Senior citizen mother with BPD and now dementia

[Our abuse recovery guide]

I would love to hear from others here dealing with an aging BPD parent with dementia.

My 77-year-old mother has been showing clear signs of memory loss in the past 5 years. She was widowed three years ago, and has been living alone in her home since then, which is about 2 hours' drive from me. My sister and I have been trying to help her to decide to move to a continuing care or assisted living place by discussing it, showing her places we recommend, highlighting the benefits of it, etc. We know that it has to be her decision, yet our mother has so far refused to choose to move. Instead, she has been working hard for two years now to emotionally blackmail my sister, who is divorced and lives alone, to live with her. My sister and I both know that there is NO WAY our mother can live with either one of us--too toxic.

Thus far, our mother has seemed alright for independent living, but I am sensing transition. Her memory and coping skills seem to have worsened in the two years since we've been actively showing her continuing care or assisted living facilities. She seems to have had a couple of car incidents as a driver, which fortunately did not involve anyone else. Of course, being BPD, it is unclear when what she tells us or how she behaves is manipulation or when it is actually caused by dementia and memory challenges. Her stories may or may not be true, which complicates how we can assess what's really going on with her.

In any case, here we are. I've been the more proactive one working on getting my mother to reveal her total assets so I can help her financially plan for long term care. Being paranoid, she has only so far shown me a portion of her assets--tax returns, and two accounts, but not the other accounts I know our stepfather left her, nor the accounts my father left her. My intention is to eventually convince her to go see an elder care lawyer with me, so we can protect her assets and be ready to meet the financial challenges of long term care. I'm aiming to get durable Power of Attorney, as well as Health Proxy since her dementia is likely to worsen.

I am struggling with all the old baggage feelings that come up when dealing with this difficult person who is my mother, who won't cooperate. I'm beginning to think that she never will. I think her dementia is making it hard for her to "decide" to move. She seems fearful of changing familiarity. I think her BPD is making it hard for her to "want" to move. She thinks she should be cared for by one of her daughters, and it seems like she won't let this go. Two years and counting, and I feel like we are running out of time before dementia or some other issue, like falling and getting seriously injured at home, may happen.

So, we are stuck. No positive change is happening. And today, I am filled with worry: What's going to happen to her if she just stays living where she is? Hiring private aides to help her is not affordable for the long term. She's too far away for me to easily help. And I work; my sister works. What if? what if? what if? I also feel frustrated and anguished and sad. My mother lacks insight, she has tantrums, she makes everything so difficult! She is her own worst enemy and she doesn't know it, so she can't help herself. She just creates distorted blameful narratives where she is the victim over and over again. My cognitive self knows I'm doing all I can to compassionately help her, while setting boundaries and letting go. Maybe it just all has to go to pot, and it will take an emergency to change things...I hope not.

I am hoping to hear from others here who may be going through or have gone through similar circumstances with their aging BPD parent with dementia. How have you handled this--the pragmatic stuff like financial planning for long term care, and the emotional stuff like how to best help a needy BPD senior?
Thanks for your kind ear and support!

[ebklin]

I would love to hear from others here dealing with an aging BPD parent with dementia.

My 77-year-old mother has been showing clear signs of memory loss in the past 5 years. She was widowed three years ago, and has been living alone in her home since then, which is about 2 hours' drive from me. My sister and I have been trying to help her to decide to move to a continuing care or assisted living place by discussing it, showing her places we recommend, highlighting the benefits of it, etc. We know that it has to be her decision, yet our mother has so far refused to choose to move. Instead, she has been working hard for two years now to emotionally blackmail my sister, who is divorced and lives alone, to live with her. My sister and I both know that there is NO WAY our mother can live with either one of us--too toxic.

Thus far, our mother has seemed alright for independent living, but I am sensing transition. Her memory and coping skills seem to have worsened in the two years since we've been actively showing her continuing care or assisted living facilities. She seems to have had a couple of car incidents as a driver, which fortunately did not involve anyone else. Of course, being BPD, it is unclear when what she tells us or how she behaves is manipulation or when it is actually caused by dementia and memory challenges. Her stories may or may not be true, which complicates how we can assess what's really going on with her.

In any case, here we are. I've been the more proactive one working on getting my mother to reveal her total assets so I can help her financially plan for long term care. Being paranoid, she has only so far shown me a portion of her assets--tax returns, and two accounts, but not the other accounts I know our stepfather left her, nor the accounts my father left her. My intention is to eventually convince her to go see an elder care lawyer with me, so we can protect her assets and be ready to meet the financial challenges of long term care. I'm aiming to get durable Power of Attorney, as well as Health Proxy since her dementia is likely to worsen.

I am struggling with all the old baggage feelings that come up when dealing with this difficult person who is my mother, who won't cooperate. I'm beginning to think that she never will. I think her dementia is making it hard for her to "decide" to move. She seems fearful of changing familiarity. I think her BPD is making it hard for her to "want" to move. She thinks she should be cared for by one of her daughters, and it seems like she won't let this go. Two years and counting, and I feel like we are running out of time before dementia or some other issue, like falling and getting seriously injured at home, may happen.

So, we are stuck. No positive change is happening. And today, I am filled with worry: What's going to happen to her if she just stays living where she is? Hiring private aides to help her is not affordable for the long term. She's too far away for me to easily help. And I work; my sister works. What if? what if? what if? I also feel frustrated and anguished and sad. My mother lacks insight, she has tantrums, she makes everything so difficult! She is her own worst enemy and she doesn't know it, so she can't help herself. She just creates distorted blameful narratives where she is the victim over and over again. My cognitive self knows I'm doing all I can to compassionately help her, while setting boundaries and letting go. Maybe it just all has to go to pot, and it will take an emergency to change things...I hope not.

I am hoping to hear from others here who may be going through or have gone through similar circumstances with their aging BPD parent with dementia. How have you handled this--the pragmatic stuff like financial planning for long term care, and the emotional stuff like how to best help a needy BPD senior?
Thanks for your kind ear and support!

[Methuen]

Hi ebklin

My mom is uBPD, 83, living independently with complex physical health problems, ADHD, uPTSD, and it has been suggested to us by a health care professional that she is probably uODD (oppositional defiance disorder) as well.  I was also told 5 years ago that mom has "binswangers" which I believe leads to vascular dementia.  The signs are there.  I get it.  There's a group of us on this board dealing with aging parents.  

I don't have much time here to reply, but my first question is:  does she have an existing Will?  How old is it?

I'm guessing she may have had a Will with her partner before she became a widow?

An enduring POA is important.  Do you know if she already has one, or are you assuming she doesn't because she's never spoken of it?

Hiring private aides to help her is not affordable for the long term.

Sometimes old people talk like they are in poverty.  It's like a badge they can wear.  Especially if they lived through the war.  But sometimes they have money squirrelled away they don't acknowledge to anyone, maybe not even themselves.

How familiar are you with her finances?

Also, depending on where you live, your local health authority may provide assistance for home care services if your mom gets assessed and qualifies.  Then she may not have to pay anything.  A trip to the Dr with your mom can get that process going.  That's what I did, which is another story.

 

[zachira]

I am sorry you and your sister are having to deal with a senior citizen mother with BPD who has dementia. You want to know how others have handled a situation like this. My elderly mother with BPD and obvious signs of dementia died this summer. My mother never viewed her children as separate people from herself. She groomed my youngest brother to be her caretaker in old age. When my youngest brother was terminally ill and could die any day, mom abused him to the point that social services had to get involved, and mom's ongoing concern was only that my brother would not be available to take care of her, and she took her anger out on him that somehow he had failed her by dying of cancer. My other brother who has BPD ended up living with my mother for years until she died. I think it is likely that it is just too scary for your mother to leave her home and live in a assisted living. If your mother were to go to an assisted living, she would have to adjust to the norms, which it does not sound like she has the capacity to do, though these places are usually familiar with how to handle elderly residents with difficult personalities and/or dementia.  In the meantime, I think your best bet is to get her evaluated to see if she is at the point where she is unable to live on her own, because then you would have the legal means to get her to go to assisted living. I am glad you and your sister both recognize you cannot live with your mother and you are protecting yourselves. I wish I could be more helpful. My heart goes out to both you and your sister.

[GaGrl]

My husband and I have my mother living with us -- she is 93, we are 66 and 70. I am on this forum because my husband's ex is a flaming uBPD/NPD and continues to disrupt our family system through their shared adult children. However, my mom has some BPD traits from having been what I call "un-mothered" by a uBPD/NPD stepmother after her own mother's death (very young, very tragic).

I truly feel my mom is best cared for in our home. That doesn't mean it's easy. She is cognitively sharp, in charge of her finances, socially tapped into her church and friends. She can also get offended, great us with the silent treatment, etc.

Now here's the difference between traits and full-blown BPD -- I can have a rational conversation with my mom about finances, power of attorney, final wishes for her funeral, etc. Without her going off the ledge. Just some perspective there...it's a spectrum, so where does your mom fall?

I would ask your mom's internist/primary physician for a referral to a geriatric specialist who can do a full work-up.

[ebklin]

Thank you, Methuen, for your reply.
My mother does has a will. It's how to help her with her current living situation that I'm concerned about for financial planning. I do have an idea of her assets, and she will have to pay personally for a home aide. If we go that route, her assets will easily be depleted as time goes on and she needs more help at home. What I'm hoping to set in place now is to get her to an elder care lawyer to help protect assets in preparation for moving to assisted living. I'm fairly sure she has not designated a POA. It may be that she will not agree to any of the suggestions my sister and I offer. She only wants what she wants, which is to live with one of us. She seems intent to keep pounding on that, and has not let that go for two years now, and counting...Meanwhile, her memory is not getting better.

[ebklin]

Hi Zachira, aw, what you shared about your younger brother is so sad, I'm sorry it all went like that. It must have been difficult for him as he was ailing. My mother similarly took her anger out on all family members as my father, her first husband, was ailing and died.
You may be right about my mother not being able to handle moving because of dementia and needing familiarity. I am beginning to think that myself.
I will try to get her to see a doctor about her mental condition, but she is very suspicious of everything and I don't see it happening readily.

[ebklin]

Now here's the difference between traits and full-blown BPD -- I can have a rational conversation with my mom about finances, power of attorney, final wishes for her funeral, etc. Without her going off the ledge. Just some perspective there...it's a spectrum, so where does your mom fall?

I would ask your mom's internist/primary physician for a referral to a geriatric specialist who can do a full work-up.

My mom falls off the ledge! She can't seem to handle any rational conversations about planning, but I think it's because she's hearing from me and my sister what she does NOT WANT to hear, so she does a BPD shutdown by blaming and having emotional meltdowns. How much of this is dementia, I don't know. This is the thing I'm wrangling with now. Thanks for the suggestion about getting my mom's primary care physician to refer her to a specialist. I will work on that.

[GaGrl]

Sometimes they are more open to hearing Truth from an outstretched a physician than from a family member.

I've been really impressed with what geriatric psychiatrists and geriatric internists, etc. have been able to do with my friend's parents.

[TelHill]

My 90 year old mom was having delusions. We took her to a neurologist & she had a CT Scan and an MRI. Long story short, she was faking it.

Is she willing to go to a doctor for testing of cognition? You should ask her doctor to include it during  a routine checkup.

I’d be wary of calling Adult Protective Services to force a doctor’s visit if she’s unwilling. She could accuse you of elder abuse.

You and you sister may want to consider taking a break from mom for a few months. This push-pull is taking a toll on you. It will show mom that you have the courage to pull away from her, and call her on her self-centered behavior. 

Good luck and wishing you the best.

[Turkish]

I went through a similar thing a few years ago.  Ultimately, Adult Protective Services was involved. They were very helpful.

Later, as next of kin, I was contacted of I wanted Conservatorship which would have included POA regarding health and financial decisions.  That was after I was cleared of stealing her money by investigation 

What I learned is that it ultimately falls upon next of kin if the person is unable to advocate for themselves.  It sounds like your mother is in a state of transition.

I am also two hours away and it's hard to deal with these issues given the distance.

[spotlight]

I have recently returned home to Canada from living in the UK for 7 years. I saw my family sporadically during that time but not for 2 1/2 years until I moved home.  It has become apparent my mum (uBPD) is having memory issues since before I returned.  Some days are worse than others for sure, and she seems to bring it up often -- saying that we must think she has Alzheimer's, but only in a way to try and banish us for thinking such.  Almost as if there is so much shame if she was having memory slips... trying to deflect blame as she does everything else.  For something which doesn't come with blame.   As she has other cardiovascular issues and COPD I think it is the onset of vascular dementia. 
My main concern is of course care in the long term (my mum and dad still live together, my dad is pretty fit and well but also 3 1/2 years older than my mum at 75) but also that her BPD is being compounded by memory problems -- her obsession with running the windshield wipers even when she is not driving (she rarely drives any more), and her forgetfulness of the correct settings, nearly caused us a car accident a couple of months ago.  My fear is that it is only a matter of time until she does something even more dangerous than she has done in the past and it causes serious injury or damage.  My dad is unwilling to try to broach the subject -- either with the doctor let alone my mum -- to try and get her help, until something serious happens.  (He hopes if something serious happens she will see sense, I think.  But it may be too late to save my dad, or my mum, by that point.)  My mum keeps us all between a rock and a hard place.  My sister and I are trying to develop a plan, a way to help, a sort of gentle intervention.  A way to gently approach this without having to constantly avoid the elephant in the room until it blows up.

I hope you have found some thoughts about how to get your mum some help.  As with you I have a sister and my mum has already suggested that if she survives my dad, she would need to come move in with me or my sister.  Which for both of us would be absolutely untenable long term.

[ebklin]

Hi Spotlight,
I hear you and feel for you regarding the blame, odd behavior, and obstructions you get from your mother.

This pandemic time period certainly creates more challenges in caring for already difficult family members, as they face more isolation, and in the case of my mother, more loneliness and boredom living by herself.

As for me, I've been learning how to take things a step at a time. I cannot do any more than offer the best help I can (within reason and having healthy boundaries) and if I meet with resistance, suspicion, blame, anger, or any other obstruction or difficulty my mother presents, I always try to talk calmly to let her know her options (as defined by me) and that within those options, it is her choice. She has still not let go of her stubborn insistence to force or guilt or manipulate her way into living with me or my sister. I just repeat myself and say, I'm sorry, that is not an option, but here are some good options--and redirect. Sometimes, when she is in a good mood, it works, and she says, yes, she would like to move to the senior citizen community place I have identified as a good independent living location but which has staff to assist right there when/if needed. Other times, when she is in a BPD bad mood, she yells, blames, wishes ill, and hangs up on me or if I'm with her in person, tries to order me around. Actually, it is very much like coping with a toddler having a meltdown. There's no rationalizing. One just has to say, ok, I'm sorry you feel upset, but here are your choices. You can stay as you are and continue a meltdown, which is no fun, or you can choose x, y or z (as defined by me) and we can move on and have a more enjoyable time. It's your choice. That has worked, too.

I am still unable to get her to address POA. We succeeded in getting her to choose a lawyer she trusts, and we made an appointment, but then she cancelled only days before the meeting. I will continue to try, but if she remains suspicious and unwilling, I will just accept that it may not happen, and perhaps I may have to go to court to gain access to help her after some event or emergency happens. I am also unable to get her to go to her general practitioner. My mother has remained suspicious about doctor visits, too, even when she claims she has an ailment (probably often a manipulation tactic) she will not go with me or my sister to see her own doctor. So that avenue of enlisting the doctor's help in this geriatric situation is basically shut down, too.

It is what it is--that is what I patiently tell myself, and I only do what I can do in the present moment.