BPD mother going in circles with medical providers.

[zachira]

I would consult with professionals who work with the elderly, like a social worker, about what your options are. For sure, you are not alone in having a mother who refuses to cooperate with anybody and wears out everybody around her, especially close family members. I thought there were only certain outcomes with my NPD sister, until my lawyer came up with a very clever solution. If you keep looking for solutions, you may possibly find one. Are you considering not being involved in your mother's care? I got to the point where I could not do it anymore with my mother, and that was the way it was. I am sad about this and I do not feel guilty.

[GaGrl]

I am wondering now about how to make her a ward of the state and if that is an option. She's become impossible to deal with. I have not gotten support from her medical team as until now, she's been considered legally competent but she isn't compliant with anyone. I wish there was some kind of psychiatric placement for her. But I am getting to the point where her constant crises are taking up hours of my day. My husband is concerned about this.

It might be time to get a geriatric psychiatrist involved. My ex and his sister brought in a geriatric man who recommended a geriatric psychiatrist -- their mother was having small strokes that were changing her behavior, but they couldn't really tell to what degree. She was 91.

With a geriatric psychiatrist, you would be able to openly discuss the uBPD and her history.

[Notwendy]

She's in the hospital. I turn my phone to "airplane" mode in the evenings.

I will ask for a psychiatric consult while she is there, if they are willing to do that. I am not hopeful though- she pulls it together with them. If they were throrough, they'd also speak to me. This hasn't happened- I suspect she tells them not to. She's also told her home health nurses to not tall me things-- but they do.

She's had many psychiatric evaluations and seen various ones. By high school I had caught on that BPD mother had a psychiatric issue but did not know what it was. I recall asking my father- "Has mother seen a psyhiatrist?" and his reply was "yes but it doesn't help". I asked why and he replied " because she lies to them".

And there's a large part of why people have so much difficulty helping her. She lies and even in the hospital, she doesn't tell the truth to the medical staff.

I hope to speak to the hospital social worker about some of the issues- where is appropriate placement for her. Hospital doctor asked me what I thought about nursing home placement.  BPD mother got angry. It's only a short while ago that nursing home placement was considered and she managed to get that changed. I will make it clear to them what her options are and let the hospital social worker decide.

[Notwendy]

Dad rarely spoke like this about my mother but at times, I would ask questions and it must have been obvious that I was wondering about her so he'd answer. Therapy, psychiatric treatment and the medication they have given her don't work. Her defenses from any accountability are so strong- you can not get that information to her. She projects it back and also twists history in a way that she isn't accountable.

[TelHill]

There may be strength in numbers. If possible, would her family and other sibling(s) of yours join you to speak to her to convince her to accept treatment and/or Adult Protective Services in your county to declare her incompetent? Ask everyone I listed a few times if the right thing isn't done. Using persistence at his level will give you some peace of mind that you did all that was humanly possible, regardless of the outcome.

Hang in there and please keep venting as needed. Am so very sorry.

[TelHill]

You could sum up my response above  as: be a pain in the neck to everyone involved until you get what you want. Use our bpd moms as a guide.

[zachira]

I get it when you talk about how skilled your mother is in hiding her mental and physical problems. My mother charmed a lot of people well into her early eighties AND then how mentally ill and frail she was became impossible to hide. (In my mother's family, some people live to extremely old ages, so I would translate how my mother appeared in her early eighties to be more like someone considerably younger in ill health.) Some of the advantages you may have now in getting your mother the kind of care she really needs is she is elderly, in a facility where her behaviors are observed on a daily basis, and frail. I would keep on insisting that she get care more in line with what her needs are now, as the facility where she is being cared for and the medical providers who give her regular care have a higher level of responsibility and liability than when she was living in her home.

[Notwendy]

I haven't heard from anyone at the hospital she is at. This is the hospital my father went to as well. One thing I have noticed that is different from when he was there is that it's almost impossible to get someone on the phone. I know the staff is busy- I don't call at the times they are busiest. I left messages at their social work department and no reply. Same for when she was in the skilled nursing. Automated reply and then to voice mail.

Apparently they must have felt she was competent enough to sign herself in and to speak to her directly. She can decide herself.

I did speak to the ER doctor when she went. The ER doc seemed angry at me that I would be "forcing them to treat her" when she was initially refusing. I said not necessarily but that we have run out of options and don't know what to do. He said he'd call social work.  He asked if I thought she needed a nursing home. I said yes- (because it's true- she does need to be in a nursing home but has refused that). BPD mother heard that and agreed to be treated.

Last evening, someone with her told me she told the doctor she wants to go home and agreed to take antibiotics by mouth. That was the original plan- along with visiting hospital for wound care and treatment as outpatient. She had refused to take her medicine and was in so much pain she couldn't walk. I called the assisted living to send her to hospital. If I hadn't done it, they would have.

I know there's a risk of sepsis and I don't think she cares about that. She has the right to refuse treatment but by doing so, it's very painful. For now, she is getting good pain management and antibiotics in the hospital. Her family agrees with my decision to send her there but if she chooses to leave then that is her choice.

I'm going to leave this up to the hospital staff and her assisted living. If she wants to refuse treatment and leave- then they can all figure it out.

[GaGrl]

My family also has experienced a doctor becoming angry/frustrated because he thought my mother should be "doing something" about my grandparents. She got a call one Sunday morning from their PCP angrily telling her that he had both her parents in the hospital and what was she going to do about it. We lived 200 miles away. Mom had to explain that her stepmother was in charge of their health decisions, that she was a step mother who had never adopted my mother, and thus my mother had no power to direct their healthcare. The doctor had no idea that my mother was not a bio child of her stepmother.

That situation was resolved after SGM had several days of rest. She was, at that point, resisting any household help or home care, didn't want to pay for it. The PCP called in a psychiatrist, and SGM managed to appear sane and rational, so it was left that she was " competent to make her own bad decisions."

We never established a good relationship with their doctor, especially after that initial encounter.

[Notwendy]

BPD mother has put herself into a "hole".  She's not compliant with medical care and she didn't qualify for Hospice.

So now, she's chosen something right out of the middle ages. Letting her legs stay infected with no antibiotics even though they are available now. Because of her history with drug abuse, pain medications for her are tightly regulated so she can't just ask for them.

All her medical care requires her to go to her doctor's offices but she has limited mobility due to the pain in her legs. She refuses to see the doctors who come to the assisted living, preferring her own, and also not all specialists come there. She's not compliant with the home health nurses or the nursing staff at the AL. She could get all her medical care in place if she went to a nursing home and she refuses that.

So this leaves us, the family, to watch her go through pain and an infection with no solution. I am hoping social work calls me back but all I can do is leave messages.

I have tried in the past to call the nurses station- they just tell me they are busy and can't talk at the moment. I know they are understaffed and over worked. I truly don't pester them. I know how hard they are working. But also, it takes so much effort to try to reach someone.

This is a reflection of current changes in medicine so it's probably everywhere. It was not like this when my father was there years ago. It was possible to speak to hospital staff then.

I have a good relationship with her PCP. He took care of my father too. The hospital system has its own hospital doctors now. He isn't on staff at the hospital now. He can get the medical records but that isn't the concern. I know she's being treated with antibiotics and pain medicine. That's straightforward. It's what happens when she's discharged -where and what to do for her that I wonder about.

[GaGrl]

It's baffling to me that persons with BPD can be so cunning and manipulative while -- AT THE SAME TIME -- engage in magical thinking that "wishes away" the unpleasant, or keeps them from taking responsibility for a solution.

[zachira]

Now that your mother is no longer living in her home, there should be plenty of documentation on her mental condition by staff where she has been staying whether it be an assisted living, a nursing home or hospital. My mother refused to elevate her leg and risked amputation until the doctor put her in a nursing home with the staff constantly reminding her to elevate her leg. Not long after that, she was on several psychiatric meds for many years until the end of her life while living in her own home. She was very compliant in taking her medications and overall with her medical providers after that. I do think the psychiatric medications made a big difference in getting her to be compliant. Clearly your mother is risking her life and some really painful times if she does not cooperate with her medical providers and get the care she needs for her infection. Can you make a request through the social  worker staff where your mother is currently staying that her medical documentation on her mental condition be read completely from all facilities she has stayed at and evaluated by a geriatric psychiatrist? My mother had a wonderful geriatric psychiatrist who take exceptional care of her. He once explained to me that family therapy would not work. He did try to give her individual therapy and gave up on that. He was well regarded in the community and gave some highly regarded therapy to a family friend who was severely depressed. The family friend recovered and went back to living a good life until he passed away.

[Notwendy]

One doctor spoke to me as she got me on the phone when he went to examine her. What they are doing is good- antibiotics, pain medication, nutrition management. Still, she complains about everything- that she has to lie there in the bed, that the nurses won't come and change her. What did she think the alternative would be if she didn't come to the hospital? She'd be lying in her bed at the assisted living in pain with an infection. They'd have called for her to go to the hospital too.

She takes no responsiblity for what is happening. Pain from an infection she refuses to cooperate with treatment. The doctor says she's not wearing compression stockings at the moment due to the pain but it needs to be part of the management. She refuses to wear them. If they put them on her at AL, she takes them off. If she can't pull them off, she gets scissors and cuts them off. And still- she's "legally competent." 

Then she goes on this speech to me "Sorry she can't be like so and so's mother who died peacefully and that sorry she can't be that kind of mother who wasn't a burden to her kids".

I said nothing, just listened. There is no point in saying anything back. She says "nobody ever listens to her". I said "I'm listening".

This is a reason she has come up with for why this is difficult- through no doing of her own, she didn't choose to have this situation. True, she didn't choose it but she won't do what her doctors have said she needs to do to make it better.  What is difficult is that she won't cooperate with people's genuine efforts to help her. But since to her - she is not responsible for any of that, it has to be that it's nothing she did.

It is amazing how they can be so cunning and manipulative- she does this deliberately- she knows what she is doing and at the same time emotionally absolves themselves of any part in their situation.

[TelHill]

I'm glad your mom took the antibiotics and you have a break from the drama.

My mother sees a doctor whose specialty is treating pain. It's hard for her to go to his office so we've had virtual appointments through an electronic device. It's every 3 months. My mom takes a controlled substance pain med. 

Considering the fentanyl drug crisis and economic tough times, it's state law in California to have strict control over them. All pharmacies have these in a safe. I've waited 15 minutes for the px to be filled for the pharmacist to follow protocols. I assume the pharmacist has a security camera on them as they're filling the px.

My mother has a virtual appointment to monitor her need and to see if she's alive. A wayward relative could stand to make $$$ selling the pills which are really cheap with a doctor's px. The MD would be liable for not being careful.  It might be the same in your area It might not be your mother's history at fault.

Now that things are relatively quiet, try to do self care. I mean to go over your options considering your mom's decisions, and to protect yourself legally from her non compliance.

He wasn't welcome in my life but my ex-h had the physique of a US football player. No one in my family or neighborhood bothered me. It all changed after his death. It was hard to accept harassment (it was for inheritance and neighbors trying to extort $$) but it was happening. I've protected myself legally and went NC or LC. I had a lot to lose by overreacting which I know was their goal. Staying away from the crazy has been a relief!

If your mom's relatives are a problem, do you need to include them or give them information, especially if they use it against you?

I don't know if any of this is the case for you. You have a very good head on your shoulders. You can't change her and the law backs her up.

[Methuen]

I am sorry you are going through this.

It's what happens when she's discharged -where and what to do for her that I wonder about.

Should they be discharging her without an "after care plan"?  A question you could ask if they tell you they are discharging her, is "what is her after care plan?"

A lot of years ago when my mom went into emerg for one of her many catastrophies, the emerg doc discharged her.  I was desperate and very scared.  My limbic system was in overdrive. She had been dysregulating for so long prior to the emerg visit, I was terrified to take her home and be responsible for her care.  But they discharged her.  It was a disaster.  The Doc even told me someone would need to spend the night with her as she couldn't be left alone. To make a long story short, I found out months later from a nurse in home support, that she should not have been discharged from the hospital without an "after care plan".  That was very helpful information to me.  I did not know that.

So with the next catastrophe requiring a trip to emerg, I disclosed the family dynamic issue including emotional abuse, in a private confidential conversation with the emerg doc, and clearly stated I could not be the after care plan because I didn't feel safe. They kept her overnight in emerg, and put emergency home care in place before they discharged her.

In your situation, I'm wondering what their "after care plan" is.  If she is refusing medical care, they can discharge her back to the assisted living facility, but how will they transfer her?  Is an ambulance arranged, or are you expected to drive her?  If they expect you to drive her, is this something you feel you could refuse?

I am wondering now about how to make her a ward of the state and if that is an option. She's become impossible to deal with. I have not gotten support from her medical team as until now, she's been considered legally competent but she isn't compliant with anyone. I wish there was some kind of psychiatric placement for her. But I am getting to the point where her constant crises are taking up hours of my day.

I am wondering what the social workers say about how to make her a ward of the state?  Also, you mention her crises are taking up hours of your day, but I'm wondering if there is some way you can withdraw from the drain of all these "hours"?  In other words, let "natural consequences" play out, since it's her choices driving all this, and her choices are out of your control?  Let the medical system deal with it, since she is in the system, and they are also the ones saying she has the capacity to make her own bad decisions.  Is it feeling like you're trapped between a medical system that says she's competent, but a mother that is noncompliant and creating crises after crises taking up your time?  Is there an exit ramp from this?

With a geriatric psychiatrist, you would be able to openly discuss the uBPD and her history.

Sounds good, but this is not my experience.  My mom was referred to a geriatric psych under the auspices of her family Doc saying he needed expert help to check all her meds. She agreed to the assessment for this reason.  On the day of the geriatric psych appointment mother pulled it together for an entire hour, and responded in a way that made her seem years younger, energetic and upbeat and healthy and "perfectly fine".  My husband was present and could not believe her performance. The very next day (less than 24 hours later), she called us to take her back to Emerg (back to her "real self" state).  NW has said many times that her "mother" can pull it together in situations, and that is also my experience.  I think this is how they continue to be seen as competent.  My mom is 87 and still successfully fooling people (including professionals). Or maybe they aren't completely fooled, but she can "pull it together" to not give them enough evidence to actually lose capacity.

So now, she's chosen something right out of the middle ages. Letting her legs stay infected with no antibiotics even though they are available now. Because of her history with drug abuse, pain medications for her are tightly regulated so she can't just ask for them....So this leaves us, the family, to watch her go through pain and an infection with no solution. I am hoping social work calls me back but all I can do is leave messages.

It has been a process for me to "radically accept" my mom's situation and choices and personality - all of it.  H and I still support her, but we do not take responsibility for her decisions. Boundaries are a daily struggle because she just keeps pushing them.  When she has something going on, we have to let her struggle, and resist swooping in to fix the problems that she has created because she has chosen to live at risk, and she would have us there "all the time".  I'm not in your situation NW, but I'm wondering if there are other things going on here.  What I mean by that is sometimes, when elderly people are finished with life, they quit eating.  That is usually a sign that the end is nearing.  Your mom is refusing medical care - antibiotics that she needs.  Do you think there is a chance this could be an intentional choice on her part, or is it more likely that it's the BPD "magical thinking?"

My T is working with me on a lot these days.  The recent meeting included "accepting" that my mom's choice is to "live with risk", and see that I need to manage my feelings and responses around that.  I need to do a lot of work on my own distress tolerance. You mention the situation has left the family watch her suffer with pain and an infection with no solution.  In fact there is a solution - antibiotics - but your mom is rejecting it. The parallel I see is that your mom is "choosing" to "live with risk" by not taking her antibiotics.  Neither the doctors nor you can change that.  It's her choice.  The consequences are a result of her choices.  But somehow as the daughters, we still feel "guilty", or like we need to "fix" the problem.  We feel responsible to make them feel better. But as you mentioned, "she's impossible".   I think all we can do is learn to manage our own distress over their choice to "live at risk".  I have had to accept my mom's gradual descent into blindness (because she refused home care services to put necessary eye drops in for her). Their choices are beyond our comprehension. Who chooses blindness over accepting outside help? But her magical thinking allows her to believe she can put her own drops in her eyes with her shaking Parkinson's hands (she can't). Eventually, her poor vision will result in another catastrophe in her own home...the natural consequence of this might eventually force her into a facility.  Not my fault.  Although she can twist anything to be my fault - I should be driving to her house 4X a day to put her drops in for her instead of "working". She's screamed at me that I am selfish to put my career ahead of her.  Distress tolerance is something I really need to work on.  My T made some very good points yesterday.

I'm curious, are people - doctors, nurses, her family... - putting pressure on you to "do something"?  Or do you feel the pressure from within? You mention that all her crises are taking up hours in your days, but this doesn't seem sustainable, nor does it seem to be achieving any positive outcomes.

Is it possible for you to step back from these "hours" in any way?  I'm not there and don't actually know the intricacies of what's going on, so I hope the question doesn't cause frustration.  I'm genuinely just trying to help and support.  You seem to be putting in a lot of hours.  But it's hard on you, and doesn't seem to be helping your mother's situation.  You are further along than I am in this journey, so I am also learning from you.  

[Methuen]

I'm not in your situation NW, but I'm wondering if there are other things going on here.  What I mean by that is sometimes, when elderly people are finished with life, they quit eating.  That is usually a sign that the end is nearing.  Your mom is refusing medical care - antibiotics that she needs.  Do you think there is a chance this could be an intentional choice on her part, or is it more likely that it's the BPD "magical thinking?"

Scratch this thought, since while I was writing this response, it seems that she has now started taking the antibiotics.  Hopefully if they do discharge her, assisted living dispenses the antibiotics and it isn't left up to her to be responsible to take them until they are finished.

After a life with my mother, I have a natural tendancy to see every possible thing that can go wrong.  This is another legacy of being the daughter of a BPD mother, and is a problem I am working on.  Sadly, it is for good reason we are so good at predicting all the things that can go wrong.

[zachira]

I think there is one big difference between Notwendy's mother and Methuen's mother. Methuen's mother is still at home so she is much more able to hide her mental illness. Notwendy's mother has been living in some kind of medical facility for several months now, so her behaviors are observed and documented by medical staff. Many mental health professionals are very interested in what people who spend considerable time with the client have to say about their behaviors, as they are aware of the fact that many people are ashamed of their challenges with mental illness and do everything to convince others that there is nothing wrong with them.

[Notwendy]

Thank you all for your helpful posts. Finally someone from social work called me and I think they were "feeling me out" on the idea that BPD mother doesn't want treatment. The person began by asking me if I had considered rehab for her and I said it had not been discussed. They explained that she had refused the assessements for rehab and wanted to go home.

I explained that she has the right to choose to not treat and that the main reason for my wanting her to go to the hospital is that she was in a lot of pain and the only option we had for pain relief was to go to hospital and treat the infection, that if she wants to go home, she will need better pain management.

I think at that point the social worker realized we are on the same page. She can choose to not treat, but with pain management for her sake and for her family- we don't want her to be that miserable.  I do think this is what my mother wants and have noticed a shift in her. We can accept her choice but don't want her to suffer. She's going to set up palliative care as part of the care plan. I feel a sense of relief that this could be set up for her.

I think her family understands the situation now. They won't be opposed to it. About any family squabbles over her finances- that's an easy one. There isn't much to squabble over.

[TelHill]

What I mean by that is sometimes, when elderly people are finished with life, they quit eating.  That is usually a sign that the end is nearing.


I don't know who wrote the above, but not true. It's a sign of getting older and needing fewer calories. I don't eat as much as I did 10 years ago. I am not ready to go anywhere except for the shopping mall.

Am glad you spoke with the social worker to straighten things out for your mom.

Here's a forum I read where adult children of the elderly vent and ask care questions. Some have parents with personality disorders but others don't.

https://www.agingcare.com/caregiver-forum

[TelHill]

https://www.agingcare.com/questions/what-do-you-do-when-your-father-refuses-to-go-to-the-dr-refuses-to-take-medication-for-diabetes-hear-485546.htm

What do you do when your father refuses to go to the dr, refuses to take medication for diabetes, heart issues, etc., showing signs of dementia and now extreme paranoia. Every time I talk to him, he asks me to call about cameras being installed in his house to check to see if the neighbor has put dogs in there and now wants a fence to make sure everything is kept out. So at a loss of what to do.

[Methuen]

What I mean by that is sometimes, when elderly people are finished with life, they quit eating.  That is usually a sign that the end is nearing.

To clarify, I equate quitting eating with refusing all food.  Nurses in hospital have told me this is typical when people don’t want to fight to live any longer..  I wasn’t sure if refusing medical care could be a similar strategy. 

I really wasn’t talking about reduced appetite as we all age.  Most of us consume less as we age - me included!


Sorry for any misunderstanding.

[TelHill]

It could be depression, the flu, a reaction to a new medication but not a death wish. We really don't know.

I read over my posts on this thread and realized I may have been catastrophizing.  I didn't want to make things worse for Notwendy as none of us do.

[Notwendy]

You all are very helpful- and it is much appreciated. Not being made worse at all!

The appetite issue with my mother is complicated as she's had an eating disorder. She does eat but not always the best nutrition. Her caretakers would report that she only wants cookies for dinner when she was in her home. We hoped being at the AL would change that but she complains about the food.  She does have a small fridge in her room that can hold snacks and things she likes to eat. She will send for take out sometimes.

I have also heard about the quitting eating and that it's not helpful to give them IV fluids when this happens as it stressed their bodies. She's still eating but not the right foods. If she's going to be on palliative care, she may as well eat what she wants to.

I did read the aging care links- many suggest calling APS but those are for eldely people in their home. I'd have done that if she was still in her home. Since she's been in assisted living, she has staff checking on her and they'd have called if they were concerned. She's consistently told her medical providers- both in and out of the hospital that she doesn't want to aggressively treat her leg and while she agrees to their treatment plan she doesn't comply. I believe her but she needs to have better pain control. If she can get palliative care I hope that can help.

[Notwendy]

She's just miserable and upset over everything. It's understandable- physically miserable on top of her baseline emotional miserable.

She goes "helpless" saying she just can't cope. She needs someone to help her. Then the helper becomes the target and she undoes whatever the plan is.

She will likely speak to Palliative care next week. She says she's too confused wants someone with her. I have listened in on her calls with doctors. After the call she asks me to repeat everything they said. Then she says "nobody told her that" and they did- I heard them say it and she understood it.

She remembers. She's telling me what her "cousin said 20 years ago". She's recalling who said what at events I can hardly remember and she recalls what has been said to her 5 minutes ago as well.

[Pook075]

Since I am the one the medical providers have consent to speak to - I relay the information to them.

Question- are you listed as a contact on your mom's medical care, or do you have medical power of attorney?

I'm asking because if you're simply a contact, then you have zero voice in her treatment...other than to talk to people and relay information.  But at the same time, the doctors are not required to talk to you or return your calls because you're not a decision-maker.

If you have medical power of attorney, then your mom has no choice in this- what you say goes.  They cannot create any treatment plan (except immediate life-saving) without your approval.  If the physician doesn't keep you very tightly in the loop, then there could be serious legal ramifications.

I'm a little confused which of these things you are- could you clarify?

[Notwendy]

I have both but it’s more complex - I’ve consulted an elder care attorney about what I can and can not do. Unless she is declared to be legally incompetent she has the right to self direct her care.

I think when a doctor asks me to be involved it’s because they also are concerned about her revising history and claiming they said or didn’t say something but she still can choose to agree to treatment or not.

I pushed the ER trip as she was in so much pain she was refusing to get out of bed and this was a way to get help for her but whether or not to agree to the treatment offered is up to her. She is in agreement that it helped with  the pain.

[Notwendy]

If my mother is unable to speak for herself or declared legally incompetent - then I decide . Hospital staff is not required to speak to me but some prefer to. In the legal sense she can be unreliable but still legally competent - which does make this confusing.

Really - I’m trying to do the best I can for her in this situation . I’m very transparent with other family members and get their agreement with anything I do.

[Pook075]

I have both but it’s more complex - I’ve consulted an elder care attorney about what I can and can not do. Unless she is declared to be legally incompetent she has the right to self direct her care.

I think when a doctor asks me to be involved it’s because they also are concerned about her revising history and claiming they said or didn’t say something but she still can choose to agree to treatment or not.

I pushed the ER trip as she was in so much pain she was refusing to get out of bed and this was a way to get help for her but whether or not to agree to the treatment offered is up to her. She is in agreement that it helped with  the pain.

If you have medical power of attorney, then you have to inform the hospital, treatment facility, whatever, each time she seeks treatment.  It should already be on file, but going through this with my dad they claimed not to see it 90% of the time.  This was during COVID so visits and communication were horrible.  I had to take the lead and let them know, "Hey, this document says I legally have a say in this..."

In each instance, your mom should have a case manager at that facility- that's who you should reach out to 1st.  It's the case manager's job to coordinate all treatment plans when leaving the hospital and most of them won't know you exist.  That's the easiest route though; ask for the case manager and then let them pester doctors, nurses, therapists, etc.  It's their job to do that and others comply because they have to for insurance reasons.

Sadly, the insurance companies run healthcare, not the doctors or CEOs.

The case manager will talk to you though and you can voice your concerns about your mom not complying.  They get it because it's very common with elderly...not just BPD.  You have the extra level of headaches though because of it.  If it were me, I'd blame everything on the case manager though- they said you have to do this or you're going into a nursing home.  Let them be the bad guy.

[Notwendy]

That actually happened in the ER as the ER doc went to get the case manager to be involved. They brought up nursing home as an option and she decided to let them admit her.

Case management is going to get involved with coordinating palliative care. So I do have support with this. The problem is getting ahold of staff as the system is automated so you have to leave a message and wait for them to call back unless it's an emergency- which this isn't.

I think the overall difficuty is the extent of her BPD in trying to assist her and communicate with her. She puts the people trying to help her in persector role. It's hard to get her to cooperate with a plan that is designed to help her. She also has physical discomfort too. Everyone is trying their best with her - to the extent she lets them.

[Notwendy]

Legally though - she gets to self direct. I don't have power to overide her and force her to accept any care. She doesn't have dementia- and is quite sharp mentally. Emotionally, the BPD has an effect but still she passes mental competency tests. The medical POA is on record if they need it. I could step in if she wasn't able to decide for herself.