Your Wise Advice Requested!

[Psuedonym]

WomanInterrupted, I know this is one of your fields of expertise. Perhaps you can lend me your wisdom on this.

So my uBPD/N M returned to Independent Living a month ago (from AL) against everybody's advice. I have been NC since that time so her contact has been through my BF. Last week she got a letter saying she was being kicked out of IL due to bugs being in her apartment (not sure if this is entirely legal, I do know that the letter is the first step in eviction but if a) the problem can be fixed there must be a 21 day warning first and you do have to go to court to have somebody actually removed from their place of residence.) The independent living people actually run the AL as well and were actually nice about it, they told M that they didn't think IL was appropriate for her (there's also pills all over the floor constantly) but they would be happy to move her back to AL. Of course she refused this because she's not going to live with the 'old, sick people' and said she'd just go rent an apartment first....uh, not going to happen. She is 89, doesn't drive, is not computer literate and in poor health. 

We've been working with the facility to try to work out a solution. They were willing to consider letting her stay if she got in home healthcare (we're looking into that.) Then yesterday she got a massive nosebleed that wouldn't stop and was taken to the ER. The details here are fuzzy but at some point they released her, she got back to IL, and was making her way upstairs claiming to feel very lightheaded when a neighbor ran into her. The neighbor took her to her apartment and flipped out when she saw the state of it, said M was claiming she was dizzy and didn't want to be alone, and called the front desk, who called 911 again. (Neighbor also called my BF and left a nastigram VM saying I needed to 'step up and get her to AL'....Hey lady, how bout you take a stab at that? Did not return that call).

Anyhoo, she went back to the hospital and I don't really know any more. I'm assuming they admitted her and it's weird that BF hasn't heard from her. But here are questions:

If she is indeed admitted to the hospital, do they have to assure that she's okay to be by herself before they release her?
Will they automatically assign a social worker?
If they deem that she is not okay to go back to IL, will they keep her there until something can be worked out with an AL?

It's fairly scary how dysfunctional she is. I think she truly believes that if she eliminates any other option that she will force me to have her come live with me and that ain't ever, ever, ever gonna happen. I was saying to my BF that this is basically a stalker situation, except if it was an ex who was stalking me it would be more clear cut. I will say that I am infinitely calmer going through this latest crisis now that I'm NC. I know we'll get through this but am not sure what the path forward is.

Thanks in advance for your wisdome! Sorry this is a rambly post!

[openskyblue]

First, I'm really sorry you have to deal with this. And by deal with it, I really mean that you have to have this in your awareness. It sounds like you are holding onto a healthy boundary with your mother.

Given her age and situation, it's somewhat likely  that the hospital will give her a psych evaluation for dementia. That is probably a good thing, because a social worker might then get pulled in to sort out where she should go. The hospital won't keep her until her living space is worked out. They might send her to rehab or a nursing home, depending on her medical condition. Hard to say, though.

[WomanInterrupted]

I'm going to be completely honest with you and tell you I have no idea what happens next, only that she must be released to a SAFE environment - whether that's IL, AL, rehab, or the SNF, is anybody's guess.

But yes, I believe social workers will start getting involved - and if they all work for the same facility, that's *fantastic* because they'll actually communicate with each other! 

I think they'll probably get together and brainstorm WTF to do with her - and yes, they may test her competency, and keep testing it periodically, just *waiting* for her to fail, so YOU can step up and make rational decisions FOR her *or* tell them to make her a ward of the state, wash your hands, and walk away.   

If anybody calls and tells you to do this, that, or the other, tell them your hands are tied, you have no involvement, and THEY will have to come up with a plan that doesn't involve you, in any way, shape or form. 

If they balk, I've had great luck saying this, "I can't be the first person who has ever been in this position.  Not everybody has somebody.  What do you do in those situations?"

It's true - not everybody has a next of kin, or a next of kin anybody can locate.  They *do* have contingencies for those situations, but they may have to look them up or do a little research. 

Just remain pleasant - but detached.  You're very sorry, but you can't do anything, and they'll just have to wait until she fails a competency test.

They'll probably try to convince her to go into AL - and if she balks, well, she balks, but I don't think they can just bounce her *unless* they have a specific policy about losing your place if you're in the hospital more than X amount of days - but then, the hospital social worker will have to find her a new place to live, and that's when it can get ugly - they'll call YOU and ask if your mom can stay with you for a while.

Tell them NO, that is impossible, your house isn't *safe* for her - steep staircases, no main-floor bedroom, no room to navigate a wheel chair (that's my house - ish - BTW, but nobody is going to check, so g'head and use it      ) and THEY will have to come up with another plan, don't call again - goodbye and BLOCK. 

If they start getting insistent that you be involved, or you do something - see, "I can't be the first person who has ever been in this position.  Not everybody has somebody.  What do you do in those situations?"

You're probably going to have to do a lot of pushing back - if it gets to be too much, it's okay to start blocking numbers, rather than skipping dinner after dinner, in hope of getting your stomach to calm down and STOP.   

[practical]

So sorry! It just doesn't stop.    Any way longterm for your BF to step away too? You are kind of a passive smoker right now, except you inhale your M's chaos, even if it is filtered. I did this with M, I didn't talk to her but heard about her from F, from B, was involved in fixing her problems, and so I never quite got out. It was sure better than being in actual contact with her, but it wasn't true NC as I realized after her death and coming here. You have to know what you can do and need for yourself, maybe this works for you.

I don't have concrete answers. My limited advice would be to find out from AL where she is, contact the hospital and ask for the social worker and explain the situation to this person including that you are not available to deal with her. The social worker should please sort it out with her and AL. As social workers are usually not around on weekends I would wait till Monday and try to enjoy the rest of the weekend.

[openskyblue]

 

I'll chime in hear. As kind as your BF is, his involvement doesn't help matters. First, he has no skin in the game in terms of healthcare decisions, and health professionals are legally not allowed to tell him anything about your mom's medical care or situation. Also, his first priority should be supporting you and your decisions and boundaries, not serving as a go between. It's not fair to you or to him and, eventually, it may hurt your relationship. Who needs that?

[Psuedonym]

Hi everybody!

Thanks so much for the advice! My main concern was that they just don't kick her out of the hospital, but it sounds like they will make sure that she has some sort of safe environment to go to before they let her out. Now that I think of it the last time she was in the hospital for the blood pressure thing the doctor wanted to talk to me before they released her. I had a call this morning from the hospital saying they had some questions, I called back and they paged said person, and then crickets. Haven't heard anything, which is very strange, but I'm going to let it be. I said to my bf 'maybe she keeled over and they forgot to tell us', which is dark but certainly not a worst case scenario.

I think the IL/AL facility has a vested interest in trying to work out something. I looked up state law and they can't just boot her out without taking her to court and having the sheriff evict her, and that probably wouldn't go over super well with the gossipy IL crowd. I am hearing you on getting my BF removed from the situation. The hope was that getting her into AL and/or getting a home health aid would help in that department. We have found someone great to come in and help her if and when she gets released from the hospital.

WI, I do in fact have steep staircases, a very iffy brick walkway, no ground level master, and two cats who love to trip people, so I'm ready for that argument if it comes up.

Thank you thank you for all your wisdom and support!

[openskyblue]

Pseudonym, I just have to say that if, when I am old and infirm, any one of my kids showed the concern and care that you are putting into your mother right now this minute , I will count myself a lucky woman.

I'm not pointing that out because I think you owe your mother that level of concern. I'm pointing it out because I'm not sure you might realize how much of yourself you are investing in your mom's wellbeing right now.

Would she do the same for you?

[WomanInterrupted]

I'll open with something I said before, because sometimes we need comforting reminders:  Nobody is going to dump her off on your doorstep, ring the bell, and run away.   

I agree with Openskyblue - she's taking too much of a priority, for both you and your BF.

NOT chasing down the person who called you was a smart move.  If they call back, they call back, and if they don't, they don't.

I think you trying to find her some kind of aid is a *bad idea* because she'll probably wind up firing that person within a week - and firing the one after that, and the one after that, and the one after that *because they're not you.*   

And she'll do it to *punish you* - hah!  You can just find her another or do it yourself, like she wants, or better still, move her in with you, because *that's been the plan, all along and it's never changed.* 

Your mom sounds a lot like unBPD Didi and unNPD Ray that once they got something into their heads, that was THAT, nothing would sway them and they WOULD "win" -  I don't think her plan of living with you has changed one bit, and she's probably going to make things intentionally difficult, to try to force that plan into action.   

Yeah - you're  No Contact, so it's *not going to bloody happen* and she can't *force* you to do a thing.   

If she wants an aide, she can ask the ILF to hook her up with one, but otherwise, I'd stay out of it.   

What I think will happen is the hospital will call a cab  to take her back to her ILF apartment, and she'll have to deal with the facility, regarding the eviction.  They'll probably try to convince her to move to AL with the same show they had to put on before about how will she get her meals and how will she get dressed (oh, she bloody KNOWS!   ), but she's going to have to be sweet-talked into staying (and probably paying more money, per month).

If they can't convince her - and she doesn't fail a competency test - there's nothing anybody can do.  She can find another apartment, elsewhere - and find her own way to go to mandated competency tests, if they're required, and figure out how to manage living without any sort of safety net - except for maybe APS, whom the ILF might call, to make sure she doesn't fall through any cracks.   

ALL this can happen without any involvement from you.  Pretend you and BF are on Mars, and the coms are down.  Or you're halfway around the world, in a remote place with spotty phone and internet service.

Your mom created her own problems - well, she can figure them out without *any help at all* - except for help from the professionals at the ILF and AL. 

If she needs help moving, or with anything else, I think that would be time for your BF to block her number. 

With luck, the social worker at the AL can spin enough sunshine and roses that she moves across the campus, to that facility - but that's the social worker's job, and I'll bet she's really good at convincing difficult people - even more than once.

I'm certain this is not their first time at the rodeo, and they DO have some sort of contingencies in place when a resident is evicted from one area, and they'd like to place that resident in another area. 

Really smooth folks are good at letting people like your mom think they'll be *gaining* something out of making the move to AL, and also letting them think they made that brilliant decision to move to AL *all on their own, without any prompting.*   

The social workers there have seen it ALL - and are probably very good at those tactics. 

Let all this unfold *without  you* - it's not your drama.

[HotCocoa]

Psuedonym - my grandfather just went from moving to a home, to an apartment, to IL, to AL.  He is soon probably going to nursing care so we have run the gamut of moving him back and forth.
This is what we experienced in regards to his experience.
IL - someone came in and cleaned once a week and changed his bedding and towels regularly.  If your mother's place is a wreck, then she may not be letting people in there to do their job.  If they do that at that facility.  It should not be a wreck or have bugs of any sort.  She is a danger to other people living in IL.  If she is bringing in bed bugs, or cockroaches, or flies, these are dirty and can spread very quickly.  To me, she also may need a competency test.  She sounds like she is not able to live independently. 
They may have room in AL and that would be good for her.  It costs more.  That's for sure, however, she is being taken care of and someone is in her room everyday.  These facilities have people from the state tour the facility to make sure everything is up to code.  They will evict her rather than getting fined and if she has no place to go, she will still be evicted by the court.
As far as hospitals, they kick you out when they are done.  They are not babysitters.  They may state she needs rehab, or she can go back, but when they are done treating her, they want her out.  Case managers and social workers may contact you, especially if you have POA, but they will release her to wherever when they are done treating her.
It sounds like your mother is frankly her own worst enemy.  Dealing with elderly people is hard, but add a PD onto that and it can be an impossible task.  I would push to get your mother into AL so that she is not kicked out of IL with no place to go.  She may be bucking to live with you which is why I would say, get a competency test and get her into AL.  Then you know she's being cared for, but you don't have any of the work.  Those people are VERY skilled at dealing with difficult elderly people. 
I see that you are no contact with your mother, if you have POA, you should be able to deal directly with the facility.  If you want to wipe your hands of it, have your bf block her number and let the chips fall where they may.  Rock, meet hardplace.  I feel for you, if there is a way for her to be cared for where you don't have to deal with her, then that would be best case scenario.  Hope this works out for you, this is never easy.  Good luck.

[Sneezy]

My Mom lives in an IL complex that does not have AL or any higher-level care.  There is a clause in her lease that reads as follows: "If we determine in our sole discretion that you have become unable to provide for your health care or personal care needs, or have developed a physical or mental condition that creates a danger to yourself or others, then you will promptly move out of the Community and into an appropriate outside accommodation of your choosing."

So it appears that in my Mom's case, her IL facility can boot her out if she is not capable of independent living.  I think these kind of clauses are common, so it may not hurt to check your Mom's lease and see what the terms are.  You may be able to use something like this to your advantage (sorry, Mom, I'd like you to stay in IL, but the facility is invoking its rights to kick you out if you don't agree to go to AL, wish I could stop this, but I can't).

The hospital can't release your mother out on the street if she can't take care of herself, but they can move her to a rehab facility or some other (i.e. less expensive) place.  They will try their hardest to get you on the hook to take care of your mother, because that is easiest for them.  As others have already said, be strong and make it clear that you are not able to provide or ensure any care for your mother.  Practice saying it if you have to - "I am not taking responsibility for any of my mother's care.  If you release her with the expectation that I will be caring for her, then you will be accountable for any harm that comes to her."

Good luck!

[NotFooled]

If she is indeed admitted to the hospital, do they have to assure that she's okay to be by herself before they release her?
Will they automatically assign a social worker?
If they deem that she is not okay to go back to IL, will they keep her there until something can be worked out with an AL?

I do believe the hospital will only release her unless she is going home to a safe environment.  I was recently admitted into the hospital and they ask allot of questions to make sure your home environment is safe before you go home. 

If she makes it seem like she has a safe environment to go home  to they'll probably just release her, unless the IL got involved at the hospital but I think that would be unlikely since she is in IL. 

My FIL who had advanced Alzheimer's was sent to a memory care facility when he had sepsis.  The hospital and his ASLF arranged the transportation and there seemed to be a great deal of coordination between ASLF and hospital. But OCPDMIL moved herself out of that ASLF, when FIL passed,  to one that  is cheaper and more like IL.   They don't seem to have the same level of coordination and care and don't get as involved in her daily activities. 

[Psuedonym]

Hi OOTFoggers!

Just wanted to give you an update and say that once again your wise advise was correct. So...the social worker at the hospital was useless but the PA was great and somehow talked her into going to skilled nursing. This is going to sound super weird for those of you who live in the US, but the insurance she has for supplemental insurance is outstanding, and they assigned a whole team of people to her, including an extensivist (new field of medicine), physical therapist, and social work/psych review people. They over the case of almost a week collectively convinced her that she needed to go to assisted living.  A truly amazing achievement. Then the same insurance angels called me and said 'we work with an independent contractor who finds assisted living facilities for customers (at no charge to them). Would you like him to call your mother? He'll take her around to whatever facilities she'd like to see.' Oh and they agreed to keep her at the skilled nursing facility until she finds a new place.

Throughout this I have done precisely jack shit except talk to a few employees. And somehow it's all getting done (so far) without me.

So, thanks, wise people!

[Psuedonym]

...one more thing. The independent consultant actually mentioned an AL facility near me that I never would have thought of that has just done a multi-million dollar renovation and has really big, nice apartments. So my being a monster and neglecting my poor sad abused mother has actually resulted in better options than had I tried to fix everything.

So let that be a life lesson to others that sometime truly the best thing you can do is stay out of a situation.

[openskyblue]

Wonderful news!

[WomanInterrupted]

You're a shining example of how to win at life, by doing nothing for your mom!   

I haven't stopped smiling since I read your post, and want you to know how *proud* I am of you!   

That team sounds *wonderful* - and it sounds like people are starting to realize what most of us already know:  not everybody has somebody to "do" for them, because of the sheer distance involved, a lack of living descendants, or just being so damned ornery, that we can't or won't get involved.

The new people are a novelty for your mom, so she'll probably be on her best behavior - and she'll stay on her best behavior, when she first settles into her new digs.

If she's anything like Ray, it's when she gets comfortable in the new facility, that she'll start making life a living hell for the staff and other residents.   

That's when the calls from the facility will probably start coming -they won't want you to do anything, but they just need to keep you informed, and it will probably take a hell of a lot before they'll even consider bouncing her to another facility.   

What they'll probably do, if she becomes really disruptive and unmanageable, is get a doctor in there to slap a label on her, so they can properly manage her with medications.   

This is the time in your life where you need to think ahead about being her POA - do you even  want to do it?  If not, when the time comes, you can advise the nursing home to have her made a ward of the state, and let them take it from there.

Once the dust settles and your mom is moved into a facility, you can even call the social worker and let that person know that if your mom is ever declared incompetent, you won't be her POA, and they can make her a ward of the state - they'll make a note of that, which will make things run much more smoothly, should that day ever come.   

And yes, some of the *worst* experiences I had with social workers were *hospital* social workers, who are actually paid a lot more than the social workers at the nursing home or rehab, who are the BEST of the BEST when it comes to social workers.   

Again, I'm so damned HAPPY for you - and I was really interested in Extensivist Medicine, which will hopefully prove to be a godsend to people with ageing PD parents!   

[Psuedonym]

Thanks openskyblue and WomanInterrupted!

Honestly, WI, when the nurse was telling me that she had agreed to go to AL and that there was this resource who would take her around to all the facilities, my first thought was 'whelp, WomanInterrupted was right on that one!' My stepping out of the situation has actually improved it, because her attitude all along was 'I'm an adult, nobody's going to tell me what to do' (while expecting me to do everything) and now she gets to make decisions and pick the place like a grown up. Plus, there are options that I didn't even know about.  This guy, who is sort of an independent consultant for finding AL facilities, is awesome because he's thought out scenarios and questions that hadn't.  For instance the place he's found that has the huge apartments is sort of a full spectrum facility, in that it has a skilled nursing facility onsite and can take care of people regardless of their physical/mental condition until the end. So that's a definite plus.

I am POA at this point. One thing you can say about M, she loves her medications, so if they ever want to up her Xanax or give her any sort of mood stabilizer I'm sure she'll sign off on that super fast.

I didn't know what an extensivist was until the same doctor was assigned to my dad a year and a half ago. He was/is great. My dad had a mass in his lung in addition to leukemia and the pulmonologist wanted to do a biopsy. The extensivist stepped in and said 'so if it turns out to be cancer are you going to treat it? No, because the treatment would kill him. Are you going to do major surgery to remove it? No, because, again, that would most likely kill him. So if those things are true, what's the point of doing the biopsy other than to definitively find out what the mass is while running the risk of him dying from that surgery or developing an infection afterwards?' And the pulmonologist was like, 'well, when you put it that way....' It's  great to have a doctor who considers the quality of a person's life first.

Anyway, your great advise has gotten me through these uncharted waters. It was very unsettling (huge understatement) for about a month there, but I absolutely have no regrets about going (mostly) NC. Before this, I imagined that I could just tough it out and go on pretending until she keeled over one day, (which I hoped for constantly so I wouldn't have to deal with her anymore.) Over the past few months I have realized just how damaging that is. Because its really not about sucking it up and being the bigger person or telling white lies in order to keep the peace, it's basically annihilating yourself by denying the truth and living in someone else's lie in order to appease them. I don't believe now that you can refuse to stick up for yourself and demand to be treated with respect and be okay. In truth it's M who's chosen NC. When we were last at her apartment (she was at skilled nursing) we found the infamous letter on the kitchen table. It was all marked up and parts were underlined with notes (my BF said 'as if she were a legal scholar'. ha). She refuses to acknowledge her behavior, let alone apologize or change it, and instead keeps asking when I'm coming to see her. She literally would choose dying alone over admitting any sort of fault. As BF again wisely pointed out, it's been decades since she hasn't gotten her way by throwing a fit so she's completely bewildered by it.

A million  for all your help and support!

[practical]

Really happy for you! This is such great news!

And here is another point with her picking the AL facility, she can only blame herself if she doesn't like it. Doesn't mean she won't try to pin it on you, but you'll always know it isn't your fault in the least.

The extensivist sounds awesome, might be close to a geriatrician in the US, somebody who sees the whole person not just the one disease and keeps the age in mind.

[Psuedonym]

Thanks, practical! I am in the US! I think the difference is that an extensivist handles complex cases regardless of age, but I could be wrong. In any case, it's awesome. The whole was this insurance company runs is great, which is something I thought I would never ever say.

BF informed me that M left a message saying she wants my financial input on what she can afford. My first thought was 'I ain't falling for that by telling you where to live! You decide!'

Something else I just heard, the Catholic named AL that has the great apartments also has a policy that if you live there for 3 1/2 years, you can stay for the rest of your life, regardless of your ability to pay. This includes their health services center. isn't that amazing? Never heard of anything like that. They seem to take the good Christian thing very seriously.

[WomanInterrupted]

By staying out of it, your mom has more options than anybody realized.   

Not that she'll feel any sort of gratitude toward the team helping her, though - or find any enjoyment in  the place she eventually settles!   

And yes - you're right - stay OUT of the financials.  She can sign papers that allow disclosure, and you don't need to do a thing.       

Your mom's supplemental insurance sounds a lot like Ray's (and yes, I'm in the US) - they were the ones who put a team together for home care, and all he had to do was pay a measly $15 co-pay, per day, and NOT try to sexually harass the women who were making his life an easier place to be.   

But, Ray being Ray, $15 spent meant he could cop a feel or say any disgusting thing on his mind, so they sent men, and *that's* when $15 a day for a *team of people!* became too expensive.   

I *think* the goal was to try to get a team - much like your mom has - together to sweet-talk Ray into considering IL or AL - but instead, he slammed the door on them and got ADT because he was *determined* to keep kicking the broken washing machine (me), that had requested the original competency test and was firmly on the side of Team Authorities,  working behind the scenes with them.   

I can't help but wonder if we have some sort of Extensivist in our local hospitals - normally, they wait for a person to be stabilized before doing any sort of competency interview, but in Ray's case, the psychiatrist came in *immediately* and declared him, before he was hydrated and back on the correct doses of his meds.

Somebody knew WTF was going on, just like I did - and Ray only limited his options by being Ray.   

I can't help but wonder if an Extensivist - or somebody blessed with the gift of Common Sense - said, "If you send him back home, he's going to die.  It's just a matter of time."

If he'd listened and let the team at the supplemental insurance work their mojo, there are at least 10-15  nearby  campuses that sound very much like you describe, and probably many more options he could have chosen - instead, he's in something that seems  very  much like a free-range animal shelter - and smells about the same!   

He's *not* receiving sub-standard care, by any means - but if he'd listened to reason, he'd have had many, many, many *choices*.

I just saw an advert  today for a campus that has a pool and a great room,  for family gatherings. 

Not that Ray actually cares about that - he'd rather remain in his dark room  and snarl and snap at anybody trying to provide care, or even bring him a meal or not show him their boobies.   

He's just a nasty piece of work.  Always has been.  And if I'd written a letter, he'd have done the same thing  - picked it apart like he's a  lawyer, determined to put the blame back on ME.   

How I got involved with Saul, the eldercare attorney -  I called Ray's supplemental insurance and spoke to the Social Worker.  She was the one who told me to hire an  eldercare attorney, to see if I could  get POA.

I made the *right  decision* - just like  YOU are doing NOW!   

Your mom can yap all she wants that you don't make good decisions, you don't  think about her, you only think about yourself, you just don't want to  be BOTHERED, you're  lazy, cruel, mean,  live in the past, are mentally ill - it's not true.

IT'S  NOT  TRUE!   

You are a GOOD  DAUGHTER and you make GREAT decisions!   

Please don't  ever forget that - you probably have a few months or weeks before she starts blowing up your  BF's  phone  - use them *wisely* in determining  boundaries that are   acceptable for you both, while allowing it to sink in that the facility of her choice *has this.*   

You don't have to do a thing  except live your lives  and enjoy  yourselves. 

Your mom can live her life however she pleases, without you or  your BF to kick around.