aging uBPD mom and a home care case worker who is unfamiliar with BPD

[Methuen]

Hi again,

Aarrgh!

Before, I begin the next chapter, a quick recap:  my 83 yr old mom had a fall on Sept 5 which led to 4 fractures (which initially were missed by 2 Xrays, but later seen on a CAT scan when symptoms had worsened after a month).  Her pain became acute at the end of September, and resulted in 2 trips to emergency, including one in an ambulance.  This level of pain lasted 3-4 weeks.  Her recovery began very slowly, but through all this, I supported and advocated for her (with care and concern and attention) to the tune of 3 - 4 hours a day.  When I began to burn out sometime around the end of October, her family Dr put in a referral to home support, and services (such as shower, meals on wheels, Lifeline etc) were put in place.  I was also burning out.  Towards the end of all this (it was obviously stressful for mom), she raged at me, as I was driving her to another Dr appt, that her pain was all my fault because I made her go to physio and her pain started after physio (I did not make her go to physio, but that's not the point here).  It was a crazy rage.  I kind of fell apart after that.  I was also still recovering from the rages prior to Sept 5.  Meanwhile, she had a RAI assessment done, and was deemed to qualify for assisted living (a two year waiting list).  She declined that offer to her case worker.  When I shared my story of my uBPD mom with the case worker privately later on, she seemed very sympathetic, and I understood services would be available for mom.  I was SOO relieved, because it looked like there would be community support, and I wouldn't be left alone to deal with a chronic situation that affects my wellness (my mom has been assessed to be a serious fall risk (with weakness, 2 hip/1 knee/back surgery, osteoporosis, and a mild lifelong eating disorder).  But after the case worker had another meeting alone with mom to give her the results of the RAI, I got an email back from the case worker that included this line:
  "Your mother has declined assisted living.  I hope at some point when you have explored your feelings with your therapist, that you will be able to discuss them with your mother".
Any thoughts, suggestions, or ideas of what I should do with that?  I have requested another meeting with this case worker, and she has agreed, so I figure I have a small opportunity to discuss my concerns further.  One of my points is: since my mom's BP affects me and my wellness, it also affects my ability to be the sole caregiver for my mom.  That in turn, affects the case worker.  But I (and my counsellor) suspect she knows nothing about BP, or how could she say "I hope at some point when you have explored your feelings with your therapist, that you will be able to discuss them with your mother"?  Could a health care professional say that if they understood BP?  It felt like the support I thought I had with this case worker initially, evaporated after her meeting with my mom (where they discussed her RAI results, and mom declined a waiting list spot for assisted living).  I can imagine mom presented herself to this case worker as a peppery independent lady quite capable of looking after herself.  I feel like telling her that sometimes what one sees, is not what one gets.  But I can't.  Feeling trapped is just so depressing, and sometimes it just feels hopeless.
 Any suggestions with what to express to this case worker when I meet with her?

[zachira]

I am sorry that you shared the situation with your aging uBPD mom with a case worker who responded inappropriately and indicated that you were the one who needs therapy. My best guess is that the case worker felt uncomfortable with what you shared and then put the blame on you by suggesting you needed therapy, so the case worker could avoid dealing with her own feelings and lack of experience in knowing how to deal with a client with BPD. I recommend that you share with the case worker's supervisor how you felt about the case worker's inappropriate response while centering your complaint on how you are concerned about your mother getting proper care with her mental health challenges with BPD. You may want to ask the supervisor some questions about what she knows about BPD, and about dealing with challenges with elderly who are mentally ill, to see if you are likely to get some real assistance. In my experience, those that were involved in my mother's care, always made it clear that she was the primary client and not me. I also found that there were certain people who work with the elderly who really get BPD. One home health nurse went out of her way to get the social worker involved when my elderly mother was abusing my brother who was dying of cancer.
Do keep us posted on how you are doing and the feelings that are coming up as you bravely face having to get help for an aging uBPD mom. It is terribly stressful and painful to have to deal with a mother that treats you so badly while pretending to be another type of person in the presence of people from the outside.

[GaGrl]

Our you are going to have another conversation with the case worker, you can discuss the possibility of bringing in a geriatric psychiatrist. Such specialists have seen it all, heard it all, and can help assess your mom's mental health.

It sounds l I'm me the case worker has had little exposure to BPD.

[pursuingJoy]

Methuen this sounds soo stressful. I think zachira offered every thought I have.

"Your mother has declined assisted living.  I hope at some point when you have explored your feelings with your therapist, that you will be able to discuss them with your mother".

Based on this statement I'm with you: I'm not at all confident she understands BPD and the responsibility was misplaced. This is not about you sharing your feelings more clearly, your mom needs specialized care and advocacy because she is mentally ill.

Very thin silver lining is that now you know, and like zachira and GaGrl suggested, you can find support in a supervisor or alternative professional. My hope is that we can offer you back-up so that you have the peace of mind to push back, clarify and ask for what you need.

I really hope you are able to find other professional advocates to help you carry this heavy, heavy load. Keep us posted on how this goes. We're here.

pj

[madeline7]

I had a similar situation with my recently widowed elderly uBPDm. The situation went on for a few years with me and my siblings attempting to help care for her in an independent living place. The continued manipulations, rages and silent treatment became too much for me. And when I no longer had support from my siblings, esp one who began ghosting me, I had had enough.
I found that many of the health care professionals were understanding, but as long as she had capacity, there was little I could do, and was told by her Doctor, private care manager and a social worker for senior services that we might have to wait for a crisis where she would end up in ER, and then things could finally happen and we could get appropriate care for her. I made sure to reach out to a variety of health care professionals, and a private care manager made several attempts to work with my Mom, but Mom refused. They ALL told me to take care of myself, that they did not want me to become one of their patients. It was soo hard to set limits and not swoop in to save her. Because no matter how much I did, it was never enough. And since she will not change, I choose not to let her bring me down with her.

[Methuen]

Thanks all for your words of support, and your suggestions. 

[pursuingJoy]

Methuen, keep us posted and let us know how we can help.

pj