Having to use POA to override BPD mother

[SaltyDawg]

NW,

   I can see your perspective of the inheritance going to the Golden Child.  I am glad that the GC is in agreement.

   It sounds like you have a good head on your shoulders and your ideas are sound - I believe and feel that you are doing the right thing with your stated intentions.

   Hugs and good luck.

SD

[zachira]

One of the biggest challenges in your situation is some people, mainly your mother, are going to be extremely critical of what you do, no matter if it is in your mother's best interests and done with a lot of time, efforts on your part in figuring out what is best for your mother. At some point, we have to mitigate living in fear of how people like our disordered family members are going to react and take revenge on us for not getting their way. It does not mean we can totally let our guard down. You have a lot of people who respect you and understand how you are doing what is in your mother's best interests and despite how badly your mother treats you, are still helping her. Can you tell us who are the people who do support you and are there to help you? There are probably a lot more people than you think and realizing who those people are and focusing on them and reaching out to them in the difficult moments may make this easier to bear. Sometimes I wonder if you feel you are all alone and nobody quite gets it, and you are right about this to a certain point. We are unique and nobody will every fully get us, though there are always people who get important parts of us, and those are the people who become our allies and sometimes our closest friends, though no individual will ever be fully understood by anybody. The aloneness is compounded by being a family scapegoat, especially one of a BPD mother, always being told that our point of view is wrong and living in fear of the pain of their revenge. You are a caring person and no doubt well liked by your mother's caregivers who probably wish they could tell you they get the situation you are in, and don't say much because they feel uncomfortable doing so. Do let your mother's caregivers do as much of the work of taking care of your mother as you can, and ask for their advice. They will help you as they see these situations regularly. I hope at some point, you will feel a little bit lighter and taking care of your mother will be less of a burden for you because you feel the support and respect of so many people, including the members on this site.

[GaGrl]

NW, how soon do you have to have the conversation with your mother about staying in the SNF indefinitely?

Is the conversation itself -- and your mother's resulting reaction -- causing you the most angst right now?

[Mommydoc]

NW, thanks for explaining the inheritance. It makes sense.

I had a thought… have you talked to the AL Director? In my recent circumstance, my mothers AL Director wanted to move my mom to a Skilled Nursing Facility because of the location of and severity of her pressure ulcer. I had to arrange additional care and they ultimately agreed because they knew she was dying and it was her wish to die there (what she considered home). I am just wondering at what point they force the issue and it isn’t your decision, even though you support and want the same thing?

[Notwendy]

My mother's case manager has advised me to not involve the AL. This is a high cost, nice place in a metro area and they have access to health care providers. Even though state regulations don't allow a grade 3 pressure sore, they bypass this with bringing in their own specialists so they will recruit her back.

GaGirl, the confrontation with my mother will be a miserable situation. She's determined to not stay there and is manipulative. She has paid people to do almost anything for her (off he record). She also talks a good game in the short run ( in the long run she unravels) and has a way of sweet talking people. She's wiley and devious. I am not speaking to her until the ducks are in row as I don't want to tip her off. My fear isn't confronting her, it's that she could find some way to get herself out of this, even with bedsores.

People ask well why not let her just go and face the consequences. I have considered that. Her funds would cover a lower cost place if she could not afford this one. It would be better for her to stay where she is so I at least want to give this one a chance.

[zachira]

What does your mother having her ducks in a row mean to you?

[Notwendy]

That is me having the ducks in a row- that means all the plans need to be in place, because she will argue with me or anyone else over details. I and her other family members have had discusssions with her but discussions don't work, reasoning with her doesn't work.

[zachira]

You may never be able to explain to your mother what the plans are. You are right that she will argue with you about everything. This is why I gave up talking to my NPD sister and a lot of my disordered family members, as I always had to be made wrong because I am one of the family scapegoats. It feels so uncomfortable not to be able to explain because if it were us, we would want to know what is going on so we could accept the situation and cooperate with the people who are trying to help us. You and your mother are two completely different people.

[SaltyDawg]

Perhaps treat your plans (ducks in a row) like classified data.  Only tell her and/or your sibling what they really need to know - and this can be different for each, and keep the rest to yourself and her health care team.

[Notwendy]

Classified data would have been nice but someone at the facility told her what the recommendation and the plans were.

She then, mounted her campaign to go against them. She's very good at enlisting rescuers and manipulating them. She appealed to the PT and OT therapists (probably as a victim of her terrible daughter- I know this woman and how she works) and they rallied for her at the care plan meeting. It is now documented that she is legally competent and will be the one to make the decision.

Or as the social worker told me when my father was ill and left BPD mother in charge of his decisions (and this is so deja vu of when I was attempting to act in his best interest then) "your father is legally comepetent to make his own bad decisions".

Next step is to leave this between the skilled nursing facility and the AL. Case manager has presented her medical situation to the AL. Now it is up to them to decide if they can handle it. Once they meet with her, she will likely persuade them too.

Once I heard this, I felt relieved actually, (albeit aggravated at her behavior but that's how she opperates so it's not new to me) - relieved that I am not the one to go against her wishes because I know how she reacts to not getting her way and it's horrible. That said- if it was my role to do it in her best interest- I would have done it.

The issue of her reckless spending has been brought up and is documented. I can't do anything about that either. I realize that it may cause her other issues later but it's up to her. I raised the question of other people exploiting her and there's been a report to adult protective services. If they ask, I would be happy to provide her bank info to them and they can see for themselves what is going on. I don't put it past her to accuse me either but they would find nothing if they looked to support that and with the statement that she makes own decisions, no reason for me to intervene.

Whatever happens, people know I have tried all I could as this has been going on for a while now. Most important is that her family has seen this and knows, so they won't think I have been neglectful. They have tried too and she's undermined them several times. The social worker and case manager know I have tried as well and that she is considered in charge of her own decisions.

What will I do? I haven't talked to her in a while. She has not called me. I am actually happy with the distance. I don't want to talk to her at the moment. I plan to back off as much as possible and not engage with her unless necessary. I have been more involved due to her condition and it's been disruptive.

One of her relatives commented to me that "this is how it happens- she always wins- when it comes to any conflict. She finds some way to get her way". This is true because she's very skilled at this and her goal is to do this. It's not possible to have a collaborative relationship with her.

This also has given me perspective on what happened when I tried to intervene on behalf of my father. But she was out to "win" and she did. Same pattern here. For now, it's between the AL and the skilled nursing and her and I will stay out of this. She can sign her own forms with them.

I am actually feeling more calm now

[Methuen]

I am sorry that happened NW.  Sadly, this world is full of people who think they know more than they do.

Information is power.

My question is:  why did the PT or the OT or whomever it was think they had the authority to share this in with her, over the family or admin?

I would even question whether it was necessary and appropriate for them to have this information in the first place.

If the docs and family and social worker and admin are all on the same page, why did the PT/OT interfere?  Is that outside of their professional scope?  Especially since it could lead to real financial or medical harm to the patient?

In your place, I would ask hard questions, but that’s just me.

You could request that their actions be reviewed, so this doesn’t happen again to some other poor family.

[Notwendy]

I don't know who presented the plan. She is allowed to be present at care meetings, and she was at one of the recent ones. Since she has been working with PT and OT- she has spent more time with them. She has met their "goals" for her- which are to be able to walk with a walker to the bathroom and down the hall. She still needs assistance but that isn't their domain. Since she meets their goals, they are allowed to "discharge her" from PT, OT and they have done that. They may have made the request for evaluation. She can pass a mental status exam. She's certainly capable of scheming and manipulation. Technically she is free to do what she wants if the AL will accept her.

That's the hitch. The case worker has made it clear to them what her needs are. They have to determine if they can meet her needs or not. BPD mother can certainly push them with this decision. Ultimately- they are on the line if they accept her back and the recommendations that she needs skilled nursing care are there. So now it's in their hands. This is actually better for me. I am now not involved in this decision. I plan to make it known that I am not going to be a part of it, not going to sign for anything. This is now between my mother's wish to go to her AL and the AL to debate.

[GaGrl]

If your mother is able to go back to AL, it will probably start another cycle -- fall, hospitalization, skilled nursing, etc.

For the time being, the pressure is off you to make any decisions or take any action. So take a breath.

You are seeing patterns that help you understand what is going on with your mother. As this cycle continues, she will eventually lack the physical and mental resources to continue forcing her will on her care situation. But that may not happen for a while.

[zachira]

Lots of respect for your decisions at this time. Since there is nothing you can do about how your mother gets her way, it gives you the freedom to follow through on your decision to not be involved for now. I am sure there are lots of people who take care of your mother who see what is happening and they cannot override her decisions. My mother was making some terrible financial decisions several years ago and her lawyer explained to me there was nothing I could do, as she was still capable of making her own decisions (though obviously impaired and mentally declining in dealing with reality from my experiences with her).It seems with people with BPD, control is the last thing they have, and they will hang onto it until the end.

[So Stressed]

Wendy, I'm so sorry to read that you have all this to deal with. I understand the challenges, as I know how impossible my mother can be.

[Notwendy]

Thanks, I realize this is a game to her, with empathy as the hook. I fell into it as she had been ill recently. As sick as she was, her health care providers were calling me for consent as they didn't think she was capable of that but now she has recovered enough to do that.

Part of my efforts are also for her family. They are supportive of me but they are recently more "new" to her behaviors and they still wanted to try to be helpful to her. She's sabotaged their efforts a few times but they still wanted to try. The hope was that she could stay in the higher cost facility while she still had the funds for it. I think they also have seen the futility of any attempts to intervene on her behalf.

At this point, it is now up to the AL to decide if they can meet her needs or not. The case manager has made the proposal to them that her needs exceed what they can provide for her. Whether or not they are able to meet them is now between them and my mother. It's actually felt a lot more peaceful to not be involved in this decision with her. There will be some care plan meetings and I plan to say as little as possible- and make it clear that she decides, she signs whatever papers need to be signed, I will not.

[zachira]

Now that the Assisted Living knows what kind of resident your mother is, do you think they will take her back? Is the money the Assisted Living would make from your mother having round the clock individual paid care an incentive for the Assisted Living to take her back? Does the Assisted Living have nursing care and would the Assisted Living be at risk of being sued with a resident who qualifies for a nursing home? All things to perhaps think about or not think about. It is really out of your control and you have accepted that. You have done everything possible to protect your mother and you are protecting yourself by having your mother be the one to sign all the documents without your signature. Your mother may run out of money and if so, Medicaid would pay for her care in a much less desirable facility with a shared room, which you have done everything possible to prevent from happening. Once again, so much respect for how you are handling your difficult mother, and not taking what she does personally.

[Notwendy]

The AL doesn't provide the extra full time aides so they don't benefit from that. I would think the staff doesn't mind as it's less stress for them to have them there.

BPD mother's point of view is - she wants to do what she wants. This means, she spends her savings down to zero. This is what she wants and she doesn't care about anything else.

What is interesting is the sudden change from the nursing home social worker encouraging me to use my POA to have her stay there because it is the best situation for her to the position of her being legally competend to make her own decisions.

We had a care meeting by phone. BPD mother was there as well. That was my cue to stay quiet except for a few neutral  questions such as how are the bedsores? They had two social workers there- I think they anticipated a family disagreement over the issue.I  figured they might push for my mother's position. I planned to just let things go as they would.

The OT/PT representative sounded young and has only heard what BPD mother tells her. Then BPD mother starts with the "my family is making me stay here, they just want to dump me in a nursing home. If I can't go back to the AL, where will I go, what will I do, do I have to stay in half a room forever? My family is just dumping me here" ( at the best nusing facility in the area)

The AL will likely accept her. The wounds are healing up well. They are not likely to be grade 3 when the AL assists her. What a useless endeavor on my part but I really believed she was at the point where I needed to step in.

[Turkish]

On my last call/zoom, one of the nurses at the home said, "I never see anyone come see her." I felt like a putz. Yet >2 years of covid lockdowns??? You know my story of getting grief from multiple sectors even before she ended up under county conservatorship before covid. People will think what they think no matter what you do.

[Notwendy]

Yes, Turkish- I think this happens- when we just can't manage a relationship with them after trying many times to. You even tried having your mother in your home for a while.

I got agitated at her during a phone call a while back. People in her room heard that. I got the feeling she had set that up after that.

Her medical needs are high. What we have noticed is that her health and well being improve when she's in this center. The food is good and she likes it. They also have her drinking protein drinks and going to PT. When she is in the AL- she does worse- not due to the fault of the AL but with her own actions-choosing cookies for meals, not going to any activities.

I think it's important to let people be self directed - and yes, it's much nicer to be in her own room at AL, but she can't manage herself there. She can meet the criteria for AL physically, but emotionally she's high need and yet, she holds it together when they assess her so they don't see it.  The choice of the nursing home facility was not based on any "dumping" but on her needs and the results we see when she's there. The shared room isn't as nice but the rest of it is good. She can have her snacks there too if she wants.

Well, if she wants to pull the "family is dumping"--- accuse her family - who have tried to help her in many ways and she has sabotaged it- that's her choice.

There was an elderly woman in our community who we would visit. She was in her own home with assistance- she had saved for that. She has daughters who live out of state. We didn't ever see the daughters. Maybe people questioned that but I didn't. I know how pwBPD can be very pleasant with aquaintances and be different with their own family. I don't know if she had BPD or not. I couldn't tell and it didn't matter. As a visitor- all was fine, but I also know it may not be that way with everyone. I see how people can jump to the conclusion that the family is neglectful, but there's no way to know the dynamics in a family.

[Mommydoc]

NW, I am sorry that you had to expend so much emotional energy and didn’t get the outcome that is likely best for your mother. You did everything and have to be content with that. My mom’s hospice nurse told me “ you have done everything possible for your sister, the rest is in her hands, and you have to let her be her, there is nothing more you can do.”

It may come down to radical acceptance. I am learning with help from all of you, that it is OK to embrace the sadness that comes with accepting the reality of my situation. My sister will never accept responsibility, she will always resent me and project anger on me, and she will never appreciate all I did to care for mom. She won’t recognize the lengths I went to, to support her and her relationship with my mom. It is what it is. I have no regrets, other than how long it took me to put truly effective boundaries in place.  It really doesn’t matter what anyone else think Turkish, as we all know in our hearts how hard we try. We know that part of our own learning journey is to have boundaries and stop putting in 200% with hope for a different reality. Acceptance of our reality is so hard, but also incredibly freeing.

NotWendy, please take this as an opportunity to distance yourself, let go and focus on yourself and your needs. You deserve self care too!

[zachira]

It wasn't a useless endeavor on your part. You stepped in because you thought you needed to. It sounds like it was necessary and in your mother's best interests. It seems you have made the decision to not step in again as your mother won't accept your help, unless she is deemed completely incapable of making her own decisions by the medical staff. So sad that the medical staff is now taking her side, though I don't think all of them are fooled by her, likely doing what is legal.

[Notwendy]

Thanks all-
I feel relieved, got a good night's sleep for the first time in a few weeks. I think it's because I do feel I have done all I can do for her own well being and she's determined her course. Her family knows that too.

I don't think the medical team at the nursing home bought into her act- other than the young PT who she could influence. I got the sense that social workers were playing to her narcisism- on purpose. They told her they would "treat her like a special guest" . She's all over that "they told me they had my back" but I don't believe they bought into it. Her case manager doesn't. I think it's clear that this place meets her needs the best but if she doesn't want to be there, it will be a misrable situation. The staff is aware of her behavior as she does it with them too. I am actually surprised that they accepted her another time after her last visit there.

She thinks she's outsmarted me but she's actually naive to what she's doing to herself. She has no clue about how long term care vs assisted living works. It wasn't that anyone had a preference for her staying there. One can not just put someone into a nursing home. She qualified and it met her needs better than the AL could. She also has no clue how private pay or Medicaid works. Without her savings, she reduces her chances of getting a choice of being there if she were to need it for ling term care, and that is known for being a good facility.

But whether or not that happens, it's completely out of my hands. I don't need to try to step in or explain it to her. That doesn't work anyway.

[zachira]

You are so wise to just let the medical staff be involved in helping your mother decide where she is going to go, be it Assisted Living or staying where she is. You have done all you can do. Glad you are feeling better and getting some rest.

[SaltyDawg]

NW,

   It sounds like you went above and beyond, and have done everything you possibly could have done. 

   I know it is bitter-sweet - at least you might be able to have a clear conscience know this.

   I'm sure this all has been very stressful for you, please be sure to do some much needed self-care this weekend.

   Take care with self-care.

SD

[Turkish]

I'll forever admire my mom's APS social worker. I gleaned how tough it is to deal with crotchety older folks (I hope I'm not one later!). At least professionals are protected which is why I felt less badly turning it over to her. She didn't give my any grief whatsoever about how I was dealing with it. If she thought less of me, she hid it well.

[Notwendy]

I'd be willing to bet that the APS worker has seen all kinds of situations and doesn't question. It's people who don't know these situations who do.

I think the staff at the facility are aware of my mother's behaviors. She engages in them with whoever is helping her. I think they were placating her to avoid a possible scene. I noticed there were two social workers at the meeting- the one working with my mother and the supervisor- not to supervise the main social worker- I think they were on guard for a possible escalation.

They know my mother better than they know me, and perhaps they were anticipating a family argument. My mother may have said her family was "dumping" her as possible argument bait with me- but I didn't respond. There was no escalating on my part. Mostly I listened to what the medical team had to say.

What will self care be like? One is distance. Speaking to her less and looking at ways to dimimish contact with her, not NC but less. The staff at her assisted living ( where she will likely return to) will call me if there's something I need to know.

[livednlearned]

It may come down to radical acceptance. I am learning with help from all of you, that it is OK to embrace the sadness that comes with accepting the reality of my situation.

This is what I've been learning here too.

I have to radically accept that disordered people make decisions that are theirs to make, and the consequences are theirs as well.

I may be impacted by these decisions and consequences but I also have choices.

Lately I have been doing this visualization with my parents where I imagine they have something happening in their nervous system that they would like me to take from them and manage. Often it is quite busy and unpleasant and there isn't much I can do with it so I wordlessly decline.

Because so much of this is not conscious for them, they do not usually understand, even if they do seem to notice that a pattern has changed. Since it was a wordless exchange (I'll pass on this offer), there is not really a target for their distress and it so it dissipates around me instead of leveling me.

[zachira]

I have just learned that there are different kinds of POAs. I always thought there was just one kind. Some institutions like financial ones like Vanguard require that there specific form be filled out for a POA to be honored. I realize that this may not be of much help to Notwendy and may be helpful to others who are in the process of getting a POA for an elderly parent. I was shocked that Notwendy's POA was not honored.

[zachira]

I have just learned that there are different kinds of POAs. I always thought there was just one kind. Some institutions like financial ones like Vanguard require that their specific form be filled out for a POA to be honored. I realize that this may not be of much help to Notwendy and may be helpful to others who are in the process of getting a POA for an elderly parent. I was shocked that Notwendy's POA was not honored.