Elderly sister with BPD

[Janiek]

Hi this is my first post. Here is some background. My  73 yr old sister has BPD. I believe there are other issues, such as health anxiety, depression, and general anxiety. She is not like other BPD people that I have read about. She is completely dysfunctional…..mostly ,she says, due to overwhelming anxiety. She has never worked, depended on parents, (who are now deceased), gets SSI, and food stamps.  She was fortunate in that there was money to buy a small apartment.  I pay the monthly maintenance.
She is very concerned about her health ALL the time.  If she has a small or big medical issue it’s a HUGE deal for her, which results in trips to drs, ER, fear, depression, panic and neediness.  Additionally,  because the family doesn’t jump in to take care of her she freaks out and starts down the rabbit hole of…”everyone hates me; why don’t you care; you would help——- if they were in my position;  why can’t you treat me the way you treat —?”  I get long emails and in the past, before computers, long letters  saying that she needs help, support, she has this problem, that problem, etc.  it never ends and what I do is never enough.
My problem is that I am overwhelmed by her. Its been decades of hearing about problems and trying to help her. I want to have my own quiet and peaceful life. having her in my life is emotionally exhausting. She is so needy and overly emotional and it makes me uncomfortable.  I don’t know how to explain to her that I don’t want to listen to the constant complaints and be around the negativity.
Basically, my question is how do I say it? 
Sorry this is so long.  Thanks in advance for advice.

[CC43]

Hi Janiek,

It can be so hard to deal with dysfunctional relatives!  You're right, no matter what you do, it's never enough, and it's both worrying and draining to be around them.  It's as if they are a bottomless pit of neediness.  Most people who get a cut can put on a bandage and get on with life.  With BPD, it's as if they keep bleeding, at least figuratively.

At her age, your sister is likely too old to change, and she has no incentive to change, because her behaviors have worked for her until now.  If she hasn't sought help to alleviate her anxiety or other issues by now, she probably never will.  So I think you have to change how YOU deal with her.

I have a relative who complains incessantly, and to cope with her, I give her a time limit, which depends on my energy level that day.  After I hit my limit for listening to complaining with no resolution in sight, I employ a three-strikes rule.  So after she rants and complains for a time (I usually give her 10 to 15 minutes to vent), I'll say something like, "We're not getting anywhere, so let's talk about something else."  If she says, "Well, but . . . " and continues her rant, then I'll reply, "This conversation is really stressing me out, so if you continue, I'm going to hang up (or leave)."  And if she continues, it's a third strike, and I hang up (or leave the room or house).  That way, I regain some peace for me.  And she can continue the conversation another day, when my energy level has recovered.

I have another relative who is a supersized hypochondriac (and an undiagnosed NPD).  His tales of medical woe are not only tiring, but unbelievable.  He seems to believe that his body is unique in this world, resistant to conventional medical treatments.  And he uses purported aches and pains as an excuse for everything under the sun--for example whenever he is late or doesn't fulfill a promise or commitment.  He has an advanced degree, and yet he has been unemployed for years, and he neglects taking care of his young children, using his ailments as excuses not to parent.  Worse, he complains of all sorts of issues, and yet he refuses to see a proper doctor!  He'll use ER and Urgent Care services, but he never follows up on any recommendations.  Does that sound familiar?  My theory is that he has untreated NPD, depression and alcoholism.  He doesn't want to do anything other than seek attention, drink or play video games.  And he doesn't have much else to think about, so his aches and pains command all his attention, while serving as an excuse du jour.  My advice?  Don't listen (or maybe you listen, but you don't say anything in response--be as boring as a gray rock).  Don't even recommend any treatments or potential solutions, because he doesn't want to get better!  He's happy being miserable, and in a way, he wants you to be miserable right along with him.

You are a wonderful and caring sister.  Unfortunately, if your sister has BPD, she'll probably never appreciate what you've done for her.  I hope you find some ways to cope with her a little better.  You must be exhausted and frustrated after trying to help her all these years.

[Janiek]

Thank you so much. I will try yout suggestions.

[Notwendy]

Sorry you are dealing with this. My elderly BPD mother is also low functioning and struggles with anxiety. She was completely dependent on my father. He planned well for their retirement so she was financially stable when he passed away but she has spent almost all of it.

Family has tried to help her- with money magement, moving her to assised living, and other aspects. It's been difficult as - like your sister- my mother is not happy with the efforts and also sabotages attempts to do things for her benefit.

You are, in a sense, a better position to step back from your sister. She is already on SSI and food stamps. Medicare provides medical coverage but if your sister ever needs a nursing home- she would most likely qualify for Medicaid coverage. Due to my mother's handling of her finances, it's unlikely she would qualify.

One idea to possibly help put your mind at ease is for you to consult an elder law attorney about what can be done for your sister. I did, and although my mother would she cooperate, with any kind of financial planning, it was helpful and informative. I think it would put your mind at ease to have it- a "what if" you stopped helping her financially.

For instance, the apartment can be considered an asset if it's in her name. Medicaid will look back 5 years at any transfer of assets. And if it is in your sister's name, she can do anything she wants with it. I hoped that if my mother needed assisted living, the value of the house could help provide funds for her. Well, she took out a home equity loan on it and didn't tell anyone until she had to move due to lack of funds. One idea to discuss with an elder law attorney could be how to protect the apartment as an asset so your sister can't do something like this, or in the case she needs to have Medicaid assistance.

Who is her power of attorney? I am the "disempowered" POA meaning, I try to make sound decisions, BPD mother overrides them- mostly over her money so she has it for her care but she's gone through most of it. With your sister on social services, if there isn't a POA- she can become a ward of the state if she isn't able to make her own decisions and that can be a boundary for you to keep you out of conflict with her over decisions.

I have a friend who has a narcisistic father in a Medicaid covered nursing home. In these situations, the person has very little money for "extras". All their social security income goes directly to the facility for care cost. In these situations, if there are going to be extras, friends and family provide them. She visits him, brings him his favorite snacks, clothing if he needs it. Does he appreciate her? He doesn't act like it but she does it because she chooses to. The relationship is still difficult for her. But she also has the peace of mind that he has a place to stay, food, and medical care. She can have boundaries with him because he has these basic needs covered.

[CC43]

Notwendy, you make some excellent points.  I'm taking notes. 

[Janiek]

Thank you notwendy….great advice!.  My sister is already on both Medicaid and Medicare so that won’t be a problem going forward. The apartment is owned jointly by me and her.   
To be honest it’s her expectations that we (the family) should be taking care of her, i.e. driving her, helping with food shopping, talking to the dr., generally just listening to her complaints about her “cursed” life as she likes to put it, that make me so upset, guilty, etc.  and also the drama! Everything is a crisis and any help is not enough.  And she lets me know it.  Anyway….im trying to figure out how to set boundaries without hurting her.  Thanks again for responding to my post with ideas. 

[Notwendy]

The apartment is owned jointly by me and her.   

This is a big reason to see an elder law attorney. I don't know about siblings as co-owner of a house, but if this were a joint bank account- the way they handle this is that each of you owns all of it. So if your sister needs to be placed in a Medicaid covered nursing home- Medicaid may still take the value of the house for coverage for her care.

The only joint protection for a home is when two people are married and living there. If one goes into a nursing home, they don't take the house as the surviving spouse has to live in it but they might after the surviving spouse passes. I am not sure about home ownership and Medicaid as my mother was sole owner when she took out the loan and when it sold, the bank took its share of proceeds. So even if she did qualify for Medicaid, the house was not available as an asset.

The Medicaid "spend down rules" are complicated. It surely wasn't anything I knew about. Another thing is that Medicaid looks back 5 years so if you were to put the house in your name and your sister needed a nursing home within 5 years, it would still be considered a possible asset.

There is a way to put assets into a trust that is Medicaid laws compatible. However, for my situation, this would have required that my mother cooperate and she doesn't so it wasn't possible to pursue that.  With your sister's situation, if you are paying maintenance- and you own the house- I think an elder law attorney who is familiar with Medicaid rules can best advise you on how to protect your investment.

As to your sister's expectations, there's no way to change her thinking. It's boundaries on your part. However, I do think it's a good idea to consult a knowleagable attorney to protect your share of the investment in that apartment.

[Janiek]

Thank you. I will look into this!