uBPD father now w/ severe TBI. How to prevent imminent death & suffering/harm?

[roxientist]

My 61-year-old father suffered a severe traumatic brain injury (TBI) 4 months ago after falling down the stairs in his home. My mother found him when she returned home from work and he was flown to shock trauma where he was found to have suffered significant bleeding in two areas of his brain (temporal lobe and frontal lobe) and then underwent a craniectomy to manage major brain swelling. My mother/his wife was his full-time caregiver while he required one before getting the skull piece put back on (she still is at the house all the time and has continued to work from home). I live close by and help as much as I am emotionally capable, and my brother (my dad’s most idealized person) lives far away. My parents have no friends in the area, no family in the area, and really very little access to assistance in that way. What family they do have live at a distance and are not great mental health navigation resources.

His brief uBPD background:
My dad has always been a challenging person with volatile relationships, stubborn black-and-white thinking, a need for control, and unreasonable expectations, but also a deep feeling, loving, hard-working, self-sufficient provider who worked his butt off to (successfully) get away from his small, blue collar town and abusive childhood. After years of enduring his verbal abuse and his worsening control over his emotions, I did extensive research and armchair-diagnosed him with BPD. He is officially undiagnosed. A symptom of his BPD became severe alcoholism, which really developed only after my brother and I had left for college.

Over the past 5-7 years, he has participated in a cycle of:
1) falling off the wagon,
2) gradually building up in intensity of anger and issues over the course of a few days,
3) reaching a level of emotional volatility such that he has some sort of "episode" (such as driving off drunk, punching a hole in the wall, changing all the locks of the doors so my mom can't get in, etc.),
4) having a shameful, brooding "come down" over a day or two, and then
5) detoxing on his own and being sober for anywhere from a couple of days to at most 2.5 weeks. Rinse, repeat. In the past 2 years, he has had the cops called on him 3 times by family members for driving drunk; he was forced into early retirement from his job of 20 years; he has drunk-driven his car at top speed, flipped and totaled it, walked away with no injury, received an insurance payout well beyond the 5-year-old car's original worth (with which he bought a newer, fancier car), and got all charges dropped.... you get the gist.
And, to top it off, he was in the midst of the anger episode portion of one of his destructive cycles when he fell down the basement stairs. His BAC was 0.3.

Now, at home post-fall, and although he hadn't been drinking for 4 months, he:
a) has chosen not to take any of his mood stabilizing medications that I worked so, so hard to get the psychiatrists at the hospital to re-prescribe when he got his skull piece put back in (meds that the psychiatrist at his rehab center weaned him off of despite my telling her that they were making him joyful and pleasant - which I have NEVER been able to describe him as, and her saying that he could in theory stay on them after his time in the rehab…).
b) hid a set of car keys from my mother and has driven himself countless times apparently: to the gas station to get cigs, to his PT/OT, to his substance abuse counseling group classes. Note: he does not have a license since his TBI because you automatically lose your license when you suffer a TBI for a multitude of reasons/risks.
c) absolutely berates my mother CONSTANTLY and treats her like his slave to do anything he yells at her to (often using his risk of further injury or destroying her things to manipulate her). She was once a fairly idealized person to him and in the past couple of months she became so devalued that he often acts like he truly hates her (but sometimes doesn’t…). For context, my mom is incredibly meek and passive and certainly suffers from her own levels of codependency and possible personality disorder. She does a lot of enabling and has been making progressively poorer decisions regarding this situation and her own safety.
d) has been having more and more frequent and intense outbursts that have involved changing the locks, driving, shutting off my mom’s phone line, and other reckless and dangerous behavior. He has taken over most of the accounts they share and is withholding access to them from her.

 
My brother recently informed me that, through his many recent conversations with my father, it is clear to him that all he wants to do is die and it seems that the only thing preventing him from ensuring that fate is that he wants to screw my mom over and doesn’t want her to get any of his assets or anything. He’s frustrated that she is not allowing him to divorce her (which he would have to do with a POA for himself given the TBI, but he doesn’t have anyone to ask to be his POA) and so now he’s trying to offload all the assets he can within the marriage just so she doesn’t get anything, including trying to buy my brother expensive things and send him all of his money. He has progressively made more frequent and more explicit statements regarding suicidal ideation and is “hoping the next time he falls he just dies.” I am rarely (if ever) privy to direct threats or more explicit comments to this effect.

  Most recent incident:
The most recent incident that has occurred has been one of the most immediately traumatizing for me and is what has prompted me to seek guidance. In brief, after a night of driving to and from the gas station multiple times, drinking (and significantly) for the first time since his accident, and getting the cops called on him by management (cops just drove him home), my mother sought refuge at my home (which she has been doing regularly for maybe 6 months or so now). My dad shut off my mom’s phone, repeatedly tried to call her on her work phone, and ultimately drove to my house at around 2:30am. However, he mistakenly went to my neighbor’s and crashed his car off their driveway. He called me multiple times and I finally woke up and answered, but all I heard on the other line was this awful painful moaning sound and crunching snow (he had fallen and broken ribs). He didn’t answer when I called him back so I had my mom look up where he was on Find My Friends. So then I went over and saved him from my neighbor’s barn, which he thought was my house. It was 11 degrees F that night and had recently snowed - he was not dressed for such conditions. He refused to let me take him to the hospital and stayed at my place to warm up and sleep it off in excruciating pain. So, now my safe space has been violated and I very well could have woken up to my father having frozen to death practically in my backyard.

 
We cannot go on like this. But I am at a loss for what to do. It feels so specifically complicated to navigate the BPD, the alcoholism, and now the TBI as an enormous nightmare trio. Deep down he is sensitive and caring and good and he just wants to be loved and do the right thing... but his demons have had a hold on him for so, so long and they are the closest they've ever been to finally drowning him for good. I don't want to sit there and watch his demons take him out but I also don't want to walk away as he suffers what I know is unfathomable inner (and now outer) pain.

He's just physically and cognitively capable enough to be independent enough to execute all these poor decisions and actions and to fool medical staff into thinking he can make decisions for himself. All of this was EXACTLY what I had expressed to every single therapist he had in rehab (including the psychiatrist), multiple times. Yet no one had any guidance or nuanced care plan for him and his specific issues... and for us as his caregivers. Only regurgitated, pamphlet-level, standard ways to mitigate basic post-TBI challenges, such as "be patient" and "redirect him".

I feel we’ve been failed by the medical system multiple times to get him mental health help (including an immediately denied Emergency Petition to get him involuntarily admitted to psych, submitted by the cops on our behalf after one of his “episodes”... just to name one). His primary care doctor is aware of everything and does nothing within her power. He refuses therapy. I have tried to help my mom by providing her with resources and support and she does nothing with it and it has ultimately caused me consequences by association.

I don’t know what is in my power to ensure I have done EVERY SINGLE THING I possibly can to do my part in finding a way out of this for him, my mom, my brother, and myself. Ideally, he would be admitted to a psych facility and receive the care he needs there for any hope of a life beyond this affliction. Right? It would remove him from the home for my mom, prevent the consequences of his episodes to us and others, and hopefully give him a future. But he’s definitely not going on his own and I am unclear as to if there is a way/what is the right path forward to make that happen - if that is even what should happen.

This situation feels is very actively life or death at every given moment and I constantly fear getting the call that my dad has slipped on ice and died because of how feeble he is right now, or that he got a hold of the keys again and drove and killed others and himself, or that he burned the house down, or that my mom has been harmed, etc. I’m exhausted and heartbroken.

Thank you for listening to me and for any guidance you may have. Sorry for the length.

[Notwendy]

I can understand your feelings. I too wanted to "rescue" my father who was ill and married to my BPD mother. It's a long story but to summarize it- it was chaos, and I got so concerned over the situation, I called social services to see if I could somehow get oversight of him. I have posted their response to remind others that there is only so much we can do. This was their reply after hearing the situation.

"Your parents are legally competent to make their own bad decisions".

Unless you have medical evidence that your father is legally mentally incompetent, you don't have control over his decisions. If you can get this evidence from a doctor or court- that may be possible. Unfortunately, being reckless and impulsive doesn't necessarily mean legally incompetent.

I can share a similar situation where it was clear that Dad should not be driving. But BPD mother didn't drive and insisted he drive her places. Dad, being co-dependent and enabling didn't say no to BPD mother. Understandably, her reaction to not getting her way is hard to deal with.

One day, I got a call from their local ER. "We have your parents here". I had to sit on the floor to keep from toppling over at the shock of hearing this. Fortunately nobody was hurt. The accident was their fault. The car was totaled. I was upset, but the silver lining was- nobody was hurt, and they don't have the car and Dad won't be able to drive.

Nope, he got his license back and BPD mother insisted he buy another car...

That kind of chaos and more...

There is much I wish I could have done. Now that BPD mother is an elderly widow, the situation is similar. It makes sense-they were so enmeshed. Whatever anyone tries to do to help her situation, she somehow opposes it.

She's also elderly and physically and emotionally feels terrible. We wish we could do someting to help the situation, for her, and wished it for my father. But we can not control their decisions.

We want to intervene when they do self destructive things. It's hard to see our efforts not succeed and it's hard to not blame ourselves but truly- if we didn't succeed it's because it isn't possible. It is not due to lack of trying or lack of something on your part. You do not control his decisions or their outcome.

You are his daughter and your role is to let him know you love him, and to help when you are able to but not at the neglect of your own well being. Whatever happens with him,- you will know you do care. That is all he needs from you, whether or not he has the sense to know it at the moment.

[TelHill]

Hello roxientist,

Am very sorry you and your family find yourself in this situation.

My elderly mother is the pwBPD - diagnosed. My father put her on a leash so to speak by not allowing her to drive or hold a job outside the home. He was afraid she would be arrested for physically attacking someone. He has told me on a few occasions. She would do that to me as a child in addition. I understand the level of behavioral chaos tinged with violence which many with BPD exhibit. She doesn't need mind altering substances to be out of control.

If your parents are US residents, your father can divorce your mother without her consent.   He might be in a state of delusion or is creating drama to control your mother, you and brother by deliberately putting you guys in panic mode. Am sure his fall made him feel out of control. This is his way of heading back to normal no matter how wrongheaded it is.

My mother has fallen many times - it's a wonder she's still alive after breaking her hip twice, her leg twice, her foot, her collarbone and her shoulder.  She was hospitalized three times in the last five years. She exhausted the staff each time with her antics.  A few nurses complained about her but nothing could be done to get my mom to behave.

The last time, in early 2023, she broke a hip and was admitted to another  hospital 10 miles away (I'm sure the one right near her house where she was treated twice before didn't want her). This hospital is the best in the Western US and has the top gerontology department in the US with full time researchers and published studies. She had 4 gerontology residents (a prestigious medical school) who spoke to her and my FOO a few times. I told them her bpd diagnosis and they could do nothing for her mental health.

She continued to tear out her IVs and fell down a few times when she was trying to leave the hospital on her own. They tied her to the bed and she managed to wriggle out of it. They finally had to put a security camera pointing at her bed. When there was motion outside the range of the bed, the staff would be alerted to put her back in bed and restrain her again.  It's totally bizarre. She is one out-of-control person.

The reason I'm telling you this is this hospital did nothing and could do nothing to get her to obey besides what they did. Even if they were to, my mother has rebuffed all attempts at psychotherapy. No one can make her go without her permission. Her problem, according to "Dr. Mom," is severe depression which runs in her family and she knows only prescription pills can help her. 

You can consult an elder care attorney to make sure you guys (mom, brother and you) discover what you can do with a volatile immediate relative per your laws. They might be able to give you some good advice.  Am sure they all have plenty of experience with ill, horribly uncooperative family members with substance abuse problems.

Please read through the tips and tricks on this site to help you deal with your father's agitation and not accidentally add to it. I've done that many times with my mother to get her to listen to common sense. It's never worked.

[Notwendy]

I second the idea of a consultation with an elder care attorney. I had resisted the idea for a while, thinking I didn't want to spend the money as I knew I didn't have any legal right to control BPD mother. However, the information from the session was well worth it.

In the US there are regulations for what Medicare will or will not cover, Social Security, and eligibility for Medicaid. It is good to know what these are.

Is your father legally mentally incompetent? If so, he can't designate someone as POA himself. He also should not be in charge of his finances if he's legally incompetent. You would need to petition the court to have a guardian appointed to him- either a trusted family member or someone appointed by the court. He can't legally sign contracts or consent to medical care ( or refuse) if he's not mentally competent.

[roxientist]

That's the issue we're struggling with. We have tried to have him deemed incompetent by medical/psych professionals but they don't. They claim he may not be making good decisions but he's competent enough to choose to do so or not. WHICH IS NOT TRUE. When I interact with him during his episodes, he is NOT a present, rational-thinking, competent person. It's like looking into a void. He is putting himself and others at risk physically, financially, emotionally, etc.

Is declaring his mental incompetence something that we should pursue with an elder care attorney then? And is it something I can pursue with any hope of result or would my mother have to since she is still around and they are married? Either way, I think you are both correct, pursuing elder care legal advice is the next step. Even if just for my own information gathering, separate from my mother. And yes, I am in the United States.

As far as his control of finances and accounts and such, I don't know what to say. I fight back my frustration with my mother for even allowing such things to be susceptible to his influence and action. He was in the hospital/rehab for 42 days. Why were accounts not secured in that time???? Even if he did not have uBPD before the fall, that's one of the first pieces of advice for TBI patient families!

[Notwendy]

The problem with your mother is that she is used to being co-dependent and enabling your father. She is likely to be afraid to not go along with him.

But this is serious as it is financially harming her. What she "gets" isn't up to his feelings. It is marital property and also either or both of them may need their savings for their care as they age. There are also rules about how to manage money, tax laws for how much one can gift to children, regulations for how to stay eligible for Medicaid if either of your parents need long term care in a nursing home which might be a possiblity for your father at some point.

An elder care attorney can help map out these things for you, how to get financial custody, how to be able to make medical decisions for your father in the event he is unable to.

I hope you can appeal to your mother that getting this done is in your father's best interest and also hers. She needs to also designate someone as POA for herself while she is mentally intact and doesn't need anyone to make decisions for her.

After my father passed, everyhing went to my mother. She wrote me out of her papers as POA. I had no idea what she had or what she was doing with it. Then later, she redid all her papers, designated me as POA. She's done herself significant financial harm but we don't have the ability to intervene as long as she is "legally competent"- she can override any attempts. I have tried, her family members have tried- to assist her with managing her finances better. She refuses or lets us set up a plan - then undoes it.

When family members ask me if I want them to try again, I tell them this: do what you feel you need to do to know you have tried your best - what you think is all you feel you can try. For me, I know I have tried all I know to do. It hasn't worked. I think if we need to try for our own peace of mind - then do it- for you. It's up to her to decide to cooperate or not.

I think it's worth trying to get financial guardianship or conservatorship for your father if possible - according to the laws in your state. He could be eligible for SSI for disability and possibly Medicaid. If he isn't safe at home without supervision, possibly some kind of respite or nursing home placement- if not now, if he needs it in the future.

I am guessing here and the idea may not sit right with your mother but if your father is set on ruining their finances- would divorce be in her benefit as it disconnects their finances? He might still be able to ruin his part but not hers. I am not an attorney so this is an idea to ask one as there are social security regulations about divorce and also if he doesn't have a will, what happens to the assets if they stay married vs divorced in the event that he did pass. If she is on his health care insurance- that might impact it too. I am not suggesting she leave him but to look at how can she legally protect herself from his financial irresponsibility- what are her options?