BPD mother seems to have overwhelmed the staff at assisted living.

[Notwendy]

I'm posting this for support/advice but also to share that being in assisted living may help with some issues but still is complicated with BPD. It's been a series of "crises" with BPD mother, not unlike how she has been as far as I know. Emotionally, she doesn't tolerate being alone and one on one private care is unaffordable, now that she's spent most of her money. Assisted living is designed to provide a social environment but she won't socialize ( she's too disordered) or attend any of the activities. She stays in her room most of the time. She does have a private aide come to help some of the time but what she wants is someone there all the time. She's constantly calling the floor staff for something- to get their attention, but they have other residents to assist and so can't spend all their time with her.

In addition, she's emotionally and verbally abusive. I think it's obvious the staff is stressed by her and they are keeping a united front when it comes to her. BPD  mother seems to alternate between being lucid and causing a scene and acting crazy. This isn't new behavior- she did this when she was younger too, but now, with aging, she's also having age related cognitive changes. When she is acting lucid, she takes control. During the times of confusion, I have to use the power of attorney if needed.

At the moment, she is confused and not making sense. The nurses are looking at physical causes, her medication, for possible reasons for this. She doesn't have a urinary infection, they are going to change some of her medicine doses. One problem is that no action will be a solution- because she goes in and out of the confusion states- so it's hard to know what to do. Address the confusion - she snaps out of it. I'm not even sure all of it is real or her acting out to get attention. I think it's a bit of both.

I understand the staff is stressed by her behavior- but it's now another issue. BPD mother stopped answering her phone, so I called to check on her. When I try to call and they put me through to the floor staff- they don't answer. It's gotten to the point where I don't even try- they don't respond. Then BPD mother told me one of them hit her. I don't know if it's true or not- she doesn't tell the truth but in trying to look into this (by email to the assisted living since they don't answer by phone) - their response is defensive. Then they reported that she wandered into someone else's room- but nobody called me if she did. I don't know who to believe as I didn't think she was that mobile on her feet to wander down the hall ( she uses a walker around her room but a wheelchair- not motorized- someone pushes her). If I try to ask her more about it, her reply makes no sense.

There's been a lot of staff turn around and I am now getting uncomfortable about the assisted living. I hesitate to move her to another one- if the issue isn't them- she'll just do the same thing with the staff somewhere else. I think though- this staff has had it with her and by extension- they aren't responsive to her family either. I hope someone didn't hit her and they shouldn't- but her behavior could drive someone to lose it with her. Not that this is acceptable- it's not. We have to look into this. If she's being neglected or worse - we have to move her.

[Notwendy]

And here it is- a voice mail message "please take me home with you, I want to go home with you.  All I want is to go home with you"

When my father was ill, I felt the expectation that my parents wanted me to be her caretaker. I was initually willing to bring them closer to me and help out- not 24/7 but if they had agreed to be in an assisted living situation, I considered it. I even visited some that I thought would be nice ones.

They rejected the idea and refused my suggested ones. During this time period, BPD mother was so emotionally and verbally abusive, it was overwehelming. For the sake of my own family and myself, I had to have boundaries and not facilitate my mother moving closer to me. Even my husband has stated he doesn't want my mother to move closer to us.

My other concern if my mother was in assisted living nearby is that she'd get herself thrown out and it would be a crisis situation and she'd end up with no other option than to stay with me. Her current situation may be becoming unworkable. There are other assisted living options in her area if needed.

She's been in assisted living over a year now. I didn't say anything to her about this- but to me it was also a test situation- if she did adjust, and did well there emotionally- I may have reconsidered the idea- if her needs could be taken care of and she had cooperated with me. I believe that older people need to be as self directed as they possibly can, but if they need assistance from an adult child, it has to be a mutually cooperative situation. This is not. But I now have evidence of how she is in that setting and they aren't able to manage her, her sabotaging attempts to help her and her not being cooperative with attempts to assist her.

As a teen, I was useful to her as an emotional caretaker. The times I did go home for college breaks to see my family- these were "working" visits - doing things for her. It's been that way all along. She wants a 24/7 caregiver. I've tried to help -stayed with her and it's no sleep, constant needs 24/7, and her raging and being verbally abusive. She doesn't care about how the other person feels- her emotional needs drive her.

It has to be a no, it is a"no"but it also feels awful to say that no.

[HappyChappy]

Hi Notwendy,

I'm so sorry you're having to deal with this. Do they use CCTV ? I.e. if you see that, then you can see who's telling the truth. In my country, you have a right to CCTV footage that you appear on - so if the staff are willing to share and your mother isn't, that might give you a clue ?   

[HappyChappy]

Also if your mum is willing to give permission and the staff "lose" the footage, another clue.

[HappyChappy]

If not, you can offer to pay for a coms / CCTV system in her room. If something is being monitored, then people tend to behave (or switch it off, before doing something they shouldn't). 

[mugsydublin]

NotWendy,

I can so relate to this, and I have no advice. My mother recently got into a "rehab" home, essentially assisted living. We had hoped that she would stay there for a while, but the staff could not get her to cooperate in any way with her basic care. Even bathing. They sent her home, which I am convinced was due to the fact that she sabotaged every effort that they made to care for her.

We siblings would really like to see her in a place where our dad is not her 24/7 caregiver. But she refuses. I don't know the answer. But it is good to read your account and recognize that even if she were to be in assisted living, the problems don't just go away. They might even manifest more.

[Tangled mangled]

NW,

I’m sorry about the issues you have described here especially your mum’s account of being hit.

In Europe you are allowed to keep one of those home security cameras to monitor an elderly person- don’t know if that will be helpful or possible in your mum’s situation.

It may be that your mum hit a staff and they hit back- again not acceptable to hit an elderly person but I can see how someone who’s stressed by her behaviour if physical may snap.

Another possibility would be that your mum has made that up to push your buttons- being her caretaker, she knows that will get the maximum reaction/ attention from you- to the tune of you changing her living situation- the goal being her moving in with you.

Since she’s only been at this facility for a year, is it possible to explore more security for her room eg a camera to monitor things. I see her abusing your sensibilities response to this escalation- eg if you move her closer then she gains a new weapon to use against you- fabricating another claim that’s even bigger than being hit in order to achieve her goals of having you as her 24/7 carer.

Now that you have contacted the facility- might be useful to follow up with their complaints process or any other means of ensuring this event is recorded.

[zachira]

Notwendy,
Perhaps the best criteria to use to decide whether to contact adult protective services is if you have any reasonable suspicion that there is elder abuse going on. The fact that the assisted living people seem to be isolating your mother and there is high staff turnover are red flags. When you visit, you might try to get to know the family members of some of the other residents, so you can have someone to talk with and contact about what they see going on. When I visited my aunt, there was a lady always at the nursing home, and when I asked her about that, she said she spent as many hours there as possible because there was abuse going on and her father had dementia. The staff was not nice to my aunt, the food was horrible, there was high staff turnover, visitors were made to feel unwelcome, and my aunt was not allowed to have any of her pictures on the walls in her room. After talking to me, my cousin who had power of attorney moved my aunt to another nursing home.

[Notwendy]

Thanks everyone for the advice. I will look into the camera idea. I think once they know this will be reported, it might avoid a future situation.

Mugsydublin- BPD affects all relationships and this includes the ones with the staff at any facility. Of course your mother prefers your father as her caretaker- it serves her better- but it is more complicated. When my father was in a rehab situation for care- after a hospitalization, we were relieved because he was being taken care of and away from BPD mother's behavior. He hated it though- and wanted to come back home.

The not bathing baffles me. My mother has refused to bathe in a long time. I know elderly people are afraid of falling but she would have someone helping her. It's not modesty either. She allows them to give her a sponge bath but not a real bath or shower. This seems odd as she is meticulous about her appearance. Her hair is done nicely and she always has a pretty nightcoat on. It just doesn't make sense.

Zachira- what makes me more suspicious of the staff is their behavior. They are defensive and evasive. It was a holiday weekend and they may have had temporary staff fill in- so it is possible someone did that, and also possible my mother made it up, but I have no way to know. If she is wandering into other people's rooms, then they should have notified me. Admittedly, I don't live close enough to visit in person often, but I have tried to call and be in contact with staff and it's difficult to do that. It's also possible she told them to not speak to me like she did with the Hospice nurses. Whatever it is, I don't know what actually happened.

[Tangled mangled]

There are cameras that allow you to communicate too. I’ve owned one in the past for monitoring an empty home. And it can serve as a substitute for telephone calls

Since your mum is not answering her calls, you might be able to chat with her without her needing to pick up the phone.

I’ve worked with elderly patients, it’s not uncommon for them to get aggressive when confused, wandering into other people’s spaces too is quite common. She may have gotten out of her room to call for help or any other reason then forgot her way around.

If the staff are saying she wandered down the hallway, then this would be easy to prove if there are cameras in communal areas.

Also your mum’s fluctuating levels of confusion/cognitive decline may be a sign of dementia ( Lewy body subtype). If there are no organic causes for the confusion, it might be time to look into an assessment for dementia.

[Methuen]

My mom will never go into assisted living because her MO is to "fight everything".  She is a "fighter".  And she is extremely "proud" of that trait. Community care used to provide various services for her after her falls, but she has gained a reputation for being difficult and non compliant with them.  Because she is deemed competent, she can refuse service to her house, which any rational person can see is a poor decision and against her own health and safety interests.  They used to try to reason with her, before they really knew her.  They no longer have any conversations with her that I know of.  My mom spews vitreolic "hate" against any form of community care or any person associated with it.

If my mom failed a competency assessment, and went into care, she would behave exactly like your mom.

Emotionally, she doesn't tolerate being alone and one on one private care is unaffordable, now that she's spent most of her money. Assisted living is designed to provide a social environment but she won't socialize ( she's too disordered) or attend any of the activities. She stays in her room most of the time.

This is exactly what my mom's sister did after going into a care home.  She stayed in her room and refused to participate in activities.

Since the personality disorder is the person (my mom, your mom etc), it's to be expected that it travels with them, so it is no surprise that your mom is as disordered in a facility as she was in her own home.

Certain things are probably better now.  You are more able to exercise responsibilities over her finances.  There is nursing care available should she need it, or "accept receiving it". 

The chaos she has caused since going into assisted living would exist if she were still living outside of it as well, because physical and cognitive changes with aging bring on more stress for the BPD, and they don't cope with stress. Right now in assisted living, she is still being
 monitored. Who would be responsible for doing the medical monitoring if she wasn't in assisted living?  Who would be doing all the "doing" she would be demanding to have her needs met?  I reckon that you would be hearing a lot more from her and also "doing" a lot more if she wasn't in assisted living. 

That is my lot. The stress of having to deal with my mom has taken a huge toll on my mental health, and also my physical health.  My mom gets to refuse all community care if she wants to.  So who does that shift the burden to?

My physical health issues are serious.  I have been off work for some time and am still off work.  I suffer chronic inflammation from stress on multiple body systems.  I am on medications.  I am in pain, and my daily functional life is disrupted by this.  I can't do the things I normally do.  I can't even do yoga right now.  My mental health?  Well, I'm not sure that I'm not heading towards a nervous breakdown.  I can't even post and maintain involvement on this site like I used to.  I feel the only people who really understand are my H and my T.  There is little support because nobody can really understand if they don't have my lived experience of being responsible for my BPD mom when she refuses all community care in her home.  Her needs as a vulnerable 88 year old living alone with pages and pages of physical and mental issues are a bottomless pit.  Yesterday she "had it out" with my H screaming that she "wants to die" (she doesn't).  He was delivering her groceries when this happened.  She makes up the grocery list, and he makes the purchases based on her list.  Of course "everything was wrong". Up until two years ago, I was her "caretaker".  Then I returned to work, and he took over certain tasks (grocery shopping, appointments etc) to give me a break because I burned out.  I used to come home from those visits saying "nothing I do is ever good enough" all while taking the abuse.  Now, after two years, he "gets it".  Before he was responsible for her, even though he lived with me and saw her, he couldn't really "get it". 

Be very careful with how you proceed on your mom's allegation moving forward.

To shift gears, have you read "Stop Caretaking the Borderline or Narcissist. How to end the drama and get on with life" by Margalis Fjelstad?

https://bpdfamily.com/message_board/index.php?topic=203887.msg12271876#msg12271876

This is Margalis. She is a member here.

<iframe width="320" height="200" src="https://www.youtube.com/embed/yoiOoDe6-_w" frameborder="0" allowfullscreen></iframe>

Date: Apr-2013Minutes: 4:56
Stop Caretaking the BPD or NPD | Margalis Fjelstad, Ph.D., LMFT

I have seen you post the story from SLATE about the borderline daughter "letting go" the caretaking of her mother, and "choosing herself and her family". 

I have also seen you post the poem The Bridge (written by ? a monk? a priest?).  The man at the bridge choose to "let go".

My H and I are in crisis mode all the time.  Mom texts us each multiple times a day.  It's constant chaos and dealing with her. 

From my perspective, assisted living is a dream that will never happen because she will NEVER agree to it. From my perspective, assisted living means someone else who is trained and professional gets to deal with her behaviors, in an environment where there is actually medical care available if she should need it, and monitoring happening.  When I use the word "hate" as in mom "hates" community care and anyone associated with it, you know that a pwBPD will never capitulate and agree to something they hate.  This translates to my H and I never getting a break from being responsible for her.  This is her power.

Of course I still love her.  She's my mom.  My whole life I tried above and beyond to please her and have her love me back.  Being "the good daughter" was futile.  I can see that now at 62, as she ages and only gets worse with her behavior.  Her family Dr doesn't even do cognitive testing on her anymore.  Both her Dr and home care recognize she is non compliant and difficult, and so they let her execute her choices, and focus their time on their patients who do want the help and are compliant.  I can't really blame them. 

Again that shifts the problem to me and H.

I am currently reading "Stop Caretaking the Borderline/How to end the Drama and get on with life".  I'm about 1/3 of the way through.  I recommend this book, or a re-read whichever is relevant for you.

I used to do so much for my mom.  For example, I used to bring my mom 2-4 meals a week.  I no longer do this.  At some point I realized that all the things I was doing as a loving daughter (to be the "good daughter") was actually enabling her to refuse all community care.  Why would she accept "meals on wheels" when I bring her home cooked food?  In healthy families, daughters/sons can do this and feel good about it because there is appreciation and reciprocal love.  However, I feel only resentment.  The cumulative time and energy I have put into my mom over a lifetime because I love her was one sided.  It is never enough.  My mom is negative and toxic and abusive, and her behaviors became too much and finally overwhelmed me.  That is when I returned to work which provided a safe "boundary" where she didn't have the same access to FOG me.  Now just 2 years later, my H is kind of where I was, and also full of resentment.  She is toxic.  She was a terrible mother/mother in law. 

We would be jumping for joy if she were to go into assisted living, not because it changes her behavior, but because we wouldn't have to be the ones to deal with it on a day to day basis.  The paid and trained staff would.  And they are trained to deal with difficult residents, just like teachers are trained to deal with difficult students, and counsellors deal with difficult clients, and doctors deal with difficult patients. 

You can lead a horse to water but you can't make him drink.

I understand the staff is stressed by her behavior- but it's now another issue. BPD mother stopped answering her phone, so I called to check on her. When I try to call and they put me through to the floor staff- they don't answer. It's gotten to the point where I don't even try- they don't respond. Then BPD mother told me one of them hit her. I don't know if it's true or not- she doesn't tell the truth but in trying to look into this (by email to the assisted living since they don't answer by phone) - their response is defensive. Then they reported that she wandered into someone else's room- but nobody called me if she did. I don't know who to believe as I didn't think she was that mobile on her feet to wander down the hall ( she uses a walker around her room but a wheelchair- not motorized- someone pushes her). If I try to ask her more about it, her reply makes no sense.

There's been a lot of staff turn around and I am now getting uncomfortable about the assisted living. I hesitate to move her to another one- if the issue isn't them- she'll just do the same thing with the staff somewhere else. I think though- this staff has had it with her and by extension- they aren't responsive to her family either. I hope someone didn't hit her and they shouldn't- but her behavior could drive someone to lose it with her. Not that this is acceptable- it's not. We have to look into this. If she's being neglected or worse - we have to move her.

Now in a "normal" family, of course this is the right thing to do. No question.  Ours is not a "normal family".  Perhaps some important questions are:  "How did it get to this?  Who is ultimately responsible for this outcome?  Who should pay the price for her behaviors (which aren't going to change regardless of where she is)?    If she moves to a different facility, is it reasonable to expect a different outcome in the long term?  Or might it lead to "going from the frying pan to the fire?"  How is her behavior affecting your well being?  What is her goal?  Where will she stop?  What are you willing to put up with?

At what point to we "let go" and stop the "caretaking"?  What choices do we have?

I can't say what a good path forward is for you in your situation.  The way I see it with an elderly BPD parent, there is no good path forward.  So it becomes a choice between how to balance our needs and values with the needs and chaos that our aging BPD parent brings into our life.  How do we choose?  Is being the "good daughter" worth our own health and life? I can see how much courage it takes to be the guy that "let go" on the bridge, and the daughter of the woman in the SLATE story.

It sucks. 

[Notwendy]

Methuen- I absolutely recognize that your situation is far worse than mine. I tried be more involved when my father was ill. I don't live near them but I would visit and stay and help and it was more than I knew I could do.  I knew then that I couldn't be in that situation. At the time, I was considering moving my parents closer to me and even suggested some assisted livings near me. Dad refused at the time. I know now that this was to protect my mother from discovery- if they were there, her behavior would be noticed by someone.

I also wanted to be a good daughter but what they expected was for me to allow my mother to be abusive to me and be her caretaker- but if I wanted to be emotionally intact for my own family- this was not something I could do. By not doing it, my parents got angry at me. While I had experienced BPD mother painting me black- I didn' think my father would. I loved my father and looked up to him.

While I haven't completely stepped away from my mother, I have kept a distance. Does it take courage? I don't know if it's courage. I think for me it was being "discarded" by my father. People have reassured me that he really didn't mean it -that he was sick, and not making sense. But I still experienced it and with BPD mother refusing to let me have any of his belongings it felt that way.

I read all the books on BPD. But mostly my relationship with her was due to my attachment to my father- and he was connected with her. Mostly I grew up feeling afraid of her.

So I don't have courage - I think this experience was a sort of "hitting bottom". The reasons I am still involved with my mother - I think- are due to what I think is a level of decency for me- what can I do for her- and still keep a distance. It's also because she's at risk for elder financial abuse so it's better for her that I have POA- (when she allows it)

I don't meet her expectations. I think people who don't know the situation are probably thinking her kids are horrible people. We don't visit as often as we probably should. This is not normal. Normal would be that she would be closer to me and I'd be helping more. "Normal" is what I have wished for. A "normal" Mommy- someone to take care of me and love me as a child, and I would care and love her in her older years. I tried "normal" - it doesn't work.

I did "let go" of the bridge rope. I am the "monster" who isn't keeping close to my elderly mother. It's unsettling as I don't want to be the monster but it seems that in a relationship with someone with BPD we have two choices- let go of the rope or go over the bridge- and so the bridge is not an option.

I am wishing you courage to take care of yourself. I agree- there's not a comfortable "balance" between our needs and theirs. It feels more like a wobbly balancing act and leaning to one side or the other.

[Methuen]

Post script:  Karpman Triangle

I am wanting to come across as an observer here.  From afar, it is easier to see the bigger picture than it is for us when we are caught in the eye of the drama storm just trying to survive moment to moment.

So from afar, this is what I think I see, but if I've got it wrong, I know you will set it straight.

The Karpman Triangle has 3 roles.

Persecutor = the assisted living facility, and the people who work in it (doctors, nurses, aides etc).  Eg. the person whom she reports "hit her".  

Victim = your mom

Your mom has reported she is being abused at the facility.  I would be surprised if there wasn't another side to this story, knowing how a BPD can twist things.

This is followed by an email:

"please take me home with you, I want to go home with you.  All I want is to go home with you"

And there it is.  You are her designated caretaker.  Every pwBPD has a caretaker.  They NEED a caretaker.  

Rescuer = you

Moving forward, having a conversation with a supervisor is a good idea.  Since the facility staff aren't answering your calls (your mom told them not to talk to you at some point?), this may mean a trip there to meet with a supervisor.  There is a cost of time and energy to you.  And your mom gets you to do stuff for her.  Always chaos. And rescuing.  But probably necessary under the circumstances.  I would exercise caution in how to approach it though, so that it doesn't come across as "accusing", but rather as a daughter trying to keep in touch with how things are going for the facility with a difficult resident that happens to be your mother.  You might get better results if they know you are also on their team, and not just there to take your mom's side.

Setting up a camera is a really good idea.

Help me remember, but when she first moved there, weren't you quite happy with the facility and the staff?  Has there been a change in how you see the people who work there doing their job, or did you have concerns from the time she entered the facility?  Does your concern stem from what you have witnessed, or from what your mom reports to you?

My dad was in a facility for 1 year before he passed (Lewy Bodies).  My opinion of the staff never changed - if anything it improved.  One difference is my dad was well-liked, gracious, grateful, kind, compliant and agreeable.  The staff were so good to him.  There were a couple of exceptions, including one time a staff smacked him, but it was dealt with and that person left. There were other residents there that were more like your mom.  One was also a screamer, and terrified our little kids every time we went to visit dad.  There were also "wanderers".  One time, someone's teeth went missing.  They were found soon enough, and cleaned and returned to the rightful owner.  The way most people approached it was with calmness, and a sense that it is what it is, it's going to happen, and everybody just worked together to locate the missing teeth and return them to their owner.  Humour in the mix didn't hurt either.  Dad's facility also a "group" for family members which met regularly.  Along with the family members there were a few members from staff representing the facility.  The goal was dialogue, communication, listening to concerns, solving problems.  Not sure if your mom's facility has that, or if it's even something you would want to participate in since you don't live in the same town/city.

Beyond that, my advice is to proceed with caution, and beware of "rescuing" from a situation that she herself has created, and will probably create again at the next facility.  Of course, if she was mistreated, it needs to be dealt with, but does this reflect on the employee or the facility or both?  Nothing is ever perfect, and so I would proceed cautiously and slowly and carefully.  Because now you know what your mom's goal is.  And she gave it to you in writing. She wants to move in with you.  So she will stop at nothing to put you in the caretaking role to achieve her need.

[Methuen]

So I don't have courage - I think this experience was a sort of "hitting bottom".

I get the "hitting bottom".  Yes.  But I have to loudly disagree on the courage piece.  NW, I think you have so much courage. You, like to many, have had to grieve, make really hard decisions, and live with the sadness.  Those really hard decisions always take courage. 

I think we undersell ourselves, and do a poor job of acknowledging ourselves because we were raised to believe we were never "good enough", despite doing many folds more for our parent than some of our friends whom we hold in high esteem as being "good sons/daughters" to their elderly parents.

You, NW have courage.  I believe it with my whole heart, and it hurts me to see you write that you don't. I can think of so many examples from the stories you have told over the years.  But I think it is for you to come to on your own.  Just know that I and probably everyone else on this forum believes in your courage.  You are a role model and have provided support to other members here for years.  You have faced your mom and her behavior with so much courage. My mind is being flooded with examples.  I think it might be a good exercise for you to examine why you think "I don't have courage".

The reasons I am still involved with my mother - I think- are due to what I think is a level of decency for me- what can I do for her- and still keep a distance.

Me too, but I unfortunately don't have the distance.  My advice is to hold fast to keeping the distance you have, regardless of what she reports to you.  Trust me when I say as bad as it is right now, it CAN get worse. 

I don't meet her expectations. I think people who don't know the situation are probably thinking her kids are horrible people. We don't visit as often as we probably should. This is not normal. Normal would be that she would be closer to me and I'd be helping more. "Normal" is what I have wished for. A "normal" Mommy- someone to take care of me and love me as a child, and I would care and love her in her older years. I tried "normal" - it doesn't work.

Hugs  . I wish we could cry with each other.  But this forum has a different kind of benefit - safety in anonymity.

I did "let go" of the bridge rope. I am the "monster" who isn't keeping close to my elderly mother. It's unsettling as I don't want to be the monster but it seems that in a relationship with someone with BPD we have two choices- let go of the rope or go over the bridge- and so the bridge is not an option.

It is so hard living 5 min from her and not going over the bridge with her

I am wishing you courage to take care of yourself. I agree- there's not a comfortable "balance" between our needs and theirs. It feels more like a wobbly balancing act and leaning to one side or the other.

Thank you.  Just please don't jump to be her rescuer because of an "allegation" that may or may not have any basis in fact.  Both our mom's are pathological liars, so it is hard to believe anything that comes out of their mouths, especially when it is followed by "Please take me home with you".  OMG the FOG alone is traumatizing. 

I'm so sorry NW.

[Notwendy]

Just please don't jump to be her rescuer because of an "allegation" that may or may not have any basis in fact.  Both our mom's are pathological liars, so it is hard to believe anything that comes out of their mouths, especially when it is followed by "Please take me home with you".  OMG the FOG alone is traumatizing. 

I'm so sorry NW.

Thank you for your kind words and encouragement Methuen. I don't believe someone hit her and I am not going to "rescue" her from that place. On the other hand, I have been concerned about how the staff is treating her for a while. I understand they most likely don't like her due to her behavior- but she is also paying to be there. I rarely call the facility but when I do, I often can't reach someone there. I did ask to speak to the director that "my mother expressed concerns"- I have tried to speak to her and she does not respond. My mother also told a nurse advocate and the advocate decided we need to report our concens- for mediation, not an allegation that someone hit her- so an advocate is stepping in to facilitate communication. We are not assuming it's a real accusation but the staff is avoiding her, avoiding us and that makes me concerned about how they are treating her in general.

If we moved her it would be due to overall hostility or neglect. They can have boundaries with her and don't have to tolerate abuse but they should not treat her poorly. If this advocacy results in things getting worse, we may not have a choice. I hope not.

But if we do, it will be near where she is. I will not bring her closer to me.

[Tangled mangled]

I don't meet her expectations. I think people who don't know the situation are probably thinking her kids are horrible people. We don't visit as often as we probably should. This is not normal. Normal would be that she would be closer to me and I'd be helping more. "Normal" is what I have wished for. A "normal" Mommy- someone to take care of me and love me as a child, and I would care and love her in her older years. I tried "normal" - it doesn't work.


NW,

I don’t speak for the staff looking after your mum but from my own experience of dealing with families in your situation- generally staff dealing with difficult patients/residents know far more than you think about the dynamics between you and your mum.
I personally don’t remember a relative being seen as horrible when the patient/resident in question is as difficult as your mum.
They may keep their distance because generally your mum has been labelled as difficult and that’s enough for them to deal with and they may be expecting you to be as difficult as her. There also legal implications for the facility if a staff member shares information about your mum that may be inaccurate.

The worst I’ve seen-and I’ve been around residents/patients who were both verbally and physically abusive to staff- is were relatives behave as if their difficult elderly parents were oil paintings that could do no wrong- relatives who lacked empathy for staff and would go the mile to launch all kinds of legal attacks. That could be the reason why the facility staff maybe distant and not because they see you as horrible.

Like you have described it’s expected that relatives visit their parents more and from the behaviours your mum has displayed at the facility no one is in doubt of your reasons for keeping a sensible distance.

Don’t be hard on yourself NW, you have done more than enough to keep your mum safe and to maintain her dignity.

[Notwendy]

NW,


They may keep their distance because generally your mum has been labelled as difficult and that’s enough for them to deal with and they may be expecting you to be as difficult as her.

The worst I’ve seen-and I’ve been around residents/patients who were both verbally and physically abusive to staff- is were relatives behave as if their difficult elderly parents were oil paintings that could do no wrong- relatives who lacked empathy for staff and would go the mile to launch all kinds of legal attacks. That could be the reason why the facility staff maybe distant and not because they see you as horrible.

That's the sense I am getting- that they are avoiding me due to her behavior and may assume I am also difficult.

My mother lies a lot, so the only way I can know what is really going on is if I can talk to the staff and medical providers so their distance makes that difficult.

Thanks for the reassurance. It's an odd in between. I don't feel a warm emotional connection to her and yet, I also don't want her to be in a situation were she's neglected or worse- harmed- at least to the best of my ability. I can't control how the staff interacts with her.

On one hand, she's cruel and manipulative, and on the other, dependent and also is elderly, frail, and can't do a thing to help herself. It's like 2 people in one. I know who I am dealing with but how much to let her experience the consequences of her behavior isn't as clear as if she were a competent and physically healthy adult- especially if she's confused at the moment.

She hasn't been diagnosed with dementia. At the moment, they decided to go ahead and treat her for a possible urinary infection- and they reduced some of her medicine doses and see if her confusion gets better.

[zachira]

Notwendy,
I am under the impression from what you have shared that your mother is making constant demands on the staff and that if anybody walks into her room, she makes all kinds of unreasonable demands on them. My aunt who had strong BPD traits wanted to stay in her home and have her daughter who was in poor health herself be her full time caretaker. Her children hired an agency to give her 24 hour care. The problem was that my aunt would not allow her caretakers one minute of peace, constantly demanding they do something for her, like get her a glass of water if she saw they were idle. Eventually all the caretakers quit with her daughter spending a few nights sleeping on the sofa to provide care for her mother. My aunt met the qualifications for nursing home care determined by an outside evaluation, though she might have qualified for assisted living if not for her disordered personality.

I went to visit my aunt in the nursing home. From what I saw, she was the most able bodied mentally alert resident there, able to walk and interact with people. The staff at the nursing home told her children she was the most difficult resident that they had there. I am wondering if the staff just avoids your mother so they are able to provide the necessary care to the other residents. My aunt's children tried to take over her finances because she was not filing taxes. My aunt hired a lawyer to keep control over her money. My cousins were honest people and would never have helped themselves to their mother's money. Much of the inheritance was lost due to penalties because my aunt did not file taxes in the years before she died. I don't know if this story helps or not. I think you are up against impossible odds to figure out what is going on, with your mother determined to fail at the assisted living, so you will have to take her in. My aunt was determined that her daughter was going to take care of her, and made sure to be the worst person to care for while at home with caretakers and at the nursing home. Do you think this is what is going on with your mother?

[Notwendy]

Yes, Zachira- this is a lot like my mother and I don't put it past her to do anything to get what she wants. We will not bring her to our hometown- my husband also feels the same way.

BPD mother even as a younger person would threaten to "cause a scene" if she didn't get her way and that could be extreme- screaming, destroying things, calling up people and saying things to them and self harm. Sometimes she did these things when dysregulated but other times, deliberate.

I can't tell if she's truly confused or faking it.

Got an email from the nursing director that the staff can't manage her and she needs to have private  care there. She can not afford that. Apparently she put one of the nurses in tears.

Assisted livings centers can evict a resident if they make the case that they can't provide the level of care they need. There is a memory care unit- with a higher staff/resident ratio, that might be possible but I also think they may just want her to leave. They haven't said that yet. They have to give 30 days notice if they do.

I am already looking at other assisted living situations in her area but it could be the same issue anyway. If she truly is that confused, my power of attorney would be effective- but she also sometimes snaps out of it and also she might be faking it. She can't live on her own. She's very dependent -  but she's still in better physical condition than people in nursing homes.

[Methuen]

Since she is already in a facility, can you request a geriatric psych assessment? 

[HappyChappy]

Got an email from the nursing director that the staff can't manage her and she needs to have private  care there. She can not afford that. Apparently she put one of the nurses in tears.

Hi Notwendy,

I'm so sorry to hear this. It's a bit like expelling the difficult children at school, it's all they can do with limited resources. Do you think there's any chance your mother would change her behaviour, if people proved to her it no longer works ? I ask, because the only time my BPD has conceded has been when everyone including the authorities - block her. I.e. she can't get what she want's by being rude and disrespectful, so becomes complainant ?

[HappyChappy]

... Correction, not "complainant" I mean, compliant - i.e. does what she's told. It's the system that works with the "worst offenders". Maybe offer to work with the nursing home on this - i.e. united front ? The BPD system is to set people against each other - so a united front may help ?

[Notwendy]

She will face a united front- that is- she will need to stay in the area- even if it means another facility. She has limited funds now- so she doesn't have a lot of choices. She's responsible for that. She had money but she chose to decide how to spend it regardless of our advice to please save it for her needs.

With all behaviors- people use the behaviors that have been reinforced. This is an elderly person who for decades, has been enabled by my father- ( and by extension- us kids because we had to behave) because we all feared her escalation. These are the only behavioral tools she has and they have worked for her until recently. It's not likely she's going to undo decades of reinforcement.

The assisted living has tried- this has been going on for a while. I think they are fed up. They called me again with another behavioral issue that they are documenting. I suspect they are documenting to build their case for eviction.

While I don't want my mother to be abused or neglected, I agree with the lesson of "natural consequences" and to not rescue someone unless it's a danger to them. She only agreed to move out of her house when the risk of the bank repossessing it was there. She didn't slow down with her spending until her funds were too low to continue that. If she gets evicted- I will ask the assisted living to address that with her- she needs to know that and that she needs to move. I don't think they will give her another chance.

Family will not rescue her but there is a limit to the extent of the consequences. One can't just put an elderly and infirm person out on the streets. She has to go somewhere that meets her care needs. Likely social services will be involved. They will present her options to her. I have a say in where she goes, but we are all aware that pwBPD take advice better from other people rather than family members. It's better to have her be aware of the consequences and choices.

[zachira]

The psych evaluation sounds like a good idea. Let the assisted living do what they have to do to get your mother a placement that better fits her needs. I suspect they will try to place her in a nursing home, like what happened with my aunt who to me would have seemed to be able to be in an assisted living if it weren't for how demanding she was to the staff.

[zachira]

I am wondering if a better fit for your mother would be a mental health facility.

[GaGrl]

I am wondering if a better fit for your mother would be a mental health facility.

Or perhaps the memory care unit could be explored.

[HappyChappy]

While I don't want my mother to be abused or neglected, I agree with the lesson of "natural consequences" and to not rescue someone unless it's a danger to them.

Notwendy,
 
You're very wise, it sounds like you know how this must roll out. You've clearly done your best for your mother, you can't do better than your best. Be good to yourself, you must be exhausted by all this.

[Notwendy]

I am wondering if a better fit for your mother would be a mental health facility.

Zachira- There really aren't any. There are facilities for shorter term issues- addiction, to get someone stablized on medicine- with the goal of the person going back home to their regular lives. There may be a few in certain areas of the country- not any I know of.

GaGirl-It would be good if the assisted living offers to move her to memory care but by the defensive tone of the staff and nursing director- I get the sense that this would be an opportunity for them to evict her if they wanted to do that.

They have made some medication changes to see if that is the issue. If her state of confusion doesn't improve- I will ask for a mental health evaluation and also to determine mental competency.

It's hard to tell what is "real" with her and what is her being manipulative. She calls me being all sweet- "I'd really like to see you". She doesn't usually do that or even ask me to visit.  It would be nice if it were sincere, but I can't believe what she tells me. Her usual demeanor with me isn't "nice" or affectionate- unless she's manipulating me. She may be confused but she still has her manipulative behaviors.

HappyChappy-thanks, yes, it takes time and attention. I know I am doing what I can to the best of my ability, while protecting myself from her behavior and exploitation. It seems that with BPD, they are emotionally unsettled much of the time.

[Notwendy]

I also wonder how much of the "confusion" is real or she's faking it. She's been "confused" before- and it has generated a crisis situation and medical consults. No cause has been found. After a while, she snaps out of it- becoming completely lucid. During these "crisis" - decisions are made and when she's lucid again, she takes control again, sometimes reversing decisions.

I wonder if plans are made to move her to memory care or she's evicted if she will become lucid and refuse the plans. If she's evicted though- she will not have the choice to stay where she is.

I feel sorry for her in her situation but also, I've experienced her behavior.

[zachira]

I don't think the assisted living can just put your mother on the street, that they have to find her a placement somewhere. Perhaps it would be better that you do not visit at all, because maybe the assisted living could say we are evicting your mother and you would have to take her home with you.