My father-in-law (FIL) has always been a narcissist. Not diagnosed but it is pretty clear, and I do mean raging, in your face, clear. My husband and his sister continue to try to please him but now even they are fed up. All of the grands have distanced themselves and don't visit except briefly at holidays.

Several years ago sister-in-law and her husband moved in for a number of reasons, but the long and the short of it is that he has turned it into his very own nursing home at home. SIL is worn out and fed up. They are working on a move out plan. But I'm concerned that because they have lived there and provided care for 2 years already that we need to do things in a certain order. He is not above calling the police if they leave him because he knows he can't stay there alone. They aren't to the move out point yet, but what is the best way to do this?

He isn't going to choose going to a nursing home on his own. He refuses to listen to us about figuring out a plan. He is still competent to make his own choices. To him, everyone in a nursing home is old and he still lives in a world where he doesn't believe he is aging. (86, tons of medical issues, nearly immobile, mostly incontinent - so I think even AL is not enough) He maintains and expects that his children will continue to facilitate so that he can live the way he is accustomed.

So what steps do we need to follow as we move towards them moving out? He can't stay there on his own. But he will refuse to move out. I know we are likely going to have to get APS involved or go to court to execute the POA/guardianship, which we don't want to do because though he makes TERRIBLE choices, they are still his to make and I doubt they would find in our favor anyway. He is a genius when it comes to an audience. He is mean and abusive to family but makes others think he is a sweet old man. Anyone outside of family that questions him or sees his true colors he just cuts out of his life. It is very telling that family is all that he has left and extended family members are dropping like flies because his carefully crafted demeanor slips more these days. Anger is at the surface anytime anyone questions him. So all hell is likely to break loose soon.

BlueEyedGirl, your family's same scenario is going on everywhere at any given time on this planet. I'm assuming from your info that FIL has not assigned any PoA. I was in a similar situation with my controlling stepFIL. Too long of a story to tell it all, but basically he had Parkinsons, was 6'5" tall and had no intentions of caring for my MIL (his wife) or going into a facility. He had estranged his 2 very nice sons and they lived out of state, far away anyway. Also, he was completely broke and got around it by gaming the system, and very secretive. Wanted me/my family to care for him without giving us PoA or applying for Medicaid. So one day I told him the reality of his 2 remaining options for his future:
1) he assigns someone in our family PoA since no one recovers from Parkinsons and we need to manage his (very meager) affairs. This was not a promise to orbit around him or to never move him into a facility (again, 6'5" tall person falling on the floor daily due to denial). Without legal authority we could not legally help him in certain things.

OR, if he didn't agree with #1...

2) we would remove his wife (because she had severe short-term memory issues and mobility problems, weighed more than 200 lbs, in a house with stairs) and then we'd call APS and allow the county to become his guardian and no one in the family would be able to control what happened after that. Nor would we care.

He called my bluff and chose #2. He died a lonely man as a ward of the county in a crappy county facility. This is an intelligent man with a degree in (wait for it...) Finance. We could never figure him out. No logic to his thinking. Just control and fear and secrets. I had no bandwidth to play that game.

This is what awaits your FIL and he needs to be told this, in front of everyone, with someone videoing it. If no one is his PoA or guardian, I don't think he can accuse them of neglect if he is uncooperative. But your relatives should probably call the county social services (without telling FIL) and ask what they advise, this way they know your relatives aren't wanting to neglect him. The county social workers have seen this scenario played out a thousand times a year. They will understand and will have him on their radar as a vulnerable adult. They will come in for assessment to see if he qualifies for some in-home help. That differs from state to state and it won't be full-time help with everything. Your relatives are not obligated to do what he wants, as caregiving must be muatally agreed-upon and satisfactory for both parties, not just one.

I wish you and your family peace in your hearts that FIL is getting the retirement he planned for - a sad, crappy one. Some of his decision-making and behaviors may be driven by dementia, since no one really knows when that line is crossed, especially in those with prior "challenging" personalities. But that fact won't change the trajectory of his future unless he cooperates today.
Helpful Answer (12)
Reply to Geaton777
BlueEyedGirl94 May 21, 2020
Thank you for your response! Technically he has POA jointly assigned to my husband and his sister. We really need to look at the will and associated paperwork because we were under the impression that POA can't do anything in the way of making any decisions unless he is medically incapacitated or deemed legally incompetent. The legal things are in order, we just don't know what power the POA gives them in his current "competent " state. His doctors are ready to basically "fire" him for lack of compliance. He has done the in and out with rehab, this last time he basically was switched to nursing home status in rehab because he wasn't even trying to meet the PT and OT milestones. They discharged him as needing nursing home care. Which is basically what he has at home. COVID-19 was kind of a blessing for him because the home health nurse's aide and PT and OT were able to extend him several months because they didn't have others to visit right now. And he's barely made any progress at all. He CAN do it but won't. But he gets ugly and mean and will even throw things when he gets angry. I don't see this getting any better and honestly we are all in agreement that he is showing signs of dementia. Unfortunately because he is so incredibly sedentary (he likes to stay in bed with his CPAP on 13-19 hours a day and most of his waking time is back and forth to the bathroom and playing on Facebook ) we don't know if the dementia symptoms are real dementia or a side effect of him literally not using his mental faculties and lack of actual social interactions.
He did a number on my husband and his sister, spent years grooming them to jump when he says jump and they both know they need some therapy to deal with their past with him. He is not going to change and we've come to terms with that. But his situation will have to at some point.
I'm mostly concerned with what could happen if BIL and SIL move out without a care plan in place. He can't live there alone. APS will most certainly get involved somehow and as much as I want him to be safe and taken care of, I'm also worried about trouble for my BIL and SIL leaving him there after serving as caregivers and even my husband and myself somehow being complicit because we knew they were leaving and didn't intervene.
Is there some legal backlash that could occur as a result of us not getting involved beforehand and letting him make his own choices? What responsibility do we have?
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His anger is a cover emotion for what's really underneath, which is lifelong FEAR, which he wants to keep hidden, even from himself.. Narcissists use anger to defend against experiencing their fear of abandonment.
Refusing to respond to his anger as anger, and instead calling it "fear", "I see how afraid you are"... will begin to make his anger useless. As he begins to deny that and escalate, you can escalate your interpretation, "It feels terrifying to you"
Continue on that basis, framing every resistance to change as "I know you're scared... and we need to do this ". Narcissists don't respond to logical argument. They respond to having their feelings named and received.
Don't change your plans, just deliver them as a definite, but not a power struggle. Not a "we win/ you lose", but a "doing this because we care. Even if you don't see that right now".
Helpful Answer (8)
Reply to acacia

I heard a Doctor one day just lose it with one of his patients. He said, you keep falling, you won't use a walker, you don't take your medicine, you don't eat properly. You fell 3 times in one day & got brought to hospital. You are very old. You have multiple health problems. You can't look after yourself. We can't allow you to go home alone as you are a danger to yourself. Stop being such burden on your family. I've told you before, start picking out your nursing home or your family will!

Not saying it's good to lose your temper, or yell at old people like that. But as I stood there with my mouth gaping I thought, well said really. I told the Doctor I was impressed with his saying it like it was. He said someone had to. The family were so burned out so he thought he'd take it on.

Maybe you need a Doctor like that?
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Reply to Beatty

So sorry you are going through this difficult caregiving situation. Seems you are asking about how to get your ducks lined up. So here are my thoughts - and I hope they help.

1 - Make sure to have medical and financial POAs, wills, advance medical directives, and any other legal documents secured.

2 - Make an appointment with his doctor to decide on mental competency. Have whoever is caring for him start keeping a journal of all the caregiving they do and decision-making they have to do for him: pay bills, make sure he takes medications. his ability to call or not dial people on the phone (can he dial 911 if he needs to?) ...

3 - Once his doctor has declared him mentally incompetent. the family can then make plans for "paid care". Research all available options: in home care round the clock, assisted living (each facility can tell you their criteria and if he qualifies), and full care residential facilities. Have family meetings to discuss each type of care and what his finances will support. It is best if all can agree on a type of care and a place, but ultimately the persons holding the medical and financial POAs are the ones who must decide and sign documents.

4 - Make arrangements for paid care and start telling dad his care will be taken care of "differently". Explain that his needs have become a 24/7 job and that nobody in the family can provide this type of care. Then, explain that you have researched all options and the family has agreed that ________ type of care will work for his situation.

5 - Expect a lot of fussing, arguments, and anger. Everybody should express their love for him and their concern that he be well taken care of. Express confidence in "the plan" - no waffling. Each person should decide how he or she will keep in contact and let your LO know those plans - and reinforce them frequently.

6 - Make "change of care day" as easy as possible, Pack everything for his room if he is moving and set it up in advance of his arrival. If he will have "in home care," introduce his new caregivers and spend time slowly handing over the reins to their care: be there for the first few days, then "go on trips to run errands" for an hour or 2, then the "errand trips" extend to 4-5 hours and later to 8 hours and so on until the family only visits as already agreed upon.

7 - Realize that he may create difficulty for his new caregivers. It may be helpful to have him evaluated by a psychiatrist that specializes in seniors. Counselling and/or psychiatric medications may need to become part of his health care regimen.
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Reply to Taarna

I would also record examples of his rage and any others you may want his doctor or APS to see - since you think he may try to manipulate the interviews.
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Reply to BeckyT

To be on the safe side and for all of your protection, I'd have an attorney review the documents and the situation. I'd confirm if there is any state law that mandates how you provide notice, care, etc. for someone who is at risk. Maybe, he's competent or maybe he's not, but, I'd try to avoid a situation of leaving him and then something terrible happens and authorities knock on your door asking why you made that decision. He might advise you to have a paper trail that shows you acted prudently. If he's very confrontational and totally resistant, I'd ask the attorney about relinquishing rights of being the POA, with proper notice to the FIL, so he can make other arrangements, assuming he's competent. An experienced attorney can guide you on this.
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Reply to Sunnygirl1

Might I add - with all these phone calls you will be making, take notes including dates, times and NAMES of people you speak to. You don't want to get advice from someone which turns out to be wrong and not have the name of that will also help you keep track of which person/agency told you what. Unfortunately, when you're dealing with different government agencies you often get conflicting information; if, heaven forbid, any of you are accused of abuse or neglect you can have your notes to defend yourselves.
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Reply to notgoodenough

Looks like he has been getting his way for quite some time because people, whether they intended to or not, helped accommodate his house becoming the nursing facility. Perhaps his daughter moved in due to finances on her own part, so attempted to do a pay back by caring for him. Whatever the reason, she and her hubby have a right to decide where they will live and move out.

The first thing to sort out is what he can really do for himself, but perhaps has been done by daughter 'to make it easier' for him. Sometimes we handicap people by just doing things for them instead of letting them do it with a little struggle. He may be able to do more for himself that you currently see. Mobility issues can be created when WE jump up to get things and allow them to sit longer and longer. Physical therapy can help with mobility. There are pads and diapers that can hold the pee and still allow you to go to a toilet to finish your business.

You said dad is, although a handful, competent. You might try a sit down with him, not to argue or engage when he rages, but to explain what is going to happen. Daughter will be moving out on XX day and we need to make sure you are taken care of. These are the things she does every day for you now, so we need to talk about who is going to do them all day and night when she leaves. We will have to get someone to come in and do these things. Do you have anyone that you want to ask (let him come up with names of his friends/family)? Do make the contact with anyone he names and give him the feedback on what they all say. If no takers, then move to next option - we'll contact some companies that do this sort of thing or would you want to see about assisted living where there are people of all ages. Offer a trip to a couple of assisted living places and THEY can tell him if he is a fit for AL or not.

As a note, if daughter moved there because it was a trade off - free room and board for caregiving duties - then the family might consider something as simple as getting her some help. Tell dad he's gonna start paying for 3 days in a row of 24/7 help because daughter needs time off (3 days one week and 4 days the next). New agreement is she pays 1/2 expenses bills and provide 1/2 of the caregiving. I only say this because lots of kids move in on the parent(s) because of financial hardship and it works out well until they have to pay back the free room and board.
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Reply to my2cents

EDITED after reading your response to Geaton777:
If he's competent there should be no backlash. He's allowed to make bad choices. I do recommend my original post (included in this post below) to protect yourself.

Additionally, to further protect yourself and your family, start a journal, filling in back information the best that you can, of all that you're doing for him. Be specific with the information. What you've done, things you've recommended, trips to the doc, etc. This way, you have documentation of everything you've tried. Maybe record some of the interactions.

My original post before seeing your response:

Oh, BlueEyedGirl, I am so sorry you're all having to go through this.

Geaton777 wrote a great response with amazing insight.

You wrote: "He is still competent to make his own choices." That means he's entitled to make his own decisions, however bad. I recommend contacting APS to request information and ask about an assessment. Also, check with your local housing authority to find out how to legally remove him, such as eviction.

Eviction or the threat of it is harsh, but if he's competent, it's up to him to figure out where to go. You can assist him in figuring out where to go as your family is being very kind to him, but consider it tough love.

I'm sorry for being blunt, but I'm still recovering from a torturous period with Twisted Sisters and I have no tolerance for narcs. You and your family have tried your best and, like all the others in his life, you have reached the end. I do wish you and your father a good outcome.
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Reply to MountainMoose

It's very important for him to get his papers in order: POA, will, medical directives, etc. and to let his family know what his wishes are. You will probably need an attorney specializing in elder care to do this. Have you spoken to his doctor about the anger? Maybe he needs meds. You may also want to get him to speak with a social worker about his living options. Professionals may be more successful than family at getting him to think about his options. If he makes the choice it will be more successful. Incontinence can be managed with incontinence supplies and home aide as well as in a facility. He might prefer a male aide.
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Reply to NYCdaughter

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