Elderly Father is a stroke victim with substance abuse problems and anger issues. He is about to be pushed out of his home.  I'm so lost about what to do.


My father had a stroke about 10 years ago that left him paralyzed on his right side. He has always had substance abuse issues stemming from a lifetime of anxiety and bipolar struggles, but now he is refusing to take his Wellbutrin, and is drinking liquor. He also has a medical marijuana card and smokes all day. He is short tempered and belligerent now that he is off of the Wellbutrin, which is damaging all of his relationships. He seems to have given up, and doesn't care about consequences. His stroke also affected his ability to discern cause and effect relationships.

One of his doctors advised him that when he is feeling angry he should remove himself from the situation. This leads him to get in the car to go for long drives, often with compromised sobriety, often getting lost.

At this point his significant other is at the end of her rope, and the relationship is badly damaged. I live 4.5 hours away, and try to get there as often as possible to give his SO a break, but it's not enough. My younger brother lives closer(1hr), but is not in a great position to spend a lot of time there due to work. I think I need to find a place for him to live, as staying at the house with her is NOT working, and staying with me is not an option. I am way out of my league here, and possibly too emotionally close (read: angry and confused) to make good decisions about the future. I honestly don't even know where to start.

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I was a caregiver for 9 months for a bi-polar guy. Went off his meds...went nuts.
Every other week..begged..promising to stay on meds....yeah..that lasted about a month..then the same old rollcoaster ride started again.

Just cause he is taking meds means nothing. He gets home...he gets back in his "safe" zone...he stops taking meds. This is a pattern to endemic to the diagnosis...it is a hallmark of this medical issue.

Don't accept him back.

I think Katiekate is right about the best course of action in this regrettable scenario.

Ideally he would go back on his meds and be realistic about his abilities. He would discuss with the people who love him the need for some care, perhaps at home or in a care center.

But if things were ideal you wouldn't be posting here. Sooo .... since he is not likely to voluntarily get evaluation and make a care plan, Katiekate has a workable approach. Is he living in his SO's home? Then she can refuse to let him come back (I think).

Bipolar Disorder is a dreadful and severe disease. It is not curable, but it is treatable. If the person refuses to comply with the treatment. well, obviously it won't work. But the disease itself can lead to ideas and feeling that make the patient want to be noncompliant. It is a very difficult cycle to break.

Substance abuse (med or alcohol) is also very difficult to manage.

And then throw in the stroke and the apparent brain damage that stemmed from it, and you have a father with a very, very challenging life situation.

I feel sorry for him. I truly do. I wish him the best, as I am sure you and your brother and his SO do. But I'm afraid some really tough steps must be taken before the best can happen.

Even if he is held against his will for an evaluation, there is no guarantee he will comply with the recommendations for a care plan. But at least you will have done what you could.

The next time his SO has him go bonkers on her...she calls the police. Has him taken into ADult Protective Custody....removed to the hospital Psy ward. Then she refuses to allow discharge to her home.

Then the social worker will seek a placement to a home..

I guess I'm the odd one out here. We have bipolar in our family and they are extremely manipulative when it serves them . I would never recommend something staying in an abusive relationship. The live in girlfriend should go her own way. I'd look into getting him on medicade. He can be deemed unfit to care for himself and forced into care.

My experience with bipolar not wanting to take medication is you can't legally make them. My family was told it is not against the law to be crazy. Not a nice thing for a judge to say but there it is. It sounds like he needs that visit to a psych hospital for an evaluation. That is often non-voluntary. If you could get him sober long enough to be better able to reason with him, he might agree to take the meds?? You can be ready when the accident happens and he possibly hurts himself or someone else or you can talk to his dr and ask him to help you get him committed for evaluation. Usually that takes a judge. It would depend on the laws of his state. None of us know how to do these things until we have a situation that demands we learn. Try to find a NAELA attorney to help you with your dads situation. It is a very difficult situation your dad is in and because you and your brother and SO love him, you are right there in that bad situation with him. To a degree we are all in it with you. It's not easy. You can't fix it. But you can take steps to manage his care.
I'm really sorry. I know it's hard.

Assisted Living probably won't be the right answer if he won't go back on his medications. Stroke and Bi Polar also cause depression and irrational behavior.
He really need to be in a psychiatric hospital at least for an evaluation and medication adjustment. It does sound as though his dementia is more advanced than appears on the surface even if he has not been formally diagnosed. I would suggest contacting his Dr and therapist and tell them what is going on. They are not allowed to tell you anything under HIPPA but you can tell them everything you have observed.
Do you, your brother or his SO have Power of Atorney health and Financial? Do you think he could be persuaded to give that to someone? Maybe if you approach it from the point of view of having another stroke rather than his current behavior.
In this case persuasion is not going to work he is too mentally ill and will only get worse. Welbutin is a good drug but not the only one and needs to be taken regularly as you well know.
I have the deepest sympathy for his SO she is in an impossible situation and there is little she can do to change it by remaining with him. If he can be stabilized then they MAY have some hope. There has to be some outside intervention. Perhaps when he goes off driving and you know he has been drinking you can call the police and tell them about the Pot too.
He may have a card but it does not permit him to drive under the influence. Hopefully he will behave badly when he is stopped and they will take him to the ER for an evaluation and you can at least get a 2 day compulsory admission to a psychiatric facility.
I am sorry these are not very nice suggestions but the situation sounds desperate and there is no nice way to handle this.
At some point you will need legal advice so maybe make a preliminary contact with an eldercare lawyer close to his home. I can only hope this turns out better than it looks right now but i doubt dad is going to be happy whatever happens.

So, first of all, thank you for your responses!

cdnreader: He has a therapist that he sees around 1x/month. He had been doing pretty well up until around January, when he stopped taking the Wellbutrin because it was "holding him back". I don't know whether he tells this to his therapist or not. He has a history of being very crafty, and knowing the right things to say to manipulate a doctor into prescribing/recommending what he wants. Either way, he takes the pills he wants, and throws the others out. And when he goes off the meds, he's short tempered, verbally abusive, non-communicative and drinks.

I know that for him this has been very hard, and he struggles with feeling useless. Pre-stroke, he worked a lot with his hands, tinkering and building, but the combination of the paralysis and diminished concentration has left him unable to do much of what he used to do. Living in Vermont, he has the hardest time in winter, as it is difficult to get out a lot. I have a lot of empathy around that, and have tried many things to help make his workshop easier to work with — like lowering his bench so he can work while sitting and making tools easier to get to. None of this seems to make a difference. I think he as a lot of self esteem issues from this also.

Veronica91: She is at the end of her rope. He is non-communicative and abusive. She loves him, and this is breaking her heart, but she is human and sees that this is defeating her. She has tried to tell him that if he gets back on the meds they can try to work it out but he's not really being reasonable, and won't do it. I think at this point I'd give it maybe 2 months at most with no change before he will have to leave.

I am going there next week and am going to have to try to figure out what I can about the finances, to try to get a handle on what is even possible. I know that she receives some money from somewhere for acting as a caregiver, but that is not her main income.

In terms of assisted living, I don't even know how he will react to that, but I'm pretty certain it won't be well. He is very independant and stubborn as all h*ll, but also somewhat helpless and unable to see that. Just yesterday, his SO received a call from a police officer in a town 3+ hours away that he was in his car on the side of the road, out of gas. He had lost some bowel control as well. She had to find a tow company that would drive there and get him, as he didn't really have a clear idea of how to get back. I know that he will lose his license soon, there's no way that cannot happen, but I don't know how that will effect his already poor self esteem and outlook.

This is all so strange, and heartbreaking, and frustrating, and confusing. Thanks for letting me vent.

What does his SO want to happen?

Dear James,

I'm so sorry to hear what you are going through with your dad. I know its not easy. Given your dad's condition, I would strongly suggest looking for assisted living or a nursing home for him.

I know its not easy on your dad either. I wonder if he might also have some depression. Please consider talking to a therapist, counselor or social worker to explore all your options.

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