Need Advice: Enjoy LC or Reach Out to Share New information

[Depression = 72% of members]

I need advice on whether to update my uBPD sibling on a new healthcare development with my mom or whether to let it lie as I am enjoying low contact.

The good news is my mother’s health has stabilized to the level that she no longer qualifies for home palliative nursing care. It is a great thing, but the services were amazing.My mother continues to need maximum assistance with all activities of daily level ( so no change in level of care) but no longer has skilled “Nursing Needs”. My sister “hated” the prior Palliative Physcian (because she had made the recommendation for higher level of care and my sister felt that was not a HC decision). In recent discussions she has emphasized her distrust of my mothers physician. When I was notified this week that mom would no longer receive these services, I decided to use the care transition to also transition my mothers primary physician back to her prior out patient geriatrician who has better communication skills and who is willing to engage (neutrally) with my sister and do home visits. I expect her professional opinion will be no different than the prior physician. She will have clean slate with my sister and likely better able to engage her positively. I don’t expect a different outcome, but given my sisters concerns, this has potential to be positive step for my mother and my sister and me.

It has all happened fairly quickly and while I was traveling for work. Interestingly, my sister who was so keen on weekly meetings has been LC last 3-4 weeks. Our last meeting was almost 4 weeks ago and we don’t have any time scheduled to talk. As everyone has said, LC/NC is so positive and allows me to focus on so many other things. As HC POA, this is all squarely my responsibility and I am not obligated legally to infrom her but I feel a moral obligation to do so.

I want a better relationship with my sister, but I am realistic that even this positive development will likely get distorted and create a new eruption. ( my sisters belief is my mom should be in hospice and this is going the other direction, the new doctor is not likely to put my mom on hospice or downgrade her care recommendations ) I keep coming back to her request to be included and my commitment to keep her informed. I want to be authentic and true to my values. If roles were reversed I would want to know about this. I am trying to figure how to frame it with her so it doesn’t erupt. I worry that she will misinterpret the no longer having skilled nursing needs to mean she can go to a lower level of care (not the case, daily care needs have increased not decreased, but my sister will likely choose not  to understand that logic)

I am considering focusing primarily on the opportunity to address “Her expressed concerns” regarding the prior physician and to get her input on the new physician, rather than focusing on the loss of home nursing benefits. That is making it more about her and her feelings. I am hoping that will be validating to her. In the past, however,  most my attempts to involve her, despite how well intended, created swirl.

I have so many other places to put my energy and attention and am hesitant to stir the hornets nest. I am conflicted though as I feel like I should keep her informed and have a sliver of hope that informing and engaging her with the new physician could be a step in healing some of the recent conflict. I am realistic that the chances of that might be < 50% and there is also a risk of more drama. At the end of the day, however my desire to treat her as I would be want to be treated, and to be authentic is compelling me. Avoiding conflict has not really worked, but being consistent with my values has helped me navigate the inevitable conflict.

I am a big Brene Brown fan, and in my normal life and relationships outside my sister, I  err on the side of transparency, vulnerability and openness; that has served me well. Much trickier here. My husband is vehemently against any contact or notification,  but I am leaning the other way. Interested in others thoughts.

[Mommydoc]

I need advice on whether to update my uBPD sibling on a new healthcare development with my mom or whether to let it lie as I am enjoying low contact.

The good news is my mother’s health has stabilized to the level that she no longer qualifies for home palliative nursing care. It is a great thing, but the services were amazing.My mother continues to need maximum assistance with all activities of daily level ( so no change in level of care) but no longer has skilled “Nursing Needs”. My sister “hated” the prior Palliative Physcian (because she had made the recommendation for higher level of care and my sister felt that was not a HC decision). In recent discussions she has emphasized her distrust of my mothers physician. When I was notified this week that mom would no longer receive these services, I decided to use the care transition to also transition my mothers primary physician back to her prior out patient geriatrician who has better communication skills and who is willing to engage (neutrally) with my sister and do home visits. I expect her professional opinion will be no different than the prior physician. She will have clean slate with my sister and likely better able to engage her positively. I don’t expect a different outcome, but given my sisters concerns, this has potential to be positive step for my mother and my sister and me.

It has all happened fairly quickly and while I was traveling for work. Interestingly, my sister who was so keen on weekly meetings has been LC last 3-4 weeks. Our last meeting was almost 4 weeks ago and we don’t have any time scheduled to talk. As everyone has said, LC/NC is so positive and allows me to focus on so many other things. As HC POA, this is all squarely my responsibility and I am not obligated legally to infrom her but I feel a moral obligation to do so.

I want a better relationship with my sister, but I am realistic that even this positive development will likely get distorted and create a new eruption. ( my sisters belief is my mom should be in hospice and this is going the other direction, the new doctor is not likely to put my mom on hospice or downgrade her care recommendations ) I keep coming back to her request to be included and my commitment to keep her informed. I want to be authentic and true to my values. If roles were reversed I would want to know about this. I am trying to figure how to frame it with her so it doesn’t erupt. I worry that she will misinterpret the no longer having skilled nursing needs to mean she can go to a lower level of care (not the case, daily care needs have increased not decreased, but my sister will likely choose not  to understand that logic)

I am considering focusing primarily on the opportunity to address “Her expressed concerns” regarding the prior physician and to get her input on the new physician, rather than focusing on the loss of home nursing benefits. That is making it more about her and her feelings. I am hoping that will be validating to her. In the past, however,  most my attempts to involve her, despite how well intended, created swirl.

I have so many other places to put my energy and attention and am hesitant to stir the hornets nest. I am conflicted though as I feel like I should keep her informed and have a sliver of hope that informing and engaging her with the new physician could be a step in healing some of the recent conflict. I am realistic that the chances of that might be < 50% and there is also a risk of more drama. At the end of the day, however my desire to treat her as I would be want to be treated, and to be authentic is compelling me. Avoiding conflict has not really worked, but being consistent with my values has helped me navigate the inevitable conflict.

I am a big Brene Brown fan, and in my normal life and relationships outside my sister, I  err on the side of transparency, vulnerability and openness; that has served me well. Much trickier here. My husband is vehemently against any contact or notification,  but I am leaning the other way. Interested in others thoughts.

[Riv3rW0lf]

I am not obligated legally to inform her but I feel a moral obligation to do so.

I am considering focusing primarily on the opportunity to address “Her expressed concerns” regarding the prior physician and to get her input on the new physician, rather than focusing on the loss of home nursing benefits. That is making it more about her and her feelings. I am hoping that will be validating to her. In the past, however,  most my attempts to involve her, despite how well intended, created swirl.

The thing is, the "swirl or no swirl" often has nothing to do with the actual situation, and everything to do with them. What would happen if you were to just: give her the information without trying to frame it, without trying to "manipulate" the reaction... Just tell her the latest developments and disengage. Let her react. And then reassess as needed?

I noticed, in myself, when dealing with my brother and mother, that I am rarely genuine. I am always looking for ways to frame what I am saying and often I find myself feeling stuck, knowing that no matter my answer: there will be blame. And so... If there will be blame and drama no matter the road... Maybe I should just be genuine from the start and then disengage from the reaction...

I think, for me anyway, the worst with BPD is : I end up changing myself over time to try and mitigate the crisis... Going as far as saying things I really don't think (like telling my mother I forgave her and she was a great mother (I really betrayed myself on this one and still feel angry at myself for telling her that). Then the crisis happen anyway, and in the process, I lose myself.

You mention often in your post how your values is authenticity, how you feel it important to share the information with her. I think the best thing you can do for yourself is to be loyal to yourself and to your value. The drama will happen, but at least, you will have been true to yourself. If you don't share, there will be drama anyway because you didn't share, and then not only will she blame you, but you will blame yourself too for not respecting your own values.

For the phrasing, I am sure other members here will have valuable insights.

I am personnally still tiptoeing around my brother, and always wondering how to talk. I think he knows I am not being genuine though, and I think this, in turn, might be one of the reason behind his own discomfort in the relationship somehow...

I have to learn to detach myself from their reaction... I know I have to stop my management of their emotions and crisis... It is not easy. But it's like... When I try to manage and it fails, and a crisis ensues, I feel even worst because I failed? If I would be genuine and true from the start, without manipulation, without control, then it falls on them to manage their own reaction? I don't know if that makes sense...

Once, I tried to manage my brother reaction and he saw right through it and then accused me of acting like I was better than him... And part of me felt guilty, because in a way, he was right. I did think I could manage him and failed.

[Mommydoc]

Riv3rWOlf, great feedback thank you.

I tried to manage my brother reaction and he saw right through it and then accused me of acting like I was better than him... And part of me felt guilty, because in a way, he was right. I did think I could manage him and failed.

My sister with uBPD is highly intuitive and definitely zeroes in on things if I were to try to manipulate her. I also find it is hard to be genuine with my sister. It is more about our relationship and her baggage and also less about me. I am a genuine person, I know that. In the past during brief positive periods between us, I made the mistake of being genuine, open and honest with her. It always came back to haunt me, and I have learned we just aren’t can’t have the relationship I would hope for. My therapist has emphasized the same thing. Being concise, factual and not worrying about the reaction, and basically expecting the typical/predictable reaction regardless. There is a beautiful freedom in that.

I definitely need to tell her, but it is how much and how to frame it to maximize the validation part  and minimize the risk of new can of worms, so I am not creating new problems for my self. Thanks so much!

[zachira]

Mommydoc,
I feel sad that you are having to try to figure out whether to reach out to your sister and how you would do so, after having some peace with no interaction with her recently, and knowing full well that she will likely turn your reaching out to her with new information about your mother's medical care into more drama and misery for you. There is really no right or wrong way to address this, just what feels the most comfortable for you, and is in yours and your mother's best interests. I have had to be extremely self protective with my dysfunctional family members at times instead of generous and kind, which is not my nature at all, yet I have learned that using the golden rule to interact with them, always backfires into an open invitation to accelerate their abuse.

[Notwendy]

My sister with uBPD is highly intuitive and definitely zeroes in on things if I were to try to manipulate her. I also find it is hard to be genuine with my sister.

Oh boy, I feel you!

So, there are many things we don't tell BPD mom ( boundaries ) and she knows it. She is highly intuitive and also manipulative. She will ask a question - as if she knows something- to bait you to reply. One example is calling up a sibling and asking " is everything OK with NW and her husband? " she made that up, but she's fishing - she's hoping sibling will "spill the secret" whatever it is. I went away for the weekend, didn't tell her much. She could tell I was being evasive. What she came up with is that I was sneaking off to get a face lift and didn't want anyone to know. FWIW I haven't done that. She made it up.

But my ethics are such that I don't want to embarrass her and one thing that does embarrass her is if we tell her extended family something and they ask her about it and she doesn't know. She needs to present herself as "in the know" about the grandchildren. I wouldn't tell them much either, but sometimes in conversation, they ask. So the other day they asked about one of the kids and I replied and realized that I had not told that to BPD mom, not to intentionally leave her out, but just didn't. So I tried to do damage control and she knew immediately. My tone of voice was anxious. She was triggered. So while my motive was to avoid her feeling left out, it backfired.

Why? because I was trying to mitigate her feelings. Trying to say something in a certain way to lessen her reaction and it didn't work.

The other option would have been to say nothing, let her get angry when the relatives tell her.

Mommydoc, I believe that when we aim to manage their feelings, we are darned if we do, darned if we don't.

I am thinking with your sister, maybe a biweekly update email on your mom to your sister. Scheduled and factual. So the next one "Mom is not eligible for hospice care and her primary doc is now in charge. If you set up some kind of schedule, it takes away the need to contact her for every update right away. Other than something urgent, just update her on a schedule. Takes the emotions off for you.

[Turkish]

in my normal life and relationships outside my sister, I  err on the side of transparency, vulnerability and openness; that has served me well.

I'm similar, and I think most of us here may be the same. It resulted in friction for me at work this week.

You have POA. Your mother is being taken for care of. I wouldn't volunteer information unless asked. That provides a target. You're doing the right thing taking care of your mother. Your sister doesn't need to be taken care of. Stress from her intereferes with your role in taking care of your mother. Default to the most vulnerable here (your mom) and be assured that you're doing the right thing.

[Methuen]

I'm probably mis-remembering, but wasn't there something a while back about your sister not replying or wanting to talk to you, after insisting that you keep her updated?  You mention you haven't heard from her in 3-4 weeks...

The whole situation is - blichk - uge - yucky.  Regardless of what you do or say, it's going to affect her "feelings" about you, your mom's situation, etc so you are going to be damned whatever you do.  Accept that.  

Can it be a simple short and factual email update?  Niceties probably aren't authentic, so just brief, informative and friendly.  To the person (BPD) who needs chaos, it probably doesn't matter how you frame it, she will erupt because she needs chaos, so I wouldn't bother investing energy into figuring out how to frame it.  Write it exactly as you would if it was a patient.  

I worry that she will misinterpret the no longer having skilled nursing needs to mean she can go to a lower level of care (not the case, daily care needs have increased not decreased, but my sister will likely choose not  to understand that logic)

In my experience, once a person with BPD "thinks" something, for them it is a "fact", and no amount of rational explaining will change what they think.  It will only escalate their feelings because now their thoughts have been invalidated.  To avoid all this, could you remove yourself as the relayer of the information (even though you are a doc) and have your mom's doc explain the change to your sister if further explaining is needed (after the email)?  That's an independent 3rd party and it takes the target off your back.  I know when my FIL was declining and advancing to end of life, his Dr would have phone conversations with both my H and H's sister (they live far away from each other).  Just a thought - maybe this could work for you too.

[Mommydoc]

Thank you for all the advice. I sent her the email. Brief, informative, friendly. Totally prepared for the eruption with no intention to own her reaction. I have been printing out our emails and text chains to create a paper trail.

To  avoid all this, could you remove yourself as the relayer of the information (even though you are a doc) and have your mom's doc explain the change to your sister if further explaining is needed (after the email)?  That's an independent 3rd party and it takes the target off your back.  I know when my FIL was declining and advancing to end of life, his Dr would have phone conversations with both my H and H's sister (they live far away from each other).  Just a thought - maybe this could work for you too.

I am  hoping that the new doctor can take on that role. I had tried that previously with my moms doctor, nurse and social worker team, but she painted them black and at a certain point they refused to talk to her because of her unreasonable behavior. Given she wasn’t POA, they just wanted to deal with me. The new doctor knows the story and is willing to engage. She is definitely a better communicator than the prior doctor. I also know she will be objective and be a neutral advocate for my moms needs. Ultimately from a documentation perspective, having a new doctor validate my moms needs and consistent recommendations creates a better paper trail.

No response to the email so far, but I stand ready for the eruption. It is what I have come to accept. I feel good about being straightforward and direct, and have no intention to get sucked into the dance.

[Notwendy]

Good for you.

It's good that the current doctor is willing to communicate to your sister. However, in time, she may paint them black as well.

With my BPD mother, she's painted most of her providers and helpers black over time.

I think my mother's primary doctor has done a great job with her care. For a while, my mother was painting him black. I was speaking to one of her relatives and mentioned this doctor and they were surprised that I liked him. My mother had told them he was terrible.

So it's hard to predict how your sister will perceive this new change but you holding on to what you know is the best for your mother and staying out of the drama as much as possible sounds like a good plan.

[formflier]

Hey Mommydoc,

It will be interesting to see how she responds to this.  I'm heartened that the new doctor seems open to communicate directly with your sister, I hope that is a blessing for you.

One thing I noticed.  Sometime along the lines of "I'm trying to figure out how to say it without her erupting".  Sadly..that's just not possible and also it will likely take up a lot of your time which is better spent on your Mom.

Probably more helpful to take an attitude of  "I feel morally obligated to reach out.  My sister often erupts at this type of news, so I need to mentally prepare for the consequences of communication."

Then...if she is fine..it's all bonus.  If she freaks..you are prepared.

Did the trip reimbursement all get handled?  Is she still making demands for support from those funds?

Good to "hear" from you again.  Hope you are doing well!

Best,

FF

[Mommydoc]

After 2 days, I got a response. “ I don’t why she doesn’t qualify given it is a progressive disease. It is my understanding that she probably qualifies for Hospice. Have you discussed?”  The doctor and team have  explained to her multiple times but she doesn’t accept their explanation. Both Home Health and Hospice are regulated and you have to have qualifying conditions. My mother is highly disabled requiring maximal care but her disease though progressive is not actually terminal. I don’t want to get into the same circular conversation. I offered to have her talk with my mothers new doctor, but of course no response to that. My response will be. I will ask her new doctor to discuss with you.

She sent a second follow up email. (they often come in threes) “Are you ready to start talking about her entire situation. The last time we talked you said you needed to take time off. I still haven’t received her records and agreements from the facility.” When she was here about 2 months ago, she went to the Director of Facility asking for “all records” for last seven years including for my dad who died 6 years ago. The Director initially said she couldn’t release to her, but I told her I was OK with giving her what she wanted in terms of any bills or financial documents. They have been communicating via email and now she wants to pull me in. I want to stay out of it.

I told her I was going away for my anniversary and couldn’t meet with her that weekend. We have had multiple calls, they are all circular, so do I want to resume them, no. Am I willing to, yes. But the list of topics financial etc that  I gave her of things to discuss have never been on her agenda. It is always a rehash of her feelings. If I say no, she will claim I am not including her in decisions. I intentionally stayed out of the request to the director for the records. It’s just like all the records she has requested from me. She gets them, probably doesn’t even read them, and it is a lot of work for nothing.  Because my list included cashing in a 5K life insurance policy and considering sale of out of state real estate, she is now morphing the conversation to mom shouldn’t be in this facility if we have to sell trust assets. I raised those things as things to discuss as doing both would make our jobs as executors much easier, not because my mom is running out of money. Probably not going to happen.

I have decided since it is a Monday work day, not to respond immediately. She waited more than 36 hours to respond, so I can do same.

Thanks for listening.

[Riv3rW0lf]

She really is trying to pull you in! But it's good that you notice! Congratulations on keeping your cool and choosing to "act" instead of "react". This is much harder that I initially thought when I went low contact with my mother, so I want to recognize your strength here. Waiting a few days before answering will also give you all the time you need to find your truth and how you want to approach this.

Letting the doctor discuss with her is a good idea. Another approach if the doctor doesn't want to , could be to " get her point " ... Like : "I understand you want the best care possible for our mother, this is also what I want for her. All possibilities were discussed with the doctors, and I have no further power over the situation. This is what the doctors thought best for her situation and I trust their professional judgment." How would she react to something like that ?

For the records : "You haven't received anything? That's strange! Maybe there was a mixed up, have you checked with them? Since there is nothing else new with her situation, I don't have anything more to add. I kept in mind your worries and opinions from our last discussion, and will update you as things continue to evolve."  Just brainstorming answers, but you will know what is best for you.

I think you are wise not to engage ! Hopefully, you can regain your headspace soon !  

[kells76]

Quick thought when I saw this:

My response will be. I will ask her new doctor to discuss with you.

What if we could help you do less?

I wonder how saying something like:

"Don't hesitate to reach out to New Doctor at 123-456-7890 about your thoughts on Mom and hospice"

would go...

It's not your job to ask the new doctor to call your sister. She's an adult and if she wants to discuss something with Mom's doctor, then as long as she has contact info, she can call. Not your job! Yay!

[Methuen]

What if we could help you do less?

I wonder how saying something like:

"Don't hesitate to reach out to New Doctor at 123-456-7890 about your thoughts on Mom and hospice"

would go...

It's not your job to ask the new doctor to call your sister. She's an adult and if she wants to discuss something with Mom's doctor, then as long as she has contact info, she can call. Not your job! Yay!

10 thumbs up  This "line" of advice is the type of thing my husband suggests and I have had such a hard time learning. I wouldn't have thought of it myself, but when I read it, I thought of my H who says this kind of thing to me ALL the time

Honestly, after a lifetime of tiptoeing around and trying to please a disordered person, it's like we have been "trained" to take the responsibility to "help" and "do" these things for them.  Of course she could think of this and ask your mom's doc herself right?  Why would she need you to tell the doctor to call her?  It's all a bit of a paradigm shift for us.  We just always try to be helpful, but sometimes I wonder if our "helping" feeds the drama.

What Kells76 (and my H) are suggesting  is a kind of shift in thinking - like a positive "re-education camp" - to the end of learning how to put the ball squarely back in their court.

[formflier]

I'm giving thumbs up to Kells76 suggestion. 

You can likely expand that to "can my sister do (fill in the blank) herself"  If it is possible, then you should back away.


So...switching gears.

Do you regret sending the email?  If I remember you felt some level of obligation to send her an update.

Best,

FF

[Mommydoc]

Wow, this is really great feedback. I love it! Thank you Riv3rWOlf for the acknowledgment. The email is written in my drafts and I am holding back on pressing send. It is concise but  puts everything back on her, while still being friendly. I agree it is harder than it seems like it should be, as I am literally de-programming myself to wait to press send.

kells76, your comments are brilliant in the simplicity, something I need to make a mantra

What if we could help you do less?

. Methuen’s comment further reinforces this for me.

What Kells76 (and my H) are suggesting  is a kind of shift in thinking - like a positive "re-education camp" - to the end of learning how to put the ball squarely back in their court.

Before I learned all the tools, I felt like a victim, and that she was the problem. It is very empowering to think of this as my journey, focusing on my thoughts, feelings and actions, while accepting her “as she is” and realizing I will never change how she feels. Her job, her work. I like Formfliers simple question:

can my sister do (fill in the blank) herself

And yes, I am glad I sent the email. I was enjoying LC and didn’t want to put more energy towards her. Having said that, one of the reasonable  things she requested of me was greater transparency. Transparency and authenticity are important values to me, and the way I was interacting with her was not consistently transparent, which didn’t feel good to me. Part of my forward journey, will be to balance transparency and kindness towards her with my own boundaries, assuring I am focusing my energy on my feelings and actions rather than hers. There is almost a yin/yang subtly to this, but I am feeling good about where I am.

I got a call yesterday from our property manager that our tenant is not going to renew their lease, which means this trust real estate investment will likely go negative cash flow. Realistically the property has appreciated nicely and we should sell before interest rates go up further. The  property has sentimental value for her, and she honestly thinks “It’s hers” . There is no way to have a rationale discussion. In the past, I would have avoided the conversation as it would trigger her, but now I feel differently. I will ask her opinion, will share mine, and if we aren’t on same page (which is likely), I will let it go. I don’t need to be right, I don’t need to win, but I also don’t need to fashion my comments to avoid triggering her. If me saying we should sell triggers her and she distorts my intent, so be it. It is the outcome I expect and am prepared for.

[formflier]

Are they going month to month or are they quitting the property at the end of the lease.

Why not just put it up for lease again.  My rental rates have skyrocketed...you may get a lot more per month.

Best,

FF

[Notwendy]

I agree with the other to do less. Is there someone else who can keep your sister informed- such as a social worker who can regularly update? I am thinking an email to both of you on a regular basis?

Not only are you doing your sister's work but also you may be over functioning on the medical side. You understand what is going on better than most people, so you feel you need to be the one to explain to your sister what is going on. However your mother's care team can do that too- speak directly to your sister.

One thing I noticed is that, even if I have experience or knowledge in an area, my BPD mother would prefer the opinion of a total stranger than mine- because BPD impacts the closest of relationships. You are an expert in your field, people believe you. But your sister may not be able to do that.

[Mommydoc]

You make a great point Notwendy.

you may be over functioning on the medical side. You understand what is going on better than most people, so you feel you need to be the one to explain to your sister what is going on. However your mother's care team can do that too- speak directly to your sister

This has been a challenge for sure. As POA most health information comes to me, and I am supposed to relay it. She then asks questions, and I would answer them. This created a power dynamic that was unhealthy for us and triggered her. I actively and intentionally stepped away from that role and asked the HC team to take that role, and they did, until they didn’t. My mothers nurse, her social worker and her physician took on that role willingly, and  went above and beyond consistently.  She behaved badly, so they moved away from individual conversations to family meetings, and worked to align and provide consistent messaging, then  finally at a certain point, they individually and collectively refused to deal with her and told me they were only going to deal with me. And that is where we have been for over a year. I continue to “Inform” her, but have stopped trying to explain to her. I ask for her input, but I make the decisions.  With minor things, I don’t bother, as it doesn’t seem worth it.

As an example, I don’t report every doctors visit, only if there is a change in treatment or new condition. Yesterday she had a video visit and got a cream for her skin. Didn’t mention it. Last week she got her 4th COVID shot. I let her know about that.

The doctor change might be a new opportunity. The new doctor has a clean slate. She is a better communicator and she is willing to have direct conversation with my sister, with my permission and appropriate boundaries. She is bringing a new social worker in as well.  It doesn’t change the circumstances and the recommendations are unlikely to change. My sister frequently rejects the medical recommendations regarding care as irrelevant, and goes to these are “Family” not “Medical” decisions. That is went it unravels.

I appreciate the new doctors willingness to take this on, and since the situation with the prior team had deteriorated so much, it is likely this will be better for a temporary time. But unless my sister’s behavior changes in response to the new team, it is likely to begin well (during her charming phase) and then deteriorate once they set boundaries.  I think there is a <10% chance that she will change her behavior towards this new team in the long run. My mindset is  different this time, as I will be as neutral as possible and act as a passive observer. The prior team was trying to support me and be a buffer, they really tried too hard, as they thought they could make things better. Realistically, the only person who can change the course of this is my sister, so the rest of us, have to just be clear on our roles and accept her reactions but not own or try to change them. I can do a better job in setting this team up for success by helping them set and maintain boundaries along with me.

[Notwendy]

But unless my sister’s behavior changes in response to the new team, it is likely to begin well (during her charming phase) and then deteriorate once they set boundaries.  I think there is a <10% chance that she will change her behavior towards this new team in the long run.

This is how my mother is with her health care team. As soon as any of them ( from helpers to providers ) has a boundary with her, she paints them black. She replaces the home health agency workers frequently. She was working with an excellent social worker who set some boundaries with her, then transferred her care to a nurse manager, now both are out.

This is the main issue: she needs to be in assisted living but refuses and needs to stay in control. She likes home helpers who she can control. If they don't comply with her, she wants someone else.

The heart of the issue is that she's non compliant with her medical team. At one point, her primary care doctor along with the social worker pushed the idea of assisted living. The social worker is now out of the picture. My mother decided to change doctors, then dismissed the new doctor and is back with her primary care doctor.

This doctor knows her well and is great with her, but he has boundaries and while she doesn't like that, I think she knows that he's the best choice for her. It can't be easy to deal with difficult patients, but he knows how to do that. Your sister may be difficult, but you can trust that your mother's doctor can handle her better than you can since this doctor is not related to her.

[zachira]

Maybe it would make sense to suggest that any communications with your sister and the medical team be only through email with you as a cc on all communications. The challenge is to limit the drama and your sister wearing out the medical team and you to the point that the medical team wants nothing to do with her, and you are back to square one, being the person who has to communicate with her.

[Mommydoc]

I am feeling good  about the medical part, and really trust the new doctor. I like your idea Zachira and will see if the team is willing to do it. They typically only communicate on the HIPPA compliant email app, which she doesn’t have access to as she is not POA, but maybe we can work something out. Giving her access is not something I am willing to do.

Now things are heating up in another way! My sister has been demanding 7 years of bills/ledgers and the original contract when my parents both moved into assisted living from the facility. I kept referring her to the facility director. The Director texted me today to say she is sending me the records instead of to my sister as she doesn’t have her listed as POA. She expressed concern that the total amount adds up to a lot and she is convinced it will trigger my sister. I wanted to stay out of it. My husband says just give it to her. He knows that my sister is making a case to say my mom can’t afford her current assisted living and he thinks that I can walk her through why her logic is faulty. I don’t think that logic works with her and worried about adding fuel to  the fire.  My husband is also suggesting we put in writing that we will cover my moms expenses if/when she has exhausted all of her assets. We think that is unlikely, but it is something we are prepared and ready to do. If the underlying issue is assuring an inheritance, which we suspect, it won’t satisfy her either. Well, end of day, nothing satisfies her.

And then she texted me today that she wants to talk about moving her out of the facility. The only good news is the director shared with me that a smaller room is coming available that is 25% less expensive. Yes I would need to move her again, but it would be pretty easy and not disruptive to her care at all. I feel certain this won’t appease my sister at all. I will need to set a firm boundary that moving mom out of her home for the last 7 years, where she is happy and well cared for is not something I will support or compromise on.

[Notwendy]

I think it might help to keep in mind that the demands your sister keeps making- the bills, upset that your mother isn't in hospice are really about a need of hers that she won't articulate clearly. So she's trying to keep a smokescreen around them ( but it seems transparent). You seem to be "putting out small fires" in different places, but it doesn't solve the issue for her, because the reason is different. It's not about your mother. Your sister either wants or needs money but can't say it because she knows it sounds bad. So instead she makes statements about "what dear mother needs".

Finding out your mother isn't in Hospice means, your mother's care will cost more. If money was not the reason for her demands on you, she wouldn't care about the cost of your mother's care. It's your mother's money not hers.

Is your sister that cold hearted? My guess is that it's more out of need/want. You have been accommodating to her, but it's not satisfied her wishes because it hasn't provided what she wants. It may be time for more solid boundaries with her, not less. Keeping her in the loop due to her unfounded accusations of you didn't meet her need.

One boundary is that- this is not her money. It's your mother's. She actually has no say in how it is spent.

Two- your mother put you in charge of medical decisions, not her.

I think it is very generous for you and your H to take over the cost of your mother's care if needed, but you have no obligation to put that in writing for your sister. If your sister hasn't signed anything, she won't be responsible for any of that as it is. It also sounds like she wouldn't have the assets to cover that anyway. If you pay for your mother's care, it's not got anything to do with your sister. In addition, while you may wish to do this now, you don't want to make yourselves liable by a statement that your sister could pull up any time in the future to accuse you of something you didn't do.

I like the idea of the smaller room, not because of your sister but for you. If it will not compromise your mother's care or her quality of life, it makes sense to preserve her assets by doing this. While you may be willing to cover her expenses, you also have your own retirement to save for so conserving your mother's assets, and yours as well, seems like a wise decision.

Your sister is not in charge of your mother's care and has no claim to your mother's money at the moment.  It may be that you need to hold that front, and have some outside auditor or something to protect yourself from her accusations if needed.

[formflier]

Hey...on the demand for 7 years worth of records.   Why not let the facilities decision to only send them to you solve it?  She isn't the POA, so the facility won't send her records.

On the one hand we KNOW that getting her the records is extremely unlikely to solve "it".  (do you agree?)

So, then the benefit of getting her the records is?

Have you consulted with an elder law attorney about applying for medicaid?  Does her current facility accept medicaid?  

(I'm meeting with elder law attorney for my Mom about this very issue on Monday.  All of our documents are in order, my question is about when to apply and how long it should take.)

The smaller room seems like a win win.


Best,

Allen

[Notwendy]

While you value your relationship with your sister, I think you can see how this is playing out. She demands something. You comply. She wants something else. This is the pattern of demand/you comply and yet, it doesn't meet what she wants. She makes accusations, you are on the defense.

Your H is well meaning but he's going on the assumption that a logical explanation of your mother's expenses will suffice. But while that understandably makes sense to him, he's not dealing with a logical person who states what they mean and mean what they says.

With BPD, it seems the issue they raise isn't the real issue. My BPD mother does this. She may want something, but she doesn't say directly what she wants, but makes other circular requests around it.

I posted before about my BPD mother offering to provide dinner for us when we travelled and then getting difficult over the food arrangements and not wanting me to call the restaurant to ask about food allergies because what she really wanted was to invite more people over but knew I wanted a quiet evening. If I had called the restaurant, I may have found out that the food order was larger than for just us.

When I said no to the whole thing, she then replied " you are depriving me of providing a nice dinner for my grandchildren".

You, Mommydoc, are trying to be the good sister to her, but in this triangle, you may be the "bad guy" in your sister's view regardless. You are under no obligation to send her the bills. IMHO, I'd hand them over to an accountant to manage if you have not done so already so you are not the constant subject of her harassment.

She may be in financial straits due to her own mismanaging money but can not be accountable for this. So you become the reason for her situation.

I understand this. You want to be "seen" by her as the good person you are. I also wish my mother could see my good intentions.

You are a good daughter, and a good sister- whether or not your sister can see that.

[Mommydoc]

Thanks Notwendy and Formflier. Our last few sessions she has dominated the “agenda”, all about her feelings.  I offered to talk with her this weekend, and said we should discuss the condo. It is a time sensitive discussion/ decision as our tenant is moving out, and we need to decide what rent to list it for and/or if we want to list to sell. I am OK with whatever she wants but don’t want another session talking about her feelings and all of my shortcomings…. And then I get the let’s talk about the facility. I will tell her we need to discuss the condo first, stick to 15 min and then if time, we can begin a conversation regarding BV, and I will open with smaller room option.

Notwendy, I remember the conversation regarding your mother and the dinner. You handled it really well, and I am going to try to  use your example to maintain  boundaries. I am a people pleaser by nature  and my parents always drummed in being a good big sister, so it has taken a lot of unlearning old patterns of behavior to allow her manage her own distress and not fix it.

FF, I totally agree that the records won’t solve it. I keep remembering the estate attorney advising that I give her the information she requests ( which is why I finally gave her the medical records and other financial records) which she never even acknowledged receipt of. She is financial POA, so I think if she chose to, she could force it, but it is all about getting my mom to another, less ideal/less expensive facility. I don’t need to  participate in that.  Medicaid is an option but she is many years away from qualifying and  likely won’t last that long. Good luck with your mom FF, agree it can be a long process.

I don’t need validation from her anymore. When she was here a couple months ago and raging at me, she pulled out a cup in a brown paper bag that said “worlds best sister” and shoved it at me. She said, “ I bought this for you a few years ago, but couldn’t give it to you, because I don’t think it anymore. Maybe things will change, so I will give it to you now”.  In the past that might have hurt, but in present it was laughable in the level of manipulation. I left the bag on the floor of my car until my husband cleaned my car out.

I appreciate the support and validation here; it gives me the strength to honor my parents and their intent. My dad before he died and my mom more recently both shared their insights on the relationship which also helped me let go of expecting or striving for a different situation with her. My goals today are to focus  my energy on my mom and immediate family where I can have healthy relationships.

I may offer my mom’s trust account financial advisor up as a resource to evaluate the trust  assets and make recommendations as another neutral party. He is willing to do it.

[zachira]

I agree with you that the medical team will likely only be willing to send emails to you and not your sister because she does not have POA. Maybe you can forward the emails to your sister and your husband. Possibly your husband could read your sister's replies and only let you know what is necessary.
I know you value treating others the way you would like to be treated. Unfortunately, giving any kind of attention to a person with BPD, just seems to add fuel to the fire, and is an incentive for escalating the conflict, many times when there was no real conflict to begin with, and as Notwendy has expressed, the BPD rarely tells you what they want. (It is always about something else; often they don't  know what they want, and there isn't anything anybody else could do that would make them happy.)

[Methuen]

It sounds like you are Health POA and your sister is financial POA so by demanding 7 years of health records, perhaps your sister is within her legal rights?  But is she alleging that the facility has mishandled the expenses or overcharged?  Did your mom express a desire to be there?  Are there independent 3rd parties that can verify that?  What is behind her demands?

He knows that my sister is making a case to say my mom can’t afford her current assisted living and he thinks that I can walk her through why her logic is faulty. I don’t think that logic works with her and worried about adding fuel to  the fire.  My husband is also suggesting we put in writing that we will cover my moms expenses if/when she has exhausted all of her assets.

Rational logic works when we are dealing with rational people.  It does not work with people who think with their feelings.  Furthermore, like NW states, the BPD does not express the real reason they are demanding something. IMHO this is based on shame.  So when you state you don’t think this will work, I suggest to you that you are right.  Rational arguements and defenses do not work with irrational people.  There is mental illness operating, and we cannot expect normal outcomes in an abnormal situation.  

I am wondering if there is any way you can think of to instead meet your sister on her emotional level?  Myself, my T and my H strategized this when my H had to deal with a disrorded sister over an inheritance.  To make a 7 year painfully long story short, when my H built and presented his case to his sister last summer on an emotional and factual level, rather than a rational level, he met with success.  While as executor he walked away with less than half the inheritance, before negotiations started, he was at zero for an amount.  We had access to certain information that we were able to leverage in a kind way, and it was important to SIL and BIL that they keep their self- held high regard of themselves and their reputation.  The bottom line is that if H had built a rational case instead of a case at an emotional level (with facts sprinkled in), he would have got zero.  
He started off by telling his story about the result her  actions had on him and our family,  but it was done with a lot of thought and no blame.  Just his truth. It was a victim impact statement.  In the end SIL and BIL did not want to risk their reputation especially with their church.  

Just my belief, but when dealing with an emotional person, one has to adapt strategies.

Furthermore, your H suggesting you put in writing that you will cover medical expenses once her asset’s are exhausted is likely to obtain the opposite of the desired result, because it will confirm her worst fears there will be nothing left for her.  

Your sister’s  behavior  is about your sister’s  needs after all, not your mom.  But optics are of utmost importance for her, so she will find a way to blame it all on you instead.

I would consider if there is a way to shift gears and approach this problem differently.  

[Notwendy]

Furthermore, your H suggesting you put in writing that you will cover medical expenses once her asset’s are exhausted is likely to obtain the opposite of the desired result, because it will confirm her worst fears there will be nothing left for her.  

Your sister’s  behavior  is about your sister’s  needs after all, not your mom.  But optics are of utmost importance for her, so she will find a way to blame it all on you instead.

This is wise advice. What your sister emotionally wants is unacceptable and she knows that. I don't think it's about her not caring about her mother but her being preoccupied with her own needs and looking at this as a solution (rather than deal with the issue in other ways - budgeting, etc). It's Karpman triangle. She's in victim position if she has financial issue. The "rescue" is your mother's money and since you stand between her and that, you are the persecutor in this scenario.

You offering to cover your mother's costs if fund are depleted doesn't solve her issue. She's not liable for this anyway. This doesn't solve the reason your sister wants to conserve your mother's money. So there is no reason for you to state this. Also you need to protect yourself. Saying this tells her "mom doesn't really need the money because I will take care of it" which might make her feel even more resentful of this situation and of you. I would suggest you don't make your intentions on writing to her.




 

[formflier]

Is your sister's signature or approval needed to move Mom to a smaller room?

I kinda doubt it so I can't imagine what good comes from discussing it with her.  I can see a bajillion ways it goes south.

Maybe same thing on the condo.  Before talking to her, get a rental price opinion and also a sales price opinion.

Given the market, I have to imagine that either option will do well for you...although selling it could end up with a big chunk of cash sitting around that she would push for/find things to be reimbursed for///etc etc.

If you keep renting until the estate is ready for a final settlement...it's much more of a "one and done" situation.

The more I think about it...renting it is much much better.

There was also a suggestion somewhere for your hubby to read the emails and "summarize" them for you.  Would he be willing to do that? 

Best,

FF