of view is wrong and living in fear of the pain of their revenge. You are a caring person and no doubt well liked by your mother's caregivers who probably wish they could tell you they get the situation you are in, and don't say much because they feel uncomfortable doing so. Do let your mother's caregivers do as much of the work of taking care of your mother as you can, and ask for their advice. They will help you as they see these situations regularly. I hope at some point, you will feel a little bit lighter and taking care of your mother will be less of a burden for you because you feel the support and respect of so many people, including the members on this site.

NW, how soon do you have to have the conversation with your mother about staying in the SNF indefinitely?

Is the conversation itself -- and your mother's resulting reaction -- causing you the most angst right now?

NW, thanks for explaining the inheritance. It makes sense.

I had a thought… have you talked to the AL Director? In my recent circumstance, my mothers AL Director wanted to move my mom to a Skilled Nursing Facility because of the location of and severity of her pressure ulcer. I had to arrange additional care and they ultimately agreed because they knew she was dying and it was her wish to die there (what she considered home). I am just wondering at what point they force the issue and it isn’t your decision, even though you support and want the same thing?

My mother's case manager has advised me to not involve the AL. This is a high cost, nice place in a metro area and they have access to health care providers. Even though state regulations don't allow a grade 3 pressure sore, they bypass this with bringing in their own specialists so they will recruit her back.

GaGirl, the confrontation with my mother will be a miserable situation. She's determined to not stay there and is manipulative. She has paid people to do almost anything for her (off he record). She also talks a good game in the short run ( in the long run she unravels) and has a way of sweet talking people. She's wiley and devious. I am not speaking to her until the ducks are in row as I don't want to tip her off. My fear isn't confronting her, it's that she could find some way to get herself out of this, even with bedsores.

People ask well why not let her just go and face the consequences. I have considered that. Her funds would cover a lower cost place if she could not afford this one. It would be better for her to stay where she is so I at least want to give this one a chance.

What does your mother having her ducks in a row mean to you?

That is me having the ducks in a row- that means all the plans need to be in place, because she will argue with me or anyone else over details. I and her other family members have had discusssions with her but discussions don't work, reasoning with her doesn't work.

You may never be able to explain to your mother what the plans are. You are right that she will argue with you about everything. This is why I gave up talking to my NPD sister and a lot of my disordered family members, as I always had to be made wrong because I am one of the family scapegoats. It feels so uncomfortable not to be able to explain because if it were us, we would want to know what is going on so we could accept the situation and cooperate with the people who are trying to help us. You and your mother are two completely different people.

Perhaps treat your plans (ducks in a row) like classified data.  Only tell her and/or your sibling what they really need to know - and this can be different for each, and keep the rest to yourself and her health care team.

Classified data would have been nice but someone at the facility told her what the recommendation and the plans were.

She then, mounted her campaign to go against them. She's very good at enlisting rescuers and manipulating them. She appealed to the PT and OT therapists (probably as a victim of her terrible daughter- I know this woman and how she works) and they rallied for her at the care plan meeting. It is now documented that she is legally competent and will be the one to make the decision.

Or as the social worker told me when my father was ill and left BPD mother in charge of his decisions (and this is so deja vu of when I was attempting to act in his best interest then) "your father is legally comepetent to make his own bad decisions".

Next step is to leave this between the skilled nursing facility and the AL. Case manager has presented her medical situation to the AL. Now it is up to them to decide if they can handle it. Once they meet with her, she will likely persuade them too.

Once I heard this, I felt relieved actually, (albeit aggravated at her behavior but that's how she opperates so it's not new to me) - relieved that I am not the one to go against her wishes because I know how she reacts to not getting her way and it's horrible. That said- if it was my role to do it in her best interest- I would have done it.

The issue of her reckless spending has been brought up and is documented. I can't do anything about that either. I realize that it may cause her other issues later but it's up to her. I raised the question of other people exploiting her and there's been a report to adult protective services. If they ask, I would be happy to provide her bank info to them and they can see for themselves what is going on. I don't put it past her to accuse me either but they would find nothing if they looked to support that and with the statement that she makes own decisions, no reason for me to intervene.

Whatever happens, people know I have tried all I could as this has been going on for a while now. Most important is that her family has seen this and knows, so they won't think I have been neglectful. They have tried too and she's undermined them several times. The social worker and case manager know I have tried as well and that she is considered in charge of her own decisions.

What will I do? I haven't talked to her in a while. She has not called me. I am actually happy with the distance. I don't want to talk to her at the moment. I plan to back off as much as possible and not engage with her unless necessary. I have been more involved due to her condition and it's been disruptive.

One of her relatives commented to me that "this is how it happens- she always wins- when it comes to any conflict. She finds some way to get her way". This is true because she's very skilled at this and her goal is to do this. It's not possible to have a collaborative relationship with her.

This also has given me perspective on what happened when I tried to intervene on behalf of my father. But she was out to "win" and she did. Same pattern here. For now, it's between the AL and the skilled nursing and her and I will stay out of this. She can sign her own forms with them.

I am actually feeling more calm now :)

I am sorry that happened NW.  Sadly, this world is full of people who think they know more than they do.

Information is power.

My question is:  why did the PT or the OT or whomever it was think they had the authority to share this in with her, over the family or admin?

I would even question whether it was necessary and appropriate for them to have this information in the first place.

If the docs and family and social worker and admin are all on the same page, why did the PT/OT interfere?  Is that outside of their professional scope?  Especially since it could lead to real financial or medical harm to the patient?

In your place, I would ask hard questions, but that’s just me.

You could request that their actions be reviewed, so this doesn’t happen again to some other poor family.

I don't know who presented the plan. She is allowed to be present at care meetings, and she was at one of the recent ones. Since she has been working with PT and OT- she has spent more time with them. She has met their "goals" for her- which are to be able to walk with a walker to the bathroom and down the hall. She still needs assistance but that isn't their domain. Since she meets their goals, they are allowed to "discharge her" from PT, OT and they have done that. They may have made the request for evaluation. She can pass a mental status exam. She's certainly capable of scheming and manipulation. Technically she is free to do what she wants if the AL will accept her.

That's the hitch. The case worker has made it clear to them what her needs are. They have to determine if they can meet her needs or not. BPD mother can certainly push them with this decision. Ultimately- they are on the line if they accept her back and the recommendations that she needs skilled nursing care are there. So now it's in their hands. This is actually better for me. I am now not involved in this decision. I plan to make it known that I am not going to be a part of it, not going to sign for anything. This is now between my mother's wish to go to her AL and the AL to debate.

If your mother is able to go back to AL, it will probably start another cycle -- fall, hospitalization, skilled nursing, etc.

For the time being, the pressure is off you to make any decisions or take any action. So take a breath.

You are seeing patterns that help you understand what is going on with your mother. As this cycle continues, she will eventually lack the physical and mental resources to continue forcing her will on her care situation. But that may not happen for a while.

Lots of respect for your decisions at this time. Since there is nothing you can do about how your mother gets her way, it gives you the freedom to follow through on your decision to not be involved for now. I am sure there are lots of people who take care of your mother who see what is happening and they cannot override her decisions. My mother was making some terrible financial decisions several years ago and her lawyer explained to me there was nothing I could do, as she was still capable of making her own decisions (though obviously impaired and mentally declining in dealing with reality from my experiences with her).It seems with people with BPD, control is the last thing they have, and they will hang onto it until the end.

Wendy, I'm so sorry to read that you have all this to deal with. I understand the challenges, as I know how impossible my mother can be.

Thanks, I realize this is a game to her, with empathy as the hook. I fell into it as she had been ill recently. As sick as she was, her health care providers were calling me for consent as they didn't think she was capable of that but now she has recovered enough to do that.

Part of my efforts are also for her family. They are supportive of me but they are recently more "new" to her behaviors and they still wanted to try to be helpful to her. She's sabotaged their efforts a few times but they still wanted to try. The hope was that she could stay in the higher cost facility while she still had the funds for it. I think they also have seen the futility of any attempts to intervene on her behalf.

At this point, it is now up to the AL to decide if they can meet her needs or not. The case manager has made the proposal to them that her needs exceed what they can provide for her. Whether or not they are able to meet them is now between them and my mother. It's actually felt a lot more peaceful to not be involved in this decision with her. There will be some care plan meetings and I plan to say as little as possible- and make it clear that she decides, she signs whatever papers need to be signed, I will not.

Now that the Assisted Living knows what kind of resident your mother is, do you think they will take her back? Is the money the Assisted Living would make from your mother having round the clock individual paid care an incentive for the Assisted Living to take her back? Does the Assisted Living have nursing care and would the Assisted Living be at risk of being sued with a resident who qualifies for a nursing home? All things to perhaps think about or not think about. It is really out of your control and you have accepted that. You have done everything possible to protect your mother and you are protecting yourself by having your mother be the one to sign all the documents without your signature. Your mother may run out of money and if so, Medicaid would pay for her care in a much less desirable facility with a shared room, which you have done everything possible to prevent from happening. Once again, so much respect for how you are handling your difficult mother, and not taking what she does personally.

The AL doesn't provide the extra full time aides so they don't benefit from that. I would think the staff doesn't mind as it's less stress for them to have them there.

BPD mother's point of view is - she wants to do what she wants. This means, she spends her savings down to zero. This is what she wants and she doesn't care about anything else.

What is interesting is the sudden change from the nursing home social worker encouraging me to use my POA to have her stay there because it is the best situation for her to the position of her being legally competend to make her own decisions.

We had a care meeting by phone. BPD mother was there as well. That was my cue to stay quiet except for a few neutral  questions such as how are the bedsores? They had two social workers there- I think they anticipated a family disagreement over the issue.I  figured they might push for my mother's position. I planned to just let things go as they would.

The OT/PT representative sounded young and has only heard what BPD mother tells her. Then BPD mother starts with the "my family is making me stay here, they just want to dump me in a nursing home. If I can't go back to the AL, where will I go, what will I do, do I have to stay in half a room forever? My family is just dumping me here" ( at the best nusing facility in the area)

The AL will likely accept her. The wounds are healing up well. They are not likely to be grade 3 when the AL assists her. What a useless endeavor on my part but I really believed she was at the point where I needed to step in.

On my last call/zoom, one of the nurses at the home said, "I never see anyone come see her." I felt like a putz. Yet >2 years of covid lockdowns??? You know my story of getting grief from multiple sectors even before she ended up under county conservatorship before covid. People will think what they think no matter what you do.

Yes, Turkish- I think this happens- when we just can't manage a relationship with them after trying many times to. You even tried having your mother in your home for a while.

I got agitated at her during a phone call a while back. People in her room heard that. I got the feeling she had set that up after that.

Her medical needs are high. What we have noticed is that her health and well being improve when she's in this center. The food is good and she likes it. They also have her drinking protein drinks and going to PT. When she is in the AL- she does worse- not due to the fault of the AL but with her own actions-choosing cookies for meals, not going to any activities.

I think it's important to let people be self directed - and yes, it's much nicer to be in her own room at AL, but she can't manage herself there. She can meet the criteria for AL physically, but emotionally she's high need and yet, she holds it together when they assess her so they don't see it.  The choice of the nursing home facility was not based on any "dumping" but on her needs and the results we see when she's there. The shared room isn't as nice but the rest of it is good. She can have her snacks there too if she wants.

Well, if she wants to pull the "family is dumping"--- accuse her family - who have tried to help her in many ways and she has sabotaged it- that's her choice.

There was an elderly woman in our community who we would visit. She was in her own home with assistance- she had saved for that. She has daughters who live out of state. We didn't ever see the daughters. Maybe people questioned that but I didn't. I know how pwBPD can be very pleasant with aquaintances and be different with their own family. I don't know if she had BPD or not. I couldn't tell and it didn't matter. As a visitor- all was fine, but I also know it may not be that way with everyone. I see how people can jump to the conclusion that the family is neglectful, but there's no way to know the dynamics in a family.

NW, I am sorry that you had to expend so much emotional energy and didn’t get the outcome that is likely best for your mother. You did everything and have to be content with that. My mom’s hospice nurse told me “ you have done everything possible for your sister, the rest is in her hands, and you have to let her be her, there is nothing more you can do.”

It may come down to radical acceptance. I am learning with help from all of you, that it is OK to embrace the sadness that comes with accepting the reality of my situation. My sister will never accept responsibility, she will always resent me and project anger on me, and she will never appreciate all I did to care for mom. She won’t recognize the lengths I went to, to support her and her relationship with my mom. It is what it is. I have no regrets, other than how long it took me to put truly effective boundaries in place.  It really doesn’t matter what anyone else think Turkish, as we all know in our hearts how hard we try. We know that part of our own learning journey is to have boundaries and stop putting in 200% with hope for a different reality. Acceptance of our reality is so hard, but also incredibly freeing.

NotWendy, please take this as an opportunity to distance yourself, let go and focus on yourself and your needs. You deserve self care too!

It wasn't a useless endeavor on your part. You stepped in because you thought you needed to. It sounds like it was necessary and in your mother's best interests. It seems you have made the decision to not step in again as your mother won't accept your help, unless she is deemed completely incapable of making her own decisions by the medical staff. So sad that the medical staff is now taking her side, though I don't think all of them are fooled by her, likely doing what is legal.

Thanks all-
I feel relieved, got a good night's sleep for the first time in a few weeks. I think it's because I do feel I have done all I can do for her own well being and she's determined her course. Her family knows that too.

I don't think the medical team at the nursing home bought into her act- other than the young PT who she could influence. I got the sense that social workers were playing to her narcisism- on purpose. They told her they would "treat her like a special guest" . She's all over that "they told me they had my back" but I don't believe they bought into it. Her case manager doesn't. I think it's clear that this place meets her needs the best but if she doesn't want to be there, it will be a misrable situation. The staff is aware of her behavior as she does it with them too. I am actually surprised that they accepted her another time after her last visit there.

She thinks she's outsmarted me but she's actually naive to what she's doing to herself. She has no clue about how long term care vs assisted living works. It wasn't that anyone had a preference for her staying there. One can not just put someone into a nursing home. She qualified and it met her needs better than the AL could. She also has no clue how private pay or Medicaid works. Without her savings, she reduces her chances of getting a choice of being there if she were to need it for ling term care, and that is known for being a good facility.

But whether or not that happens, it's completely out of my hands. I don't need to try to step in or explain it to her. That doesn't work anyway.

You are so wise to just let the medical staff be involved in helping your mother decide where she is going to go, be it Assisted Living or staying where she is. You have done all you can do. Glad you are feeling better and getting some rest.

NW,

   It sounds like you went above and beyond, and have done everything you possibly could have done. 

   I know it is bitter-sweet - at least you might be able to have a clear conscience know this.

   I'm sure this all has been very stressful for you, please be sure to do some much needed self-care this weekend.

   Take care with self-care.

SD

I'll forever admire my mom's APS social worker. I gleaned how tough it is to deal with crotchety older folks (I hope I'm not one later!). At least professionals are protected which is why I felt less badly turning it over to her. She didn't give my any grief whatsoever about how I was dealing with it. If she thought less of me, she hid it well.

I'd be willing to bet that the APS worker has seen all kinds of situations and doesn't question. It's people who don't know these situations who do.

I think the staff at the facility are aware of my mother's behaviors. She engages in them with whoever is helping her. I think they were placating her to avoid a possible scene. I noticed there were two social workers at the meeting- the one working with my mother and the supervisor- not to supervise the main social worker- I think they were on guard for a possible escalation.

They know my mother better than they know me, and perhaps they were anticipating a family argument. My mother may have said her family was "dumping" her as possible argument bait with me- but I didn't respond. There was no escalating on my part. Mostly I listened to what the medical team had to say.

What will self care be like? One is distance. Speaking to her less and looking at ways to dimimish contact with her, not NC but less. The staff at her assisted living ( where she will likely return to) will call me if there's something I need to know.

This is what I've been learning here too.

I have to radically accept that disordered people make decisions that are theirs to make, and the consequences are theirs as well.

I may be impacted by these decisions and consequences but I also have choices.

Lately I have been doing this visualization with my parents where I imagine they have something happening in their nervous system that they would like me to take from them and manage. Often it is quite busy and unpleasant and there isn't much I can do with it so I wordlessly decline.

Because so much of this is not conscious for them, they do not usually understand, even if they do seem to notice that a pattern has changed. Since it was a wordless exchange (I'll pass on this offer), there is not really a target for their distress and it so it dissipates around me instead of leveling me.

I have just learned that there are different kinds of POAs. I always thought there was just one kind. Some institutions like financial ones like Vanguard require that there specific form be filled out for a POA to be honored. I realize that this may not be of much help to Notwendy and may be helpful to others who are in the process of getting a POA for an elderly parent. I was shocked that Notwendy's POA was not honored.

I didn't know these things either. Several institutions want their own POA. The IRS and Social Security do. I can not sign a refund check from the IRS with a POA and put it in her account.  Other checks, I can deposit for her. I cannot access her social security for any information. Some credit cards limit what I can do for her.

This has been a learning process but a good one. I have also learned all about assisted living, skilled nursing, what Medicare covers and how Medicaid works.

Care for the elderly is very costly in the US. Medicaid can help when someone qualifies if necessary. I am grateful that my father planned so well for these needs, even if my mother has no been careful. It's been a big help.

My wife, who is a CPA, and shared with me years ago that checks can be deposited without a signature.  Write 'deposit only' where the signature goes along with your mother's account number.  Check with your mother's bank on their policy on this.  It should not be an issue as long as the payee of the check matches the account holder's name (your mom).

I am also dealing with a disordered elderly relative, my aunt, who lives in New York City, and I live in South Florida.  I’ve had a POA and healthcare proxy for her since 2009 (and so does my brother), which was set up when I asked her if she wanted the state to manage things for her in the event she needed assistance.  She didn’t so she jumped at the opportunity to have pliable me to do her bidding.  And naive me did NOT realize how she really was… ah well.  We have no other family where she is, and she has alienated my mom (her sister) and my sister.  My brother does help by giving some money and sometimes takes things out of her apartment.  But he won’t call anyone, ask questions or help in real ways.  He calls me “the man in the chair”, whatever that means… I’m a “girl”.  An old one, but still.  And he came here when I had emergency surgery.

As far as exercising the POA goes, several institutions do want their own POAs to go along with a copy of the executed one you already have, since they know you cannot give each of them your original (it seems).  My understanding however is that different states do have laws indicating that your POA must be accepted.  I guess how hard you push against the financial institution depends on the fight you have in you considering your number of daily battles.

As far as depositing checks, that can easily be done without the payee’s signature.  One of my aunt’s home health aides deposits an annual RMD check into a Chase account simply by writing “For Deposit and my aunt’s account number”.

Regarding IRS refunds, I received a huge IRS check refund ($45K) for one of my friends who was out of the country.  I deposited it to her Wells Fargo account with no issue. 

The other thing about IRS refunds is if you establish a relationship with the professionals doing her tax returns via your POA, get them the documents for filing the taxes and include the routing number and account number for refunds, the refunds will be direct deposited very quickly.  No fuss.

Social security is another issue, unless your mother designates you as a payee on her behalf.  Something different happens once you convert to Medicaid, I’ll know more about this soon because I’m about to enter this nightmare territory for my aunt.

Although this may not help anyone else, my aunt loves when I do her bidding, always has, so if I need to get her on the phone with me to get “permission” from some company, she’ll do it.  That has made getting things done much easier.

I too, hope that someday I can drop this ball I cannot drop…. I want to call Adult Protective Services on me!

I hope anything I said is helpful in some way.

Warmly,
Gems

Yes, let us know how the Medicaid works. From what I read, I think with Medicaid, the Social Security goes directly to the nursing home. Depending on the state, the person is allowed a small allowance - something like $30/month for their personal expenses. If they have family who wants to help send snacks or clothing, or personal items, they can do that -but a disordered person will still do what they choose with them so you and your brother can decide how much you want to be involved in this.

I have a friend whose disordered father is in a nursing home on Medicaid. She brings him snacks but he gives them away. For her it comes down to her own values, boundaries and her budget. Her dad gets X amount of snacks a month and whatever he does with them is his choice. Still she knows she is providing snacks for him, regardless of what the does with them.

Yes, you have also keyed into the dynamics of "doing someone's bidding". To me, designating someone as POA involves trust that they have your best interest in mind. For my mother, I think she sees it as me being able to "do things for her". I think she designated me because she had confidence in me but also there's her need to be in control and her being critical of people who assist her.

That is how Medicaid (Medi-Cal) worked for my mom. She had a little spending allowance, the nursing home took the rest and Medi-Cal made up the difference (like $6k/mo).

From what I know right now about how Medicaid works in NY is this:

There is a spend down requirement, which means a person can have “liquid assets” limited to $30K.  This does NOT include a home.  It also excludes any retirement funds, although you lose access to those retirement funds until the person passes away.  Then they will square up with you, and if any excess funds remain in the retirement funds above what Medicaid has spent, the heirs will receive those funds.  The $30K in liquid assets can be replenished through “gifts” from family members, if they are so inclined.  You do NOT want to transfer any funds out of your mom’s (or whoever’s) accounts in preparation for Medicaid application, unless the money is spent on purchasing a funeral trust.  OR if you’re actually paying for home health care.  But don’t transfer to get the liquid assets down to the $30K.  I’m not sure who holds that $30K if “mom” is in a nursing home, but if you’re not managing the account, you’re entitled to a quarterly accounting of monies withdrawn.

In NY, there is a 5-year lookback for nursing home care.
I believe there is a 30-month look back for in-home Care (I think this is called MLTC).  This may change in April of 2024, I believe.

In NY, the monthly amount of spending money from SSI is $50.00.

Here’s the scary part, at least for me at the moment.  If my aunt is untruthful about the extent of her needs, and says during the assessment that she needs less help with her ADLs (activities of daily living) than she really needs, she will be DENIED nursing home care.  And my aunt wants nothing more than to return to her apartment.  But she may be granted some version of MLTC in home Medicaid HHA Care.  If THAT is the case, *I* have to report EVERY PENNY I spend on her Care monthly to Medicaid before I am reimbursed.  We’re talking food, depends, toilet paper, paper towels, toilet wipes, gloves, blah blah blah.  This doesn’t include her monthly bills, for which something called an “Pooled income Trust” is established.  And that’s when I’ll need to turn her Care over to the state for guardianship.  I’m often on the ledge as it is with her demands.  Her paperwork has taken over my world.

So my advice is to look at your state and research the basics of what is required.  Just understand a bit before you leap.

I’m frightened Auntie Em!  (To quote Dorothy from the Wizard of Oz)

Sorry this is so long.  Maybe someone needs this info?

Warmly,
Gems

Gems,

All info is good info. Anyone should check anything any of us say here though. Links are helpful. This would be a good Workshop.

• Medicaid Trusts
• Asset limits, etc...

I agree, Gems, the information is helpful. I would also add to Turkish's advice that since the "rules" vary from state to state- it's always good to look at the individual situation but knowing there are rules and to look for them is good advice.

What I learned is that there are two main situations where someone qualifies for Medicaid assistance. If someone has no assets, they will likely qualify. The other situation is the person who does have assets but spends them in Medicaid qualified expenses. Medicaid is for people who need it and Medicaid will look back 5 years to be sure of that. One can not give away assets and then claim need.

If someone has assets, then consulting an elder law attorney is a good idea in order to be proactive if they were to have a need to apply for Medicaid. Here is where options such as Medicaid trusts and "spend down plans" are helpful. I consulted an attorney for such information to see if it would be helpful for my mother. What I learned is that to be effective, it needs to be a relationship between the attorney and the elderly person who is motivated to work with them. This seems to parallel the idea of therapy too. If I think my mother needs therapy, and I speak to a therapist, I can learn about therapy, but for her to get help- she needs to be the one to work with the therapist. I can get the information from the attorney but with my mother being "legally competent"- she needs to be the one who is willing to work with the plan.

Like Gem's situation- the person has to cooperate with the regulations. If they don't, they could potentially interfere with the process of getting Medicaid assistance if they were to need it. When a disordered person isn't motivated to cooperate, it's a challenge.