My grandmother has suffered from paranoia and delusions all her life but has refused treatment because the medical industry is out to get her.

She has a personality disorder in the form of when she doesn't get her way she runs a wild campaign against the person who refused her.

My grandfather passed away in 2017 at the age of 70 from natural causes because she would invoke mental and emotional abuse on him every time he sought medical treatment for his ailments. My mother got Adult Protective Services involved but they could not prove he wasn't in his right mind so nothing was done to help him.

She has been living on her own ever since his passing, occasionally receiving help from family when she asks.

She is very mean and cruel, she says hurtful things to her children just because she can. No one wants her to live with them because then she will start her tirade in their house. She insults her son's wife, her daughter's husband, she told me she hates the fact that I'm married because it takes my attention away from her. When she calls it's either to guilt you into doing something for her or to get info on someone else she's upset and isn't speaking to her to pull you into her weird stalking game. She is just drama, screaming, cussing, anger, paranoia, suspicion and delusions all the time.

When my grandfather was dying in the hospital she refused to cooperate with the hospital staff, screaming at them, calling them names, cussing at them and telling them they were killing him when in reality he was dying because she wouldn't allow him to get help when he could. One of the nurses said to me, "She has dementia?" I told her no, "She's always been this way."

There is going to come a time when she cannot care for herself but what are we to do if she refuses treatment and care?

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Paranoid personality disorder is an attachment disorder whose suffers cannot form normal attachments to the other people in their lives. The combination of diminished emotional bonds and fear of being used/watched/manipulated can create a personality that uses manipulation and coercion (financial and emotional) to get what they want from others. They "hide" some aspect of themselves from everyone and generally never ask for any type of help, instead demanding it like some kind of tribute. They create problems in the family or any other organization because they want to be the only one everyone else talks too so they lie to create problems and mistrust in everyone else's relationships. Even someone who has been functional and able to control the worst parts of this disorder can become very dysfunctional and extremely difficult and abusive when dementia comes on broad too.

My advice:
(1) Accept most of the aggressive abusive behavior is the disease - either the disorder or the dementia or both. You cannot change it and your grandmother cannot control it either. Her anger is not really directed at any person, it is an expression of her fear and anxiety; aggression is used to mask venerability.
(2) Accept your grandmother is never really going to be happy ever again regardless of what you and your family do for her. She may be content for moments of time, but those moments will not last. Her need to exert control over her environment to reduce her anxiety is never ending. Medication can help, if she can be convinced to take it.
(3) NEVER even consider bringing this toxic person into your home or moving into their home. Even when you provide direct care, always limit your time/exposure and have an escape hatch readily available.
(4) Use third parties as much as possible to provide for her direct care; your grandmother will often treat them much better than family. The paranoid person is very resistant to having anyone enter his/her home, always thinking the care provider is looking to take advantage to steal something.
(5) Use APS or a hospital stay to trigger a full evaluation of her mental state and consider obtaining a guardianship (family member or the state) so she can be moved into LTC as soon as practical.
(6) When you visit her in LTC, always take a gift or favorite food (your tribute).
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Ahmijoy May 2019
Excellent advice, T. I will not comment to OP again because I am obviously rubbing her the wrong way, but I think the suggestions and information you’ve offered are spot-on. I hope a family meeting happens soon. This has to be an awful situation.
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Sadly, there is nothing that you are going to be able to do yourselves when she is unable to care for herself anymore.

When it becomes obvious that she is at that point, you will involve APS and allow her to become a ward of the State. A public guardian will be appointed who will oversee her care.
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It doesn't sound like there will much of anything anyone can do about it until she has a medical emergency that lands her in the hospital. At that point everyone needs to be clear about her issues and the fact that nobody is able to care for her at home, push for a psyc eval and then work with the care coordinator about where she will go. It will be the hospitals responsibility to make sure she is safe and cared for when released and they are probably going to be the only ones who can force any issue with her. This way the family aren't the bad guys either telling her what she can and can't do it will be the hospital and medical "officials" making the call. Just don't let anyone in the family get roped into agreeing to take on any of the actual care giving responsibility, this is not the same as walking away from her or not taking care of her it's simply not turning into her care giver (or whipping post) Good luck this does not sound like an easy situation for any of you.
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Thank you for answering. This is the best advice I have come across yet. It seems as though we are an isolated case that no one can relate to or understand. For some reason it makes me feel slightly better knowing that there are those out there who know exactly what we're going through. I will relay this to my other family members so we can all be on the same page. We know how she is but at the same time we want to ensure the best care for her. When it comes down to it she is still our mother and grandmother, it would be awful if we were to just wash our hands of her. Thank you, again. You have truly helped.
It seems you have been very accepting of her behavior all these years, possibly shrugging your shoulders and saying, “Oh well, this is how she’s always been “ Someone probably should have stepped in years ago and helped Grandpa out if it was known by the family that Grandma was abusing him. APS should have been called, or at the least your local Area Agency on Aging for help with her. You seem to have accepted her toxicity and let her go on without intervention. Now, there probably isn’t much you can do.

If she should suffer a trauma and you or another family member are summoned to the hospital, share her history with them and tell them she needs help that you cannot provide. Impress upon them that she is hate-filled and abusive and refuses any attempts to help her.

She needs a professional evaluation for dementia. If it should show that she does not have it, you cannot force help on her. If she refuses treatment and care, you will have to accept it. If someone is that vehemently refusing help and verbally attacking and abusing those who try to help them, there is nothing to be done. Be there when she asks for help, but when she begins her attacks, leave. If you force your help on her, her attacks could become physical.

If it does turn out that she has dementia, somehow she should be gotten to a geriatric psychiatric facility and treated, to be discharged with a care plan; probably to an Alzheimer’s unit in a residential facility. Someone in your family will need to apply for guardianship if no one has Power of Attorney.
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Firstly, we have most definitely not been accepting of her behavior over the years. All of us at one point in time, including extended family, have tried to talk to her, have removed ourselves from her company when she begins her tirades, nothing works to correct her behavior. It is as though everyone to her is just a knob on her control board and if a knob does not do what she wants she gets upset and comes up with these wild ideas and accusations that are just off the wall and she sticks to them. I am not even sure what her children or grandchildren can do to "correct" her behavior since none of us have any authority over her. She is our parent and grandparent, what are we supposed to do?

Secondly, my mother DID involve Adult Protective Services when she began mentally and emotionally abusing my grandfather for getting medical treatment but they were unable to prove that he wasn't in his right mind or that he was incapable of making decisions for himself.

Thirdly, I do not think that she has Dementia or Alzheimer's because she has been paranoid, delusional and temperamental all her life, not just in her old age.

My uncle (who is her son from her first marriage and stepson to my grandfather) got upset when my grandfather died and told her she should have allowed him medical treatment and that the hospital, nurses and doctors were trying to save him. Because he voiced that to her, she calls her sisters and tells them he put a curse on her husband and that is why he died. She also told them that he put a curse on everyone in the family. She then walked over to me and asked me why I was afraid of him, that I shouldn't be afraid of him (I'm not, he's my uncle) and, look, he's floating outside our window on the second floor trying to cast spells on us. That is just one example of her behavior. I'm not sure how we are supposed to correct that but okay.
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My mother is a narcissist, now has vascular dementia. They get worse . If someone has a POA, they legally can make decisions for her care. Find a nice AL facility and let them handle the care. If she refuses, then she refuses. My mother refuses to do anything we ask but doesn’t want to show her true colors to “ outsiders” so is fine with the ALF staff. If you fear legal retaliation, consult an attorney to see how to protect yourself.

its easy to say “ you should have ...” but truthfully, mental illness and behavioral problems aren’t like physical illness in that a dr can’t find them on a blood test or X-ray. Unless they are a danger to themselves or others, hospital systems don’t really want to be bothered. Sometimes the person is a master manipulator and the doctor never sees the real person behind the mask. NO one ever saw how my mother acted until now when her dementia has gotten bad enough she can’t always maintain the facade.
I hope you can find a solution but please protect yourself legally. You don’t want her accusing you of abuse
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Whatever you do, do not let your NOT elderly, mentally disturbed grandmother move in with you! My goodness - what a terrible person to cause the death of her spouse - not allowing him to be helped medically. But you could and should call APS.
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I'm going to sound really mean here. But I'm in a tell it like it is mood. My mother passed about a month ago in a nursing home. All three of her kids had room to take her and have admitted if Dad had been the last alive he'd have been welcome in our homes. Mom was like your Grandmother. Narcissistic, Controlling, OCD, abusive. We all did what we could from a distance but paid people to check in on her. When her bones began to break (she broke her hand just leaning on her walker), it was time for a nursing home. She HATED it there and at one point the abusive phone calls were so bad we all had to block her to get any sleep. My brother had POA so he did what had to be done to pay for the nursing home (selling her home, etc) but the rest of us tried to be as helpful as possible. When her kidneys failed 3 months later, she passed within 2 days (she had a dnr, her choice). She was so abusive that not one of her kids really misses her a bit. Sad, huh? I think we might have had a better relationship had she been in care earlier. Honestly, whatever little money we inherited was NOT worth the agony of the 7 yrs we put up with her since my Dad died. If I had it to do over, I'd have convinced her to do into assisted living much earlier and then had them transition her to a nursing facility. If your grandmother won't listen and go into care, then be sure to have something done up that says you and your family members are not responsible for her. I have a friend whose cousin walked away from her mother and ended up in jail for elder abuse because she didn't check in on her when she "knew" she needed help and was incompetent (the woman was a nightmare)... It's kind of terrifying.
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Yes, that is very similar to our situation. My grandfather loved and was loved dearly. He refused to divorce or abandon his wife. He loved her that much. My grandmother, I feel, took advantage of that.

Thank you for your response.
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"Elderly" grandmother is seventy. Not so very elderly, then.

Apart from her seriously unattractive personality, are there any other key issues? Has she ever been treated for a mental illness, is there anything in her history, any cultural influences or religious rules in the mix?

I'm not quite sure how you, her grandchild, would know that she has always been like this?

How extensive is the family circle? - I'm wondering if there are plenty of people willing to help, or just one or two who are stuck with the responsibility.

In any case, though, as your grandmother is seventy and lives independently, you don't have to come up with a detailed care plan right now. Has something happened that led you to post your question just now?
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This is a mean, cruel woman. What on earth do you care what happens to her. I wouldn't worry for a second. I'd put her somewhere in a facility. Someone like this does not deserve any kindness or help from anyone. Don't get involved and don't do it. She is nasty and horrible and no one should have anything to do with her and I don't care what made her that way - stay away. She is NOT to be YOUR problem. Tell her off when she acts bad and don't answer the phone and walk away. Why did you ever put up with this for so long? I would have shipped her off long ago.
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Walk away and let the state deal with her.

She will only get worse as she ages and loses filters, gets mental decline, etc.

That she gets angry when she doesn't get her way tells me that she is a full blown narcissist and that makes her dangerous, as you have pointed out.

It is sad and unfortunate but no one should subject themselves to her insanity and hatefulness.

She needs to be in a psychiatric hospital. To ensure no personal culpability call APS, have every family member call APS and get it documented that no family can deal with her and she is a poster child for state intervention.

Tough, tough situation, hugs!
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