BPD and geriatric care

[Beowolf]

Dear Community,

It has been a while since I shared with the forum. I have been living a prosperous and contented life having established low contact and considerable distance from my hostile BPD father. However, I was triggered by an intense experience a few weeks ago and wanted to share my thoughts.

My BPD father contracted Covid in December which he slowly recovered from. He however degenerated into malnourishment as he was unable to care for himself during the recovery. While monitoring his condition from abroad for a few weeks, I grew concerned when a relative shared a photo revealing considerable weight loss. Then, he fell several times in one day, suffered a minor injury and was discovered by a colleague unclothed on his living room floor having been unable to alert anyone that he had fallen. I immediately saw this was a crisis and I decided to travel to stay with him to help him recover and to observe his general condition. I travelled a long way, used well-earned vacation and sick-time and incurred various expenses relating to his care.

When I arrived, he was in a pitiful condition, humbled and fully accepting of support. His home was in a sorry state, unhygienic and disorderly. I stayed with him for seven nights straight, providing full care. Meal preparation, medication, companionship, tidying, cleaning, dressing on occasion, upgrading bed linens, bath and kitchenware.

During this time I witnessed some deeply concerning behaviour that was certainly dementia-related (severe memory loss, hallucinations, disorientation) and recognized the need to devise a long-term care plan. In a short time, I arranged several medical visits, consultations with carers, made plans to upgrade his home with emergency/accident prevention equipment. It was exhausting, but I found the energy by sheer necessity. I acted as an intermediary between my father and his GP and care advisor. I sensitively passed on their advice and researched the care options. He accepted the various proposals at first which I felt was great progress. Then, at the end of the 7 days, as he began to regain his strength, he began to reject all support. He became paranoid and suspicious of me, then finally combative and hostile. He ultimately refused any further help from me at which point for my own well-being I left and stayed with another relative.

I faced a difficult dilemma. On the one hand, both his GP and his lawyer felt I should stay long term to help built out a care plan and to handle various other personal affairs that he was mismanaging. On the other hand, my father rejected any advice to agree to a care plan and had become hostile on the subject. Ultimately, my hands were tied (as were the GPs) and so I departed to return to my life abroad and my work.

I am now faced with some hard questions regarding his future. I know that without sensible decisions being made regarding his care, he will inevitably deteriorate again, perhaps even in the short term. As his eldest son and next of kin, I will ultimately be called to act as his 'guardian' as he declines. However, I feel resistant to the role given his lifetime of narcissistic hostility. I feel reluctant to place myself in the unenviable position of advising him to accept care considering his suspicion and vehement non-compliance. I am currently trying to find the right balance between defending my general well-being by maintaining a safe distance and offering enough compassion to take the long view towards actively planning for his end of life care.

Does anyone have experience in dealing with combative and hostile geriatrics with a history of BPD?

[Fiasco]

Me! I have too much experience. I've been through the emergency where BPDm is near death and I have had to step in and take care of everything, twice. And both times as soon as she was able to, she dismantled every system I put in place, and disregarded every piece of advice. In fact it's my opinion that she makes sure to tell everyone exactly how recklessly she has decided to carry on just because she loves making everyone upset over her crappy decisions. BPDm and I are in the US (although blessedly far apart) so the rules are that even though I have medical power of attorney I can't force her to do anything at all unless doctors declare her incompetent. At this time I'm handling all her finances (with her permission) and if I weren't it would be absolute chaos. She has some significant mental decline which she is able to mostly hide from most people. Because of the way things work in the US my only option is to wait it out. Next time she goes into the hospital for something catastrophic, assuming she survives, will be my next chance to refuse to facilitate her return to her unsafe house and get her placed somewhere and it will be a nightmare.

You said "On the one hand, both his GP and his lawyer felt I should stay long term to help built out a care plan and to handle various other personal affairs that he was mismanaging. On the other hand, my father rejected any advice to agree to a care plan and had become hostile on the subject. Ultimately, my hands were tied (as were the GPs) and so I departed to return to my life abroad and my work." It sounds like wherever you are you fall under similar guidelines to what I've experienced. I'm so happy to hear you haven't decided to abandon your own life to move locally to  your dad, or even in with your dad. Please continue to maintain your distance and life. I'm also on an aging care forum which I find tremendously helpful. It's a great place to get information on what things can actually be done, and what you can reasonably hope to accomplish, while preserving your own sanity and life.

[Sneezy]

Not BPD, but my uHPD-MIL and enabling-FIL have been with us for a month now.  MIL has dementia and is delusional.  FIL has Parkinsons and some cognitive decline.  Like you, my DH is the oldest son.  For years, we have been trying to get his parents into a safer living situation.  Finally, it came to a crisis point at Christmas, so my DH flew to their state and brought them home with him.  The plan was to get MIL into memory care and FIL into some sort of assisted senior living.

It's been a month.  I am trying to remain positive, but there appears to be no urgency on my in-laws part to change the situation.  They are being taken care of and fed and they seem very content to drag this on as long as possible.  In the meantime, I am afraid they will never move out.  I am trying to be supportive and keep a healthy outlook, but I am getting tired of washing urine-stained sheets and picking up after them (they are the messiest two people I have ever had as houseguests).

I wish I had better advice for you, but I will say that you should avoid bringing your father into your home.  If things get to a crisis point again, get him into a care facility, but do not bring him into your home or you may never get him out.  It's nearly impossible to force someone into a care facility.  So if he is in your house and you can't safely return him to his house and he refuses to go into care, you may be stuck.

[Fiasco]

Oh Sneezy, I'm so sorry. I didn't know you had taken them in. Hugs and fervent prayers you get them moved along before they grow too many roots!

[DaisyGirl77]

I have a bit.  I lived with my uN/BPD paternal grandmother for 3.5 years.  (Story in signature.)  After I left, the wheels fully came off & she was forced into a nursing home/ALF combination where she's been for about 5 years now.  But it took 2-3 years after I'd gone for my eF to finally see what I'd been going through all that time, & only because she'd turned her sights onto him.  Then it took an additional year or so after she had a medical emergency for him to experience receiving multiple calls from her visiting nurse reporting that she had nothing in her fridge, freezer, or cabinets to eat & she'd expressed the wish to die.  (She'd said she wanted to die for nearly 20 years.  He buried his head in the sand.)  Then after the umpteenth call in which the nurse said that if he didn't do anything, she'd be forced to call APS, he made that call himself.  They declared her incompetent, Dad got POA & control of her finances & stuff after spending time in the courts declaring her incompetent, got her on Medicaid, & placed her in the ALF/NH she lives in now.  They pay all her bills, which are withdrawn automatically.  He just reviews the account periodically.

After she got moved in, she had the honeymoon period, which then devolved into the witch BPD--screaming tantrums because she wasn't given her pills on time, she hated everyone & everything, & even charged several staff (exactly like she did with me) to get out of her way.  Multiple incidents were documented by staff.  After a few months of this, she realized nothing would change & in fact, she'd lose even more privileges, so she's gone back to Sunny "Anna", who's always Sweetness & Light (TM), where she's been since, as far as I know.

Sometimes the thing you're forced to do is the thing you're trying to prevent them from doing.  If that's the case, let the wheels fall off.  Let them run their proverbial train off the tracks & off a cliff.  It's sometimes the only thing that forces the legal system to recognize they are failing, & gets them the help they then are forced to accept.

Good luck.

[daughter]

Our community has "senior citizen protective services" for such situations, with social worker services to sort-out competency issues "cocktail" of questionable mental health, self-neglect, noncooperation, and belligerence where independent living is not feasible anymore and sheltered sponsored housing is warranted, whether nursing bed or senior public housing.

You are not obligated to be his caregiver, or his financial manager or guarantor. For some of us here, such resumed contact for us is not advisable, regardless.  But the gap is eventually always filled. Think of all the senior-seniors who have no dutiful devoted nearby children, and yet still manage despite many hurdles too.

[Beowolf]

Thank you for your responses which have been very helpful towards my acceptance of BPDf's outlook.

I am not obligated to support anyone who rejects my support. And it is futile to try to encourage BPDf to think prudently when he has never displayed the ability to do so. Having no prior experience of geriatric care, I suppose I have a bias that involving social services is taboo and I have not ever considered involuntary senior care services as a positive outcome. The scenario where BPDf deteriorates to the degree that he is involuntarily hospitalized sounds shocking and traumatic. But I understand that these resources and laws are in place precisely for these scenarios - to prevent a non-functioning individual from becoming a danger to himself and others. I should feel grateful and reassured that BPDf will enter the care system one way or another.

I still feel unsure of how I can prepare myself for the pain that this inevitable decline will bring. I feel I am returning to the same painful conclusion I return to when concluding a triggering episode: the most compassionate thing I can do is to go LC. Best to let nature takes its course, keep myself out of harm's way and focus on my own well-being.