BPDFamily.com

BPD mother has a problem with circulation in her legs. She doesn't cooperate with how to treat this, and eventually gets an infection. She then ends up in hospital for IV antibiotics and on to skilled nursing/rehab for treatment. When she returns to her assisted living, she then doesn't comply with the medical care. She's changed home health care teams over twice now, saying "she doesn't like them" or "they do nothing for her".

The way this goes is- some provider does or doesn't do something and she gets angry at them. They either refer her to someone else due to her behavior or she decides she doesn't want them and requests it. She decides on a new provider and at first, this one is painted white but eventually she gets disgruntled at something.

She has an infection now and this time, she is refusing to go to the hospital. So, the team has referred her to palliative care/hospice for care.

I agree with the suggestion to meet with them for information, because, if she refuses the medical care and doesn't cooperate- then the palliative care services provide emotional support and more comfort care and it seems these services might be helpful to her.

Then there's her family who has been supportive in general. Since I am the one the medical providers have consent to speak to - I relay the information to them. They are of the mindset to "do everything" and so when I tell them I agree with the suggestion that BPD mother speaks to the palliative care nurse to see what services they offer- they seem to resist that.

I have told them that this is her decision to make. I feel a sense of being judged by them for not insisting she go to the hospital, and also think it is likely they will intervene and get her there.

There's a wave of emotions when getting a call about BPD mother either going to the hospital or being referred to hospice. While hospice services have expanded - there is still the emotional shift from possible outcomes and with her changing her mind it's unsettling.

I don't think there's anything I can do or even should be doing in this situation. This is entirely up to her and I also want the decision to be up to her. I have suggested to her to at least just hear what they have to say so she understands her choices. I also feel a futility to discussing any plans with her since she has a history of changing them. So this post is mostly a vent and I know you all "get" it here.

Hey Wendy.  Quick story; I lost my dad a few years ago.  He wasn't BPD or anything, although some dementia was setting in.  He had a rare blood disorder where his body couldn't fight off infection, and about every two weeks he'd turn sepsis.  Sky high fevers, horrible body pain, and his body would begin shutting down.  So off to the ER, where he'd get liquid IV antibiotics and he'd fully recover physically in 24-48 hours.  Only each time, each two week loop, he'd go insane in the hospital and hallucinate, forget who he was, etc.

It was absolutely horrible and we did this for almost two years.  Every 10-14 days, back to the ER to renew the cycle.

Eventually we got him on a long-term antibiotic...which truthfully there's no such thing.  The body adjusts and it become ineffective.  But it would buy him an extra week or two without a rush to the ER.  It was a blessing, but my dad was so tired and hated the meds, hated how he felt. 

So one day when he was fully there mentally, I asked him what he wanted.  He thought about it for a moment and said, "What if I stopped taking all the medications?"  I nodded and explained what that would mean, what would happen.  He said, "Well, maybe not...I'd like to try it anyway."  I respected his wishes and he went home 12 days later.

Many criticized me- my dad could possibly still be alive today.  Others praised me for having the courage to take the hardest possible path and respecting his wishes.

The truth is that we'll all eventually be where my dad was, where your mom is now.  All I hope is that once I reach that stage of life, my kids will love and respect me enough to let me make my own choices. 

Wendy, you may be in control here and have a say in what happens, and I understand that your mom has BPD.  I would encourage you to do what I did though and allow your mom's voice to be heard, even if it's not what you agree with.  If you don't, the end will be so much harder for a number of reasons.

This is ultimately not on you and it's not your burden to carry.  If something is life-threatening over something she doesn't understand, then sure...step in.  But otherwise it might be a good idea to let her live out her final wishes on her terms. 

That's just my opinion and maybe I'm wrong.  I would do the exact same thing over again with my father though, because I honored him above all else.

Notwendy,
It sounds like your mother will perhaps listen to her family and will not listen to anything you have to say. My mother with BPD did the sort of things your mother is doing to you regarding having me involved in her medical care. It was like my mother was terrorized with fear that she was being abandoned by me if she were to recognize that I was a separate person from her so that meant her getting angry with me for being involved in any way with her medical care. It took her doctor putting her in a two week facility with staff constantly reminding her to elevate her leg so she would not face the possibility of having her leg being amputated, which she could have done at home if she were willing to do so.
My heart goes out to you. 

Pook, at this point she is self determined and in control. I am staying out of the decison and she is meeting with the providers and calsl the shots. It's her choice.

On my part, I don't decide for her - she does have her voice. What is difficult for me is that she changes her mind. There was one day I got a call from Hospice in the morning. It was a shock- and I spent the whole day with emotions about that change. Then, I got a call from her doctor that evening- she had changed her mind and was doing better.

She has made the decisions this entire time. I can't make them for her. I have POA but only if she's in a situation where she can't decide for herself. That has happened temporarily but not at the moment and for something as big as this- she needs to be the one to decide.

I am glad your father could voice his wishes clearly and that you went with them. That is what I have been doing for BPD mother. There was a moment where she could not decide about nursing home and they asked me to decide. She was bedridden with bedsores. That decision was obvious. But she refused it and went back to assisted living-and this is what she wanted. Fortunately the bedsores healed but this other issue got worse.

Even if I did try to decide- she'd refuse it. She does what she wants, regardless. There is no chance of my intervening whether I could or not do it and there is no way I would want to attempt it unless I had to.

So my main vent is the emotions that follow the changing decisions. I try to not react emotionally but it is my mother. This is reminiscent of when my father got ill at the later part of his life. BPD mother was in control then too. It's difficult to lose a parent, even without that parent having BPD- you know that too. I agree - it's important to honor a parent's wishes but with a moving goal post- how to do that is confusing.

She's done that a few times already. Then she goes back to assisted living and refuses to cooperate. If they put stockings or wraps on her she cuts them off- with scissors. Then complains nobody is doing anything to help her.

Okay, stop right there.  She's in control, meaning that this is not your problem.  I'm sure it feels like your problem, which every single person here with a BPD relationship can attest to.  But it's just not on you and you have to let her do her own thing.  Not for her...but for you.

Step in if you need to.  Otherwise, let her drive the bus and dictate wherever it stops.

I am doing that- it's in her hands...

It's still emotional. We don't have a good relationship but the idea of my mother in Hospice is an emotional adjustment. Then if she changes her mind, that's another one. I still have feelings about it.

I'm not asking what to do about her decision. It's a vent. The feelings.

I think it's hard to explain. It was entirely different with my in laws. They don't have BPD. It was difficult and it was sad, but there wasn't so much chaos. MIL died a natural death at old age. His father was ill with several medical issues. They also arrived at the decision for Hospice care. My H was able to be with him, calmly. It was difficult but without BPD chaos.

Dad's passing was traumatic, with BPD mother raging, changing decisions, changing doctors, painting home health care workers black and dismissing them. Dad angry and frustrated at the situation. Me being left out of the information loop if BPD mother was angry at me.

I have been hands off with my BPD mother but she also has only her children as next of kin. For me to be not involved would be a form of abandonment. I can not be involved in her decisions but to not have feelings about the situation would be tough. So I don't plan any action. Just venting her to share the feelings.

Gotcha.  I'm so sorry you're stuck...it sounds endlessly frustrating.

I am very sorry, Notwendy.  I'm sorry about the extra added stress caused by the other side of the family.

Am hoping she'll change her mind and will take the antibiotics. But it's definitely her choice not to.

My dBPD mom seems to like to cut off her nose to spite her face. With the hospitalization before this last one she continued to pull out her feeding tube leading her doctors to tell us she'd be sent to a hospice if this continued. She stopped and and recovered.

She asked me in a roundabout way after her last hospitalization to hasten the inevitable.  I ignored her. It was a horrible thing to ask me to do - like the cherry on top of her abusive treatment of me. Definitely didn't want to live with this for her convenience. It was completely selfish to ask me. Continued entitled behavior.

Please continue to vent. We certainly do know how it is.

Thinking good thoughts for you.  :hug:

Even when she was healthy, she has been emotionally miserable for as long as I can recall. There were moments of contentness but it didn't last long. It's not depression. It's her BPD that seems to interpret anyone close to her as somehow hurting her or neglecting her.

It's as if she had no skin, and every nerve is exposed. She coped with self medicating- alcohol and prescription medicines- tranquilizers, pain medicine, valium. Most of the time she was on one or more of these. It actually didn't help her when these drugs became regulated as she was able to get what she needed by seeing more than one doctor. Computers and regulations made this difficult but she found ways to get around it. I was upset when I saw that my father was enabling this. I get it now. She is so unhappy without them. It gave her some relief. But since she did this, she was so drugged up she was incoherent. We were afraid she'd fall in her house.

We put hopes into moving her to assisted living that maybe it would make things easier for her and if her medicine was dispensed by the nurses, she would be less drugged up. She knew a few people there already. They had a dining hall and activities. We hoped she'd be happy there but she wasn't. Without the option of over drugging herself, she found other ways to self soothe that were also self destructive. She also would seek out medical care for an issue, then be non compliant. She's had two rounds of hospital stays with several weeks in skilled nursing rehab. She was miserable there. When she returned to assisted living, she was non compliant and has gotten sick again.

So far, three nurses have told her to go to the hospital. She has refused. I asked again if she was competent to make this decision. I am told yes she is. She is considering Hospice but her nurse coordinator thinks she will change her mind when asked to sign the papers and then go to ER.

She says that people do not acknowlege her pain. We've been the witnesses to her emotional pain and yet so powerless to make a difference. It's like she can not see other people's attempts through the distorted BPD thinking. We are all the persecutors on the Karpan triangle. She wants others to try to rescue her but she also then hikacks it and we ultimately fail. But we keep trying.

I am staying out of this decision. It's entirely hers to make. On one hand, there's more hope for her if she goes to the hospital. With Hospice, they will focus on her comfort and there is a certain appeal to her being more comfortable but it also comes with a different outcome. My feelings are all over the place.

One way or another, your mother is going to make decisions about her care that she is going to be unhappy about and blame everyone around her for how unhappy she is.
What are you doing to take care of yourself at this terribly stressful time?

I still have work and also we have gone out of town a few times, so it's not all my attention.

But there are feelings and actually, I want to spend time processing. There are similarities to when my father got ill. I didn't understand BPD dynamics then. I do now and so I don't think I react to the behaviors as much which is a good thing. I feel empathy for her but still feel I need to be guarded.

I don't think I can detatch from this, and don't want to. It felt different when my father was sick, as I was so attached. Yet, it's not as if there are no feelings at all for her. She's a significant person, even if she didn't take on the role of "mother" in the typical sense. It's like when I look for a Mother's Day card and none of the sayings in the cards seem to fit. And the feelings around this situation don't seem to fit others either but I do want to process them.

Thank you for saying that. As a parent of an adult BPD son it feels like it's always my problem when I know in my head it isn't. Thank you so much for reminding me.

As the saying goes, you can lead a horse to water, but you can't make it drink.

What you are describing is crazy making material.  Sadly, it's not surprising at all.

Absolutely.  The fact that her side of the family disagrees with this is unfortunate, but it's your mom's choice.  And you are supporting her.  Since the medical staff say she has full competence to make these decisions, your hands are tied.

If she changes her mind and flips back and forth between hospital and hospice, then all those involved in her medical care can continue to deal with it either in hospital or hospice.  Those people can't expect you to reason with her or solve this problem, because our BPD mom's just aren't fixable.  There is no way for us to guide them to make better decisions when the disease is in the way.

I understand what the recommendation to hospice means.  But this too is her decision.  If her family doesn't support it, then they can be the ones to have that conversation with her.  It doesn't make any sense for them to be displeased with you for supporting her.  That is between them and her, and good for you to step off that triangle.

I have a similar situation, but it doesn't involve hospice.  In my mom's case, she has made decisions which have predictably led to a loss of vision.  This loss could have been avoided if she had followed recommendations and accepted help to have her eye drops put in.  But she cancelled this home support.  Since she has Parkinson's, she can't get her drops in her eyes, but she tells everyone she does.  So now she is losing her vision.  It makes no sense to argue with mom.  We all know where that would lead.

Your situation is so much worse because it sounds life threatening if she refuses these antibiotics.  But the principle is the same.  

You are just supporting her.  We're all uncomfortable with the outcomes of our mothers poor decisions, but they have the right to make those decisions.  Sadly, we are left dealing with all the uncomfortable feelings around the outcomes that come with their bad decisions.


I think you are in an impossible situation.  I would respond to what is going on the same way you would, and totally support where you are coming from.  If her family disagrees with this, then they can take it up with her.  If she flip flops in her decision making between hospice and hospital, there is nothing you can do about that.  It's out of your control.  All you can do is look after yourself in all this.  I know you are trying to be kind to yourself, so please take especially good care of yourself through this.   :hug:

Supporting you all the way |iiii

Notwendy,
You are taking the needed precautions to protect yourself from the worst of PTSD flashbacks later on by doing everything to process what is going on with your mother right now while protecting yourself from becoming overwhelmed as much as you can.

Dad's passing was difficult.  BPD mother's behavior escalated- lots of raging. Dad was angry too- and so would also snap at me. I can see this is probably projections but it was also verbal and emotional abuse- and overwhelming. So yes, I am trying to avoid that kind of situation with BPD mother. Fortunately I have more understanding of BPD dynamics now.

BPD mother is doing the same thing with her caregivers and medical providers. I recently spoke to one of the nurses caring for her who said that BPD mother is telling people she's terrible and I reassured her that I don't believe it. BPD mother told me another nurse is crazy and that isn't true.

She says the staff at the assisted living isn't doing anything for her but they do attend to her needs. The staff doesn't like being verbally abused so they aren't overly attentive to her.

Methuen- BPD mother's family is being supportive but that hasn't always been the case. They have misjudged me in the past. Just as BPD mother is saying things about the nurses that aren't true, she has also said things to them about me. It's possible that my concerns about being misjudged by them now are unfounded but I am not sure. Our relationship is better now but for me, I think I will feel uncertain around anyone in my mother's circle.

Your mother is doing something similar by not taking the eye drops. She is seriously impacting her ability to be independent. This "in between state of being mentally ill while still being "legally competent" is hard to make sense of.

Notwendy, this is a horrible place to be. I haven’t been on the forum and am catching up. I think you are handling this situation in the best way possible. I am glad her family is coming around. I love your self awareness. Like you when my father died I didn’t understand BPD and therefore my sister’s behavior didn’t make sense. Even though our journey to understand this disorder better equips us, it does not really protect us from the complex emotions. I hope you can focus on naming and processing your emotions, so that you can work through them and put the focus on your own healing.

I suspect your mother’s cycle will continue to repeat itself. She will also probably change her mind, and ask to come off of hospice, or go back and forth. I hope this doesn’t sound harsh but your mother’s lack of compliance with medical advice is the main factor in her continuing medical decline and she is wasting a lot of resources. Being in palliative care allows for continued medical care (versus hospice that is limited) , but the focus is on emotional and physical support. I am hoping it helps her. I encourage you to take advantage of the social worker and emotional support that come with both palliative and hospice care, as I think they are uniquely positioned to understand and support you. They are focused on the family, not just the patient, and will validate and understand the challenges of your situation, respecting your mother’s decisions , while disagreeing with them and the resulting burden this puts on you emotionally.

Hugs and prayers. You will get through this.

Thank you Mommydoc- it's not harsh - it's the reality- and continuing to access acute care and then being non compliant is undoing the benefits of acute care. She's already cycled through this and this is the result.

I can see the benefits of palliative care for her, especially with management of emotional and physical discomfort. I think in some ways it meets her emotional needs better. However, I also understand the gravity of such a decision- it needs to be hers.

Thanks for letting me know that the services are to help support family too. With my father I was initually more involved with speaking to the medical providers but I also felt I needed to be honest with them about the situation at home with BPD mother so he could receive support. This angered both my parents and so I backed off. Then they got angry at me for that. On my part, there was so much fear.  It would have helped to have someone to talk to at the time.

My heart goes out to you NotWendy. You are doing your best and from all your posts and the supports you give to other people on this forum, it is clear what a compassionate, kind and generous person you are. Be kind to yourself.
My mother is uBPD, but diagnosed with bipolar and she now has vascular dementia. She lives alone in an isolated spot and does nothing at all to help herself. I am her only child and now at 44 am finally trying to release myself from a life timelime of FOG and emeshment. Mum also refuses medical treatment and any outside help, the only thing she wants is for me to give up my life and be at her disposal 24hours. I totally understand when you say you feel you are being judged. It is so hard for anyone unfamilar with BPD to understand the challenges we live with.

Be kind to yourself during this time. Sending solidarity xx

Lalisa, Am sorry you are in that situation. I hope you are able to find a way to secure outside help. This is totally unfair to you. You deserve your life back.

Do you need her permission if she has vascular dementia? Will she even be aware? (I believe it's brought on by a stroke.) She needs some hours of professional help. What about a care or nursing home? Dementia never improves. What's left of her cognitive abilities will degrade further.

24/7 care is what my dBPD demanded and I gave mistakenly gave. For her, it was a self-created crisis. (I left over three years ago.) It did her no good other than to whet her appetite for more outrageous demands and nasty abuse.  She's still alive and doing well for someone her age and health issues despite my absence as a caregiver.  Am thinking the same would be true for your mom.

Notwendy, my late ex-h had circulatory problems in his lower legs and a pd. He had cellulitis along with other serious health problems. He ignored all common sense to take care of it. He was non-compliant and skip appointments unless I went with him. I suspect he thought he was a superior human being who would cheat death through his strong self-will.

My mom is a bit more realistic (she would take the antibiotics if in the same situation), but has refused to go to the ER unless the pain is unbearable. She broke her shoulder and hip - she waited a few days for medical care. I know some type of magical thinking along with arrogance must be at play. My mother doesn't have suicidal ideation and hasn't attempted it, except for the last hospitalization which was long (2 weeks) and agonizing. She was forced into quarantine in her nursing home for 21 days where she was exposed to an antibiotic resistant bacteria in the hospital's ICU.

I wonder if your mother believes she will one-up a medical reality through being stubborn or make it go away by ignoring it? I don't know. Am hoping she does the prudent thing.

I am not sure what is driving my BPD mother's behavior. I think she does have an element of magical thinking. It's as if there's some kind of block with her to being proactive. Discussing her spending is an example. She seems oblivious to the fact that once it is gone, it's gone.

I think it comes down to her sense of entitlement and not wanting to have any discomfort. She expects that her medical providers will be able to fix anything for her. Her condition depends a lot on her cooperation but if the socks or bandages are tight and she doesn't like that, she just takes them off and expects others to take care of any issues that causes.

With over spending her money, I think it's entitlement. She wants what she wants. If there are any consequences later, that isn't her concern in the moment.

Both of these are self destructive behaviors but she doesn't seem to care.

Tell Hill- I don't know what led to your ex H's demise but this condition is miserable and in itself, not fatal but the consequences of not taking care of it are miserable. It's hard to understand why someone would no try to help prevent them.

At this time, BPD mother is staying with "palliative" which is different from hospice care. She didn't meet criteria for hospice care. At a recent doctor appointment, they requested I also listen in by phone. I think this is probably a safety measure for them so that they aren't at risk for her choice. So far she's been adament about wanting palliative care but this still involves treatment, just not hospital or IV treatment. So far, I think her legs have not gotten worse.

I also think they probably wonder about her mental capacity but when questioned, she is competent. She can clearly recall all her identifying information. She knows current events, time, place. When motivated, she acts as sharp as ever.

Hi Wendy,

The late ex-husband had a lot of health problems starting in his mid 40s. He had deep vein thrombosis (the first major problem) which pointed to heart problems. In the 15 years between that and his death,  he had high blood pressure, high cholesterol, pre-diabetes, and pneumonia. I noticed his swollen, red ankles. That led to a diagnosis of 2 leaky heart valves which his doctor thought caused the cellulitis. He was in his mid 50s which his doctor thought was young.

He never took care of himself. He would have died a lot sooner had I not pushed him and accompanied him to doctor visits. It wasn't a slow suicide but delusional thinking that he would die close to 100.  I am guessing he enjoyed the attention and enjoyed upsetting me. I can't tell you the harsh judgment I received from neighbors and new doctors about the state of my ex. I took many hours off from work to force him to go to his appointments. Doctors would eventually see for themselves that he was stubborn and had mental problems. They'd shift the harsh judgment to him.

He died of a heart attack at 60. We were divorced by then and he was living alone. He missed lunch with a friend and the friend had a wellness check done. An autopsy was done by the county.

Am glad for your mom's sake she's in palliative care and can live with the infection for now. I know how stressful (& lonely)  these issues are and the judgments from others -- the why can't you do this, why can't you do that -- don't help. You are doing the best you can.

P.S. I can't help but think there is bias against females with a sick immediate relative. My mother's behavioral problems are my fault... until my brother steps in and he's the gold medal winner for just showing up. The behavioral problems stick to mom alone at that point.

I think there is some element of delusion with my mother too but I can't quite figure it out. On some level, I think she wants to be completely helpless, dependent and without any responsibility. She wants her doctors to fix her but won't do her part in that.

She says that going to hospital for IV antibiotics "didn't work" but it did work, she just didn't do anything to manage what is a chronic situation. If someone had diabetes, taking insulin "won't work" if they think they can eat whatever they want to. They'd have to do their part in managing their diet and blood sugar too. I agree that going to the hospital isn't as helpful if she isn't going to do her part in helping.

She's now discovered another aspect of her decision. It's very painful. She's had two more doctor consultations, with the explanation that a bacterial infection is destroying her skin and tissues and that is causing the pain. If she wants relief of the pain, she needs to do something about it. They have arranged for her to take care of this as an outpatient in a wound care center. She balks at this because it's a hassel to get there and do this. Whatever anyone proposes to help- she finds some reason why she "can't do it". So I put it to her bluntly- she has two choices- to agree to do what her doctors suggest and have some hope of feeling better or to do nothing which would be very painful ( and horrible ) so I hope she makes the reasonable choice.

I do think there is a bias that daughters and wives are the caregivers. I think at this point, the medical providers who are helping my mother are also frustrated at her behavior and see that she's difficult to deal with. I am impressed at how her doctors are relating to her.

Hi NotWendy, sorry to hear about your mother’s skin infection. Even though the situation is chronic and treatable now, if she remains non compliant and is not cooperative with the treatment plan, it could progress to a much more serious acute infection and even become life threatening. The doctors may have already explained this to her and to you. Unless and until, she is deemed unable to make her own decisions, you are powerless. It seems like the more you try to influence her the more defiant she will become. 

I agree that our society, including many doctors, expects women to be the caregivers. It is great that her doctors are engaged and trying to relate and influence her, as many would get frustrated and give up. I hope the situation stabilizes and hope you are able to emotionally separate yourself from it.

I had an infected foot long ago and had to take very strong antibiotics to prevent the infection from spreading. The antibiotics made me feel weak and tired for a few weeks. Your mom may have experienced that or is afraid of antibiotic resistance? I know your mother remains firm in her decision. I thought it might help you to know there could be a reason besides BPD for her decision.

So true! I was in hospital during the holidays to get I/V antibiotics to resolve a resistant UTI. I came home quite anxious about future situations -- I am allergic to penicillin and so have more limited options.

I learned so much when my mom was in home hospice. I am the only surviving child, so between her long-time caregiver and my retiring to move to my hometown, the two of us dealt with what might come up. Mom had cellulitis, on and off, some minor skin problems, etc. We were able to bathe her more often than would happen in a facility -- that helped. I've never worked so hard keeping a room clean, plus laundering bedclothes, nightgowns, bed protective pads, you name it. Honestly, I think the near-OCD cleaning made a huge difference.

I know of no male in my family except one cousin (a social worker) who cared for a parent in home. But the assumption "out there) is that a daughter will do it.

My mom had a few BPD traits but she definitely was not fully BPD. I at least heard her express appreciation so many times. Her friends were appreciative. It would have been horribly difficult to have to stand back and follow the lead on bad decisions.

She won't take them because she says she gets diarrhea ( not C diff, just says loose stools) but even with this complaint, the nurses have checked her stools and they are not loose.

So she refuses them on the basis of her imaginary diarrhea while in the meantime letting her foot get gangrene.

She woke up this morning in very bad pain unable to get out of bed and then refused to take the oral antibiotics her doctor ordered. She had two doctors spend an hour each with her last week, "respecting her wishes" and coming up with a plan to treat the infection as a component of relieving her pain. Now, she's refusing that. I called it. I called 911. She's refused all possible options offered to her and now she's in miserable pain. Yes, she may get sepsis, but in the meantime, her foot is rotting off - she's not eligible for hospice. She is non compliant with the outpatient managment plan.

Everyone would be willing to respect her wishes but her wishes are to lie in her bed and do nothing and have no discomfort. That isn't an option. To reduce her pain she needs to do something. She's also insisting on being in assisted living and the staff isn't going to tolerate her lying in bed with an infected leg and do nothing. I spoke to the nurse there this morning. He agreed with the plan to get her to hospital. She's emotionally stressed her nurses and her family members.

NotWendy, this sounds as if she is losing the ability to be rational about her own care. It's difficult to figure out when to intercede. I had one doctor ask my mom about her Do Not Resuscitate order, and he still looked at me to be the person validating that she knew what she was doing.

The possibility of septicemia is is alarming. My husband's mother became septic in hospital during treatment for leukemia, and it caused her death.

Are you getting assistance from her medical team in helping you to determine when and how completely to step in?

I am wondering now about how to make her a ward of the state and if that is an option. She's become impossible to deal with. I have not gotten support from her medical team as until now, she's been considered legally competent but she isn't compliant with anyone. I wish there was some kind of psychiatric placement for her. But I am getting to the point where her constant crises are taking up hours of my day. My husband is concerned about this.

I would consult with professionals who work with the elderly, like a social worker, about what your options are. For sure, you are not alone in having a mother who refuses to cooperate with anybody and wears out everybody around her, especially close family members. I thought there were only certain outcomes with my NPD sister, until my lawyer came up with a very clever solution. If you keep looking for solutions, you may possibly find one. Are you considering not being involved in your mother's care? I got to the point where I could not do it anymore with my mother, and that was the way it was. I am sad about this and I do not feel guilty.

It might be time to get a geriatric psychiatrist involved. My ex and his sister brought in a geriatric man who recommended a geriatric psychiatrist -- their mother was having small strokes that were changing her behavior, but they couldn't really tell to what degree. She was 91.

With a geriatric psychiatrist, you would be able to openly discuss the uBPD and her history.

She's in the hospital. I turn my phone to "airplane" mode in the evenings.

I will ask for a psychiatric consult while she is there, if they are willing to do that. I am not hopeful though- she pulls it together with them. If they were throrough, they'd also speak to me. This hasn't happened- I suspect she tells them not to. She's also told her home health nurses to not tall me things-- but they do.

She's had many psychiatric evaluations and seen various ones. By high school I had caught on that BPD mother had a psychiatric issue but did not know what it was. I recall asking my father- "Has mother seen a psyhiatrist?" and his reply was "yes but it doesn't help". I asked why and he replied " because she lies to them".

And there's a large part of why people have so much difficulty helping her. She lies and even in the hospital, she doesn't tell the truth to the medical staff.

I hope to speak to the hospital social worker about some of the issues- where is appropriate placement for her. Hospital doctor asked me what I thought about nursing home placement.  BPD mother got angry. It's only a short while ago that nursing home placement was considered and she managed to get that changed. I will make it clear to them what her options are and let the hospital social worker decide.

Dad rarely spoke like this about my mother but at times, I would ask questions and it must have been obvious that I was wondering about her so he'd answer. Therapy, psychiatric treatment and the medication they have given her don't work. Her defenses from any accountability are so strong- you can not get that information to her. She projects it back and also twists history in a way that she isn't accountable.

There may be strength in numbers. If possible, would her family and other sibling(s) of yours join you to speak to her to convince her to accept treatment and/or Adult Protective Services in your county to declare her incompetent? Ask everyone I listed a few times if the right thing isn't done. Using persistence at his level will give you some peace of mind that you did all that was humanly possible, regardless of the outcome.

Hang in there and please keep venting as needed. Am so very sorry.

You could sum up my response above  as: be a pain in the neck to everyone involved until you get what you want. Use our bpd moms as a guide.

I get it when you talk about how skilled your mother is in hiding her mental and physical problems. My mother charmed a lot of people well into her early eighties AND then how mentally ill and frail she was became impossible to hide. (In my mother's family, some people live to extremely old ages, so I would translate how my mother appeared in her early eighties to be more like someone considerably younger in ill health.) Some of the advantages you may have now in getting your mother the kind of care she really needs is she is elderly, in a facility where her behaviors are observed on a daily basis, and frail. I would keep on insisting that she get care more in line with what her needs are now, as the facility where she is being cared for and the medical providers who give her regular care have a higher level of responsibility and liability than when she was living in her home.

I haven't heard from anyone at the hospital she is at. This is the hospital my father went to as well. One thing I have noticed that is different from when he was there is that it's almost impossible to get someone on the phone. I know the staff is busy- I don't call at the times they are busiest. I left messages at their social work department and no reply. Same for when she was in the skilled nursing. Automated reply and then to voice mail.

Apparently they must have felt she was competent enough to sign herself in and to speak to her directly. She can decide herself.

I did speak to the ER doctor when she went. The ER doc seemed angry at me that I would be "forcing them to treat her" when she was initially refusing. I said not necessarily but that we have run out of options and don't know what to do. He said he'd call social work.  He asked if I thought she needed a nursing home. I said yes- (because it's true- she does need to be in a nursing home but has refused that). BPD mother heard that and agreed to be treated.

Last evening, someone with her told me she told the doctor she wants to go home and agreed to take antibiotics by mouth. That was the original plan- along with visiting hospital for wound care and treatment as outpatient. She had refused to take her medicine and was in so much pain she couldn't walk. I called the assisted living to send her to hospital. If I hadn't done it, they would have.

I know there's a risk of sepsis and I don't think she cares about that. She has the right to refuse treatment but by doing so, it's very painful. For now, she is getting good pain management and antibiotics in the hospital. Her family agrees with my decision to send her there but if she chooses to leave then that is her choice.

I'm going to leave this up to the hospital staff and her assisted living. If she wants to refuse treatment and leave- then they can all figure it out.

My family also has experienced a doctor becoming angry/frustrated because he thought my mother should be "doing something" about my grandparents. She got a call one Sunday morning from their PCP angrily telling her that he had both her parents in the hospital and what was she going to do about it. We lived 200 miles away. Mom had to explain that her stepmother was in charge of their health decisions, that she was a step mother who had never adopted my mother, and thus my mother had no power to direct their healthcare. The doctor had no idea that my mother was not a bio child of her stepmother.

That situation was resolved after SGM had several days of rest. She was, at that point, resisting any household help or home care, didn't want to pay for it. The PCP called in a psychiatrist, and SGM managed to appear sane and rational, so it was left that she was " competent to make her own bad decisions."

We never established a good relationship with their doctor, especially after that initial encounter.

BPD mother has put herself into a "hole".  She's not compliant with medical care and she didn't qualify for Hospice.

So now, she's chosen something right out of the middle ages. Letting her legs stay infected with no antibiotics even though they are available now. Because of her history with drug abuse, pain medications for her are tightly regulated so she can't just ask for them.

All her medical care requires her to go to her doctor's offices but she has limited mobility due to the pain in her legs. She refuses to see the doctors who come to the assisted living, preferring her own, and also not all specialists come there. She's not compliant with the home health nurses or the nursing staff at the AL. She could get all her medical care in place if she went to a nursing home and she refuses that.

So this leaves us, the family, to watch her go through pain and an infection with no solution. I am hoping social work calls me back but all I can do is leave messages.

I have tried in the past to call the nurses station- they just tell me they are busy and can't talk at the moment. I know they are understaffed and over worked. I truly don't pester them. I know how hard they are working. But also, it takes so much effort to try to reach someone.

This is a reflection of current changes in medicine so it's probably everywhere. It was not like this when my father was there years ago. It was possible to speak to hospital staff then.

I have a good relationship with her PCP. He took care of my father too. The hospital system has its own hospital doctors now. He isn't on staff at the hospital now. He can get the medical records but that isn't the concern. I know she's being treated with antibiotics and pain medicine. That's straightforward. It's what happens when she's discharged -where and what to do for her that I wonder about.

It's baffling to me that persons with BPD can be so cunning and manipulative while -- AT THE SAME TIME -- engage in magical thinking that "wishes away" the unpleasant, or keeps them from taking responsibility for a solution.

Now that your mother is no longer living in her home, there should be plenty of documentation on her mental condition by staff where she has been staying whether it be an assisted living, a nursing home or hospital. My mother refused to elevate her leg and risked amputation until the doctor put her in a nursing home with the staff constantly reminding her to elevate her leg. Not long after that, she was on several psychiatric meds for many years until the end of her life while living in her own home. She was very compliant in taking her medications and overall with her medical providers after that. I do think the psychiatric medications made a big difference in getting her to be compliant. Clearly your mother is risking her life and some really painful times if she does not cooperate with her medical providers and get the care she needs for her infection. Can you make a request through the social  worker staff where your mother is currently staying that her medical documentation on her mental condition be read completely from all facilities she has stayed at and evaluated by a geriatric psychiatrist? My mother had a wonderful geriatric psychiatrist who take exceptional care of her. He once explained to me that family therapy would not work. He did try to give her individual therapy and gave up on that. He was well regarded in the community and gave some highly regarded therapy to a family friend who was severely depressed. The family friend recovered and went back to living a good life until he passed away.

One doctor spoke to me as she got me on the phone when he went to examine her. What they are doing is good- antibiotics, pain medication, nutrition management. Still, she complains about everything- that she has to lie there in the bed, that the nurses won't come and change her. What did she think the alternative would be if she didn't come to the hospital? She'd be lying in her bed at the assisted living in pain with an infection. They'd have called for her to go to the hospital too.

She takes no responsiblity for what is happening. Pain from an infection she refuses to cooperate with treatment. The doctor says she's not wearing compression stockings at the moment due to the pain but it needs to be part of the management. She refuses to wear them. If they put them on her at AL, she takes them off. If she can't pull them off, she gets scissors and cuts them off. And still- she's "legally competent." 

Then she goes on this speech to me "Sorry she can't be like so and so's mother who died peacefully and that sorry she can't be that kind of mother who wasn't a burden to her kids".

I said nothing, just listened. There is no point in saying anything back. She says "nobody ever listens to her". I said "I'm listening".

This is a reason she has come up with for why this is difficult- through no doing of her own, she didn't choose to have this situation. True, she didn't choose it but she won't do what her doctors have said she needs to do to make it better.  What is difficult is that she won't cooperate with people's genuine efforts to help her. But since to her - she is not responsible for any of that, it has to be that it's nothing she did.

It is amazing how they can be so cunning and manipulative- she does this deliberately- she knows what she is doing and at the same time emotionally absolves themselves of any part in their situation.

I'm glad your mom took the antibiotics and you have a break from the drama.

My mother sees a doctor whose specialty is treating pain. It's hard for her to go to his office so we've had virtual appointments through an electronic device. It's every 3 months. My mom takes a controlled substance pain med. 

Considering the fentanyl drug crisis and economic tough times, it's state law in California to have strict control over them. All pharmacies have these in a safe. I've waited 15 minutes for the px to be filled for the pharmacist to follow protocols. I assume the pharmacist has a security camera on them as they're filling the px.

My mother has a virtual appointment to monitor her need and to see if she's alive. A wayward relative could stand to make $$$ selling the pills which are really cheap with a doctor's px. The MD would be liable for not being careful.  It might be the same in your area It might not be your mother's history at fault.

Now that things are relatively quiet, try to do self care. I mean to go over your options considering your mom's decisions, and to protect yourself legally from her non compliance.

He wasn't welcome in my life but my ex-h had the physique of a US football player. No one in my family or neighborhood bothered me. It all changed after his death. It was hard to accept harassment (it was for inheritance and neighbors trying to extort $$) but it was happening. I've protected myself legally and went NC or LC. I had a lot to lose by overreacting which I know was their goal. Staying away from the crazy has been a relief!

If your mom's relatives are a problem, do you need to include them or give them information, especially if they use it against you?

I don't know if any of this is the case for you. You have a very good head on your shoulders. You can't change her and the law backs her up.

I am sorry you are going through this.

Should they be discharging her without an "after care plan"?  A question you could ask if they tell you they are discharging her, is "what is her after care plan?"

A lot of years ago when my mom went into emerg for one of her many catastrophies, the emerg doc discharged her.  I was desperate and very scared.  My limbic system was in overdrive. She had been dysregulating for so long prior to the emerg visit, I was terrified to take her home and be responsible for her care.  But they discharged her.  It was a disaster.  The Doc even told me someone would need to spend the night with her as she couldn't be left alone. To make a long story short, I found out months later from a nurse in home support, that she should not have been discharged from the hospital without an "after care plan".  That was very helpful information to me.  I did not know that.

So with the next catastrophe requiring a trip to emerg, I disclosed the family dynamic issue including emotional abuse, in a private confidential conversation with the emerg doc, and clearly stated I could not be the after care plan because I didn't feel safe. They kept her overnight in emerg, and put emergency home care in place before they discharged her.

In your situation, I'm wondering what their "after care plan" is.  If she is refusing medical care, they can discharge her back to the assisted living facility, but how will they transfer her?  Is an ambulance arranged, or are you expected to drive her?  If they expect you to drive her, is this something you feel you could refuse?

I am wondering what the social workers say about how to make her a ward of the state?  Also, you mention her crises are taking up hours of your day, but I'm wondering if there is some way you can withdraw from the drain of all these "hours"?  In other words, let "natural consequences" play out, since it's her choices driving all this, and her choices are out of your control?  Let the medical system deal with it, since she is in the system, and they are also the ones saying she has the capacity to make her own bad decisions.  Is it feeling like you're trapped between a medical system that says she's competent, but a mother that is noncompliant and creating crises after crises taking up your time?  Is there an exit ramp from this?
Sounds good, but this is not my experience.  My mom was referred to a geriatric psych under the auspices of her family Doc saying he needed expert help to check all her meds. She agreed to the assessment for this reason.  On the day of the geriatric psych appointment mother pulled it together for an entire hour, and responded in a way that made her seem years younger, energetic and upbeat and healthy and "perfectly fine".  My husband was present and could not believe her performance. The very next day (less than 24 hours later), she called us to take her back to Emerg (back to her "real self" state).  NW has said many times that her "mother" can pull it together in situations, and that is also my experience.  I think this is how they continue to be seen as competent.  My mom is 87 and still successfully fooling people (including professionals). Or maybe they aren't completely fooled, but she can "pull it together" to not give them enough evidence to actually lose capacity.
It has been a process for me to "radically accept" my mom's situation and choices and personality - all of it.  H and I still support her, but we do not take responsibility for her decisions. Boundaries are a daily struggle because she just keeps pushing them.  When she has something going on, we have to let her struggle, and resist swooping in to fix the problems that she has created because she has chosen to live at risk, and she would have us there "all the time".  I'm not in your situation NW, but I'm wondering if there are other things going on here.  What I mean by that is sometimes, when elderly people are finished with life, they quit eating.  That is usually a sign that the end is nearing.  Your mom is refusing medical care - antibiotics that she needs.  Do you think there is a chance this could be an intentional choice on her part, or is it more likely that it's the BPD "magical thinking?"

My T is working with me on a lot these days.  The recent meeting included "accepting" that my mom's choice is to "live with risk", and see that I need to manage my feelings and responses around that.  I need to do a lot of work on my own distress tolerance. You mention the situation has left the family watch her suffer with pain and an infection with no solution.  In fact there is a solution - antibiotics - but your mom is rejecting it. The parallel I see is that your mom is "choosing" to "live with risk" by not taking her antibiotics.  Neither the doctors nor you can change that.  It's her choice.  The consequences are a result of her choices.  But somehow as the daughters, we still feel "guilty", or like we need to "fix" the problem.  We feel responsible to make them feel better. But as you mentioned, "she's impossible".   I think all we can do is learn to manage our own distress over their choice to "live at risk".  I have had to accept my mom's gradual descent into blindness (because she refused home care services to put necessary eye drops in for her). Their choices are beyond our comprehension. Who chooses blindness over accepting outside help? But her magical thinking allows her to believe she can put her own drops in her eyes with her shaking Parkinson's hands (she can't). Eventually, her poor vision will result in another catastrophe in her own home...the natural consequence of this might eventually force her into a facility.  Not my fault.  Although she can twist anything to be my fault - I should be driving to her house 4X a day to put her drops in for her instead of "working". She's screamed at me that I am selfish to put my career ahead of her.  Distress tolerance is something I really need to work on.  My T made some very good points yesterday.

I'm curious, are people - doctors, nurses, her family... - putting pressure on you to "do something"?  Or do you feel the pressure from within? You mention that all her crises are taking up hours in your days, but this doesn't seem sustainable, nor does it seem to be achieving any positive outcomes.

Is it possible for you to step back from these "hours" in any way?  I'm not there and don't actually know the intricacies of what's going on, so I hope the question doesn't cause frustration.  I'm genuinely just trying to help and support.  You seem to be putting in a lot of hours.  But it's hard on you, and doesn't seem to be helping your mother's situation.  You are further along than I am in this journey, so I am also learning from you.  :hug:

Scratch this thought, since while I was writing this response, it seems that she has now started taking the antibiotics.  Hopefully if they do discharge her, assisted living dispenses the antibiotics and it isn't left up to her to be responsible to take them until they are finished.

After a life with my mother, I have a natural tendancy to see every possible thing that can go wrong.  This is another legacy of being the daughter of a BPD mother, and is a problem I am working on.  Sadly, it is for good reason we are so good at predicting all the things that can go wrong. :(

I think there is one big difference between Notwendy's mother and Methuen's mother. Methuen's mother is still at home so she is much more able to hide her mental illness. Notwendy's mother has been living in some kind of medical facility for several months now, so her behaviors are observed and documented by medical staff. Many mental health professionals are very interested in what people who spend considerable time with the client have to say about their behaviors, as they are aware of the fact that many people are ashamed of their challenges with mental illness and do everything to convince others that there is nothing wrong with them.

Thank you all for your helpful posts. Finally someone from social work called me and I think they were "feeling me out" on the idea that BPD mother doesn't want treatment. The person began by asking me if I had considered rehab for her and I said it had not been discussed. They explained that she had refused the assessements for rehab and wanted to go home.

I explained that she has the right to choose to not treat and that the main reason for my wanting her to go to the hospital is that she was in a lot of pain and the only option we had for pain relief was to go to hospital and treat the infection, that if she wants to go home, she will need better pain management.

I think at that point the social worker realized we are on the same page. She can choose to not treat, but with pain management for her sake and for her family- we don't want her to be that miserable.  I do think this is what my mother wants and have noticed a shift in her. We can accept her choice but don't want her to suffer. She's going to set up palliative care as part of the care plan. I feel a sense of relief that this could be set up for her.

I think her family understands the situation now. They won't be opposed to it. About any family squabbles over her finances- that's an easy one. There isn't much to squabble over.

What I mean by that is sometimes, when elderly people are finished with life, they quit eating.  That is usually a sign that the end is nearing.


I don't know who wrote the above, but not true. It's a sign of getting older and needing fewer calories. I don't eat as much as I did 10 years ago. I am not ready to go anywhere except for the shopping mall.

Am glad you spoke with the social worker to straighten things out for your mom.

Here's a forum I read where adult children of the elderly vent and ask care questions. Some have parents with personality disorders but others don't.

https://www.agingcare.com/caregiver-forum

https://www.agingcare.com/questions/what-do-you-do-when-your-father-refuses-to-go-to-the-dr-refuses-to-take-medication-for-diabetes-hear-485546.htm

What do you do when your father refuses to go to the dr, refuses to take medication for diabetes, heart issues, etc., showing signs of dementia and now extreme paranoia. Every time I talk to him, he asks me to call about cameras being installed in his house to check to see if the neighbor has put dogs in there and now wants a fence to make sure everything is kept out. So at a loss of what to do.

To clarify, I equate quitting eating with refusing all food.  Nurses in hospital have told me this is typical when people don’t want to fight to live any longer..  I wasn’t sure if refusing medical care could be a similar strategy. 

I really wasn’t talking about reduced appetite as we all age.  Most of us consume less as we age - me included!


Sorry for any misunderstanding.

It could be depression, the flu, a reaction to a new medication but not a death wish. We really don't know.

I read over my posts on this thread and realized I may have been catastrophizing.  I didn't want to make things worse for Notwendy as none of us do.

You all are very helpful- and it is much appreciated. Not being made worse at all!

The appetite issue with my mother is complicated as she's had an eating disorder. She does eat but not always the best nutrition. Her caretakers would report that she only wants cookies for dinner when she was in her home. We hoped being at the AL would change that but she complains about the food.  She does have a small fridge in her room that can hold snacks and things she likes to eat. She will send for take out sometimes.

I have also heard about the quitting eating and that it's not helpful to give them IV fluids when this happens as it stressed their bodies. She's still eating but not the right foods. If she's going to be on palliative care, she may as well eat what she wants to.

I did read the aging care links- many suggest calling APS but those are for eldely people in their home. I'd have done that if she was still in her home. Since she's been in assisted living, she has staff checking on her and they'd have called if they were concerned. She's consistently told her medical providers- both in and out of the hospital that she doesn't want to aggressively treat her leg and while she agrees to their treatment plan she doesn't comply. I believe her but she needs to have better pain control. If she can get palliative care I hope that can help.

She's just miserable and upset over everything. It's understandable- physically miserable on top of her baseline emotional miserable.

She goes "helpless" saying she just can't cope. She needs someone to help her. Then the helper becomes the target and she undoes whatever the plan is.

She will likely speak to Palliative care next week. She says she's too confused wants someone with her. I have listened in on her calls with doctors. After the call she asks me to repeat everything they said. Then she says "nobody told her that" and they did- I heard them say it and she understood it.

She remembers. She's telling me what her "cousin said 20 years ago". She's recalling who said what at events I can hardly remember and she recalls what has been said to her 5 minutes ago as well.

Question- are you listed as a contact on your mom's medical care, or do you have medical power of attorney?

I'm asking because if you're simply a contact, then you have zero voice in her treatment...other than to talk to people and relay information.  But at the same time, the doctors are not required to talk to you or return your calls because you're not a decision-maker.

If you have medical power of attorney, then your mom has no choice in this- what you say goes.  They cannot create any treatment plan (except immediate life-saving) without your approval.  If the physician doesn't keep you very tightly in the loop, then there could be serious legal ramifications.

I'm a little confused which of these things you are- could you clarify?

I have both but it’s more complex - I’ve consulted an elder care attorney about what I can and can not do. Unless she is declared to be legally incompetent she has the right to self direct her care.

I think when a doctor asks me to be involved it’s because they also are concerned about her revising history and claiming they said or didn’t say something but she still can choose to agree to treatment or not.

I pushed the ER trip as she was in so much pain she was refusing to get out of bed and this was a way to get help for her but whether or not to agree to the treatment offered is up to her. She is in agreement that it helped with  the pain.

If my mother is unable to speak for herself or declared legally incompetent - then I decide . Hospital staff is not required to speak to me but some prefer to. In the legal sense she can be unreliable but still legally competent - which does make this confusing.

Really - I’m trying to do the best I can for her in this situation . I’m very transparent with other family members and get their agreement with anything I do.

If you have medical power of attorney, then you have to inform the hospital, treatment facility, whatever, each time she seeks treatment.  It should already be on file, but going through this with my dad they claimed not to see it 90% of the time.  This was during COVID so visits and communication were horrible.  I had to take the lead and let them know, "Hey, this document says I legally have a say in this..."

In each instance, your mom should have a case manager at that facility- that's who you should reach out to 1st.  It's the case manager's job to coordinate all treatment plans when leaving the hospital and most of them won't know you exist.  That's the easiest route though; ask for the case manager and then let them pester doctors, nurses, therapists, etc.  It's their job to do that and others comply because they have to for insurance reasons.

Sadly, the insurance companies run healthcare, not the doctors or CEOs.

The case manager will talk to you though and you can voice your concerns about your mom not complying.  They get it because it's very common with elderly...not just BPD.  You have the extra level of headaches though because of it.  If it were me, I'd blame everything on the case manager though- they said you have to do this or you're going into a nursing home.  Let them be the bad guy.

That actually happened in the ER as the ER doc went to get the case manager to be involved. They brought up nursing home as an option and she decided to let them admit her.

Case management is going to get involved with coordinating palliative care. So I do have support with this. The problem is getting ahold of staff as the system is automated so you have to leave a message and wait for them to call back unless it's an emergency- which this isn't.

I think the overall difficuty is the extent of her BPD in trying to assist her and communicate with her. She puts the people trying to help her in persector role. It's hard to get her to cooperate with a plan that is designed to help her. She also has physical discomfort too. Everyone is trying their best with her - to the extent she lets them.

Legally though - she gets to self direct. I don't have power to overide her and force her to accept any care. She doesn't have dementia- and is quite sharp mentally. Emotionally, the BPD has an effect but still she passes mental competency tests. The medical POA is on record if they need it. I could step in if she wasn't able to decide for herself.

Yeah, it's more of a BPD thing than an age thing- we've learned that with my young adult BPD daughter.  Her whole life, the doctor would say, "This is a typical case and it's clearing up nicely...."  She hears, "You almost died and you're so very brave, so strong to withstand this on your own."  We'd just roll our eyes and laugh.

Meanwhile, If the doctor said to do x, y, and z, my kid would focus in on what she wanted and shout it from the rooftops...I can't be responsible because of x!  The doctor said so!  But she'd refuse y and z for whatever reason and try to re-write what the doctor said in the first place. 

It's definitely maddening but I found it easier to laugh and let it go.  It's on her and if she wants to get sicker because she knows better, then so be it.  I will not stand in her way.

I think we can only do so much if someone is an adult and able to make their own decisions legally. I agree that BPD makes things different- at each stage- so if it's an adolescent- there are adolescent behaviors+BPD, young adult+BPD, parent+BPD.

When my father got ill, I read a book written by someone who had experienced a similar situation with her father and how she managed some of the challenges and maintained her good relationship with him. Some of my friends were assisting with their elderly parents and we also were involved with my H's parents as they aged. So I had an idea of what to expect but this was something different. BPD mother was in control of the situation.

So yes, some things are similar and yet, the BPD element is another dimension to it. But with someone who is still considered legally competent- they are the decision makers for themselves.