My Grandmother has bipolar disorder and is becoming increasingly verbally abusive and paranoid, but she refuses help. What can we do?

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My 80 year old grandmother lives with my mom, and my mom has mentioned the my grandmother is somewhat verbally abusive, but I did not really understand to what extent until recently. She has had bipolar since she was young, but has not taken medication for it in years. My mom says that my grandfather was at his wits end before he died because she was exhibiting the same behavior and refused any treatment. After my grandfather passed away 6 years ago, my grandmother has been basically a hermit, not leaving the house except for 1-2 doctor appointments per year, and she obviously is suffering from severe depression and cannot deal with the death of her spouse. She has said from time to time that she just wishes she was dead, and I guess that is understandable in her situation, but recently she has been very combative and paranoid about everyone.
She fell in March and shattered her shoulder, which led to a shoulder replacement and an short stint in a rehab facility. She convinced my mom and myself that the nurses and aides at the rehab facility were abusing her and got us to sign her out and get home health for her rehab. Now that she is at home, she has refused her home health nurses and physical therapy, and is refusing many of her medications. She is convinced that everyone around her hates her and are conspiring against her, she also has stated several times that all of her family are mentally ill, and she is the only sane one. We have tried to convince her to accept psychiatric help, but that only causes her to lash out and become very angry, because she believes there is nothing wrong with her. Today she told me that she wished she was dead and that she could just take all of her medications and kill herself any time she wanted. I told her that if she felt like that, then maybe she shouldn't keep her medications in her room, and reached for the medication box, and she hit me and told me to never come back. I called a psychiatric crisis number, thinking that they could help, but they just sent to police out to the house. The police talked to her, and she acted like the sweetest, most intelligent and sane person you could ever meet. I couldn't believe how she could be so different in a matter of minutes. She told the officer, "I would never dream of killing myself, but you would wish you were dead too if your family treated you as awful as mine treats me!" Then she proceeded to tell him how awful we are to her. I don't know where she got the stuff she was telling him, but I am glad that he didn't really believe her! She also told him that she knew her rights, and no one could make her go anywhere unless she consented.
If she will not willingly submit to psychiatric treatment, what can we do? The police officer says there is nothing we can do, but my mom says she can't take it anymore. I don't think she should have to keep taking it, but I don't see an alternative. My mother owns the house, and my grandmother doesn't have enough money to afford assisted living, so are there any other options? Any way to get her psychiatric treatment involuntarily? If she is that good at putting on a show, how can we convince anyone that she even needs psychiatric treatment without her claiming that we are abusing her? My mom has a "General Durable Power of Attorney," it does not state that it can be used for medical, but it also does not exclude medical anywhere. I am concerned for my mom because she really can't take it anymore, and I don't know what to do for her. She says that she can't get away from my grandmother because she follows her around the house yelling at her quite frequently. Does anyone have any suggestions of what we could do? I really don't even know where to start.

Thanks,
Kim

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kimiftn - I am going to check that book out! My mom has been trying to meet Jesus for 40+ years. I have heard my whole life that she isn't going to live much longer. I think I'm jaded. She has done dramatic things in the past that looked kind of dangerous, but her fear of pain and suffering keeps her alive. I am so glad that the IL nurse put her in the ER that one time.

As far as the "Bring me home" manipulation goes, I'm getting from mom with both barrels. She tries sweet little child act, she tries demanding with profanity and swearing. Last night she tried fooling me. She said she had been cleared to go and I should get over there to pick her up. Like I don't know better. An hour later I got a call that mom's BP was 235/80! Clear to go my left foot. She is refusing her BP meds at the same time. I have been waiting for call saying she's had a stroke or been sent to the ER. It hasn't come yet....

I don't know what to tell you that can help your mom get past the guilt. There are a lot of articles on this site about caregiver guilt that might help her. She has basically just got to stop responding like grandma is completely sound of mind. She must stop trying to fill the role of "obedient daughter who does exactly as told". That role has expired and won't serve good purposes for grandma, mom, or anyone. Your mom is going to end up in the hospital herself putting herself through this wringer.

The thing that has to overcome guilt is going over all the bad things that could happen if you give grandma what she asks for. The restrictions are for her protection. Exactly like why we don't let little kids play with matches, knives, or run out into the road. ::hugs::
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My experience with a suicide threat was that it was taken seriously and mother was committed to a geriatric psychiatric facility. She is still there. She has been diagnosed with vascular dementia, has paranoid delusions, and refuses any medication. This followed some months of increasing paranoia, and difficulty with relationships - more than usual as mother has borderline personality disorder.

I have had training in suicide prevention, intervention and postvention and learned that you always take a suicide threat seriously. Mother is manipulative too - part of the BPD. That does not excuse the suicide threat. She has been manipulative all her life the suicide threat is recent.

Your grandma needs professional help any way you can get it to her. I think she needs to be in a geriatric psychiatric facility, where trained staff can deal with her. Mother was in a very good ALF, and had to be removed from there due to her increasing illness. She does not fit in one any more, and will be placed in a facility with a mental health mandate. It sounds to me that that is where your g'ma should be. Don't take her back home. She is beyond being able to be managed at home. If you/your mum refuse to take her home, saying that you cannot look after her any more, they have to find a suitable placement for her. One lady here "abandoned " her mother to the state, as her mother was totally unmanageable due to progressing Alz. All that means is that the state will place her and be responsible for her. Family still visited her. It was the best solution. Sometimes there aren't great options, so we have to choose the best available.
All the best to your and your family. I know how hard it is. ((((((hugs))))))
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I'm really impressed with everyone's advice on this. Huge sympathy to you, Kim, you must be so worried especially that your mother seems to be feeling eaten up about letting your grandmother down - gosh that must have been a chilling moment when she was wondering if she should go and pick grandma up! "Noooooooo…!!!"

It seems to me that this moment, while your grandmother is in good specialist care, is the right time to pick as the turning point. You and your mother both know that your grandmother is in safe hands. She is also, importantly, in exactly the right place to get ongoing support. Follow Veronica's plan, and what will happen is that your grandmother cannot be discharged until a suitable living environment is found for her, and the funding is all sorted out. Also, do NOT contribute money to that: you will undermine your grandmother's entitlements and handicap yourself.

I know how hard-nosed that sounds, but seriously this is a comparatively certain way to get good support for your grandmother and peace of mind for your mother. Best of luck.
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Kim you can still refuse to pick her up and take her home. You mom can tell them she can no longer care for her due to the threats of voilence. I assume Gm is capable of harming Mom. It seems a cruel solution but may be the only one. do not make yourself financially responsible for this it could go on for many years.
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Kim, as an RN you probably know that threatening to commit suicide but not going through with it can be a sign that the person wants attention and/or is a cry for help.

Being manipulative, perhaps that's what GM is doing.

Still, you have my sympathies - this must be a grueling and horrible ordeal for your family.
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Well, right now she is still there for the 72 hours, but she has already somehow called my mom and begged her to come and get her. My mom called me and apparently was actually considering it. I told her under no circumstances was she to go get her. I instructed her to call and talk to the nurse to find out what was going on. See, my grandmother had gone to the ER to rule out any medical problems before going to the psychiatric hospital, and it turns out that she changed her mind after she got there and went ballistic in the ER, so the ER doctors signed the papers to have her involuntarily committed. We didn't know any of this, because she had asked us to wait in the waiting room because she didn't want any of us back there in the ER with her (she still thinks we are all against her at this point). So when my mom called the nurse at the psych hospital, she told her that my grandmother could not leave even if she tried to come get her.
Also, my mom never told me that she was grandmother's healthcare POA, so I had her take the paperwork up there and show it to them, and they told her that according to the wording of her POA, she could have had my grandmother involuntarily committed herself if she had wanted to. Anyway, I am not sure what we are going to do when she is released. I would prefer that she go to an assisted living, but I don't think there are any good places here that she could afford. I am the only person in the family that would be in a position to be able to help her financially, but I can't make up the difference every month by myself. I have looked to see if Medicaid would help pay for assisted living, but apparently they don't except through a waiver program, and there is a 6 year waiting list in our state :( She doesn't have any medical problems, and she is pretty mobile and can dress, feed, and clothe herself. She cannot do her own laundry, cook meals, or drive. Does anyone know if there is any way she could qualify to stay in a nursing home due to psych/dementia problems? I highly doubt it, but I was just wondering. I don't think that my Mom can take care of her any more, and my Mom needs to think about her own physical and mental health. I just want to find a workable solution that will protect my mom, but also allow my grandmother to live out her life in a way that she can be happy.
Several people have mentioned that my grandmother's behavior sounds manipulative, and yes, she has been very manipulative with my mom for a long time. I recognized it several years ago, along with the signs of mental illness, and tried to get my mom to let me step in and help, but she did not want me to and said she could handle it by herself. Things just got to a point this time that the whole family ended up getting involved.
Sandwich42, you mentioned that your mom was hospitalized for suicidal ideation with a plan just for saying that the window was big enough to fit through. I'm an RN, not psychiatric, but I still know the basics, and I knew that when my grandmother said she didn't want to live anymore and that she could take her all her medications and kill herself anytime she wanted to, that was suicidal ideation with a plan. She may deny that she actually wanted to kill herself, but she was thinking of a plan if she wanted to, which is the first step. The police officer that came out to the house said that didn't count, and it was no grounds for him to take her in. I guess to be taken by the police, you have to tell them that you are planning to kill yourself, how you are going to do it, and that you plan on doing it right away, before they will do anything about it. Seems pretty silly to me, because if you REALLY want to kill yourself, you definitely aren't going to tell the police that you are planning it! After the police left, my grandmother then proceeded to refuse all food and try to starve herself. She even told me that was her plan! I asked her why she got rid of her physical therapy for her shoulder, and she said that she was only going to live for a few more days, so it didn't matter if she could use her shoulder or not. Anyway, I am VERY glad that someone was finally able to convince her to accept help, and I keep praying that all of this will work out for the best. Also, if anyone has family members that suffer from mental illness, I just read a really good book that helps to explain why they don’t think they are sick and don’t want to take medications. It is called “I Am Not Sick, I Don't Need Help!” by Xavier Amador. Thank you, everyone, for your suggestions and support. This has been a really difficult situation for our whole family, and it’s not over yet. We would all appreciate your prayers that this will work out the best for everyone involved!
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Kim, I really feel for you and your mother. You've a very kind, caring and thoughtful daughter to try to identify help for your mother and grandmother.

It seems as though Grandma is a bit manipulative as well as having some underlying mental issues. The fact that she can be nasty to your mother but sweet talk the police tells me she knows enough about what she's doing to know how to manipulate situations and who she can verbally abuse.

I don't normally suggest outside placements as our family is a "care for them at home" family, but I think your mother's mental and physical well being are in jeopardy at this time.

One possible method is to contact your county Adult Protective Services and ask for intervention to (a) protect your mother, and (b) remove your grandmother from your mother's house. I've had one experience with them in Michigan and thought they were absolutely useless and actually quite lazy and stupid, but that depends also on the particular staff.

If she perceive a threat (and the operative word is "perceive", which may depend on GM's acting at the time), they would probably call the police to have GM physically removed if she won't go voluntarily.

I would really expect a big blowup at that point, with GM making a lot of false accusations toward your mother.

Have you been documenting the verbal and/or physical abuse toward your mother and now you? If not, I would do so, with photos if she hits and leaves bruises.

I think that's the quickest way to get help if the 72-hour eval releases GM back to your mother's care. And I do agree that your mother should be firm that she can no longer care for GM, who will probably put on a good show during the eval. However, psychiatric pros can see through that quickly.

My sister was a psychiatric nurse and she saw behaviors in nursing home residents (while we visited my mother) that never even occurred to me to be manipulative.
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Well done Sandwich back to life!!!!!!!!!
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Do you have my mom? I thought I had her here.

My mom was hospitalized for suidical ideation with a plan last month. She told her med nurse she had measured the window and thought she could fit through it. Mom was just being her dramatic self for attention, but didn't take facility policy into account. She ended up in a nice empty room with a nice experience crisis social worker. This woman had my mom pegged as Borderline Pers. Disorder in 20 minutes of talking. Several days later mom was back in the hospital for a fall overnight - not eating after taking diabetes oral med. I mentioned to everyone I saw about the suicidal incident just days before. They quickly called in a psych eval and that is when life got a lot better for me.

Mom eventually went into rehab on a locked floor for dementia patients. She is being moved tomorrow to her permanent room on this same floor. Hallelujah for the geriatric psychs in the world!
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Kim I know this is your grand mother. Are you sure you want her home again. Think about it. This is your chance to refuse to have her back.
She may get straightened out in the hospital and meekly take her medications but is just as likely not to when she gets home. I hope they also assess her for dementia, many of her behaviours are similar.
She will probably have a fine tale to tell of your mom's abuse and how she hid her medicines or took them herself and how the family is ganging up against her and taking her money. don't worry about it as someone else said they have heard it all before.
YOU CAN REFUSE TO TAKE HER HOME. You will probably be given a hard time but others have done it. If you feel she deserves a second chance Mom will be facing the same situation again and it may not be as easy to get her admited a second time. Give it some serious thought. Blessings
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