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My mother is 101, and has Borderline Personality Disorder and narcissism, both for her life time, and, in recent years, increasing paranoia. She is well situated in an ALF. This summer, after some troublesome events, her lawyer activated the EPA (enduring Power of Attorney) and PD (Personal Directive) on which I am named as mother's agent. Mother's paranoia has focussed on the ALF staff thinking that they steal things from her, over charge her etc. and now it apparently has extended to her bank. Everything that mother has said was stolen has been found by the ALF staff in her unit. I live 5 hrs. drive away and am 76 myself. My sister, who is a year older than me has never been helpful. I have always been the one asked to do things - right from our 20s.I moved mother from her apartment 4 years ago to the ALF of her choice. That lasted 6 months, when there was in incident with a staff member. They did not handle it well, neither did mother (no surprise) so mother was moved to another ALF of her choice - the one she is in now. The staff in this ALF have been nothing but professional, kind, concerned for mother's best interests, and although she has caused them some problems, they are willing to work with the situation. She has been there for over 3 years now. I am very impressed with them. Her case manager recommends that mother stay where she is, as the alternatives are not as good. It is reasonably expensive, but mother's financial manager has assured me that mother has enough money to last another 8 years clearly, and more. Due to her paranoia, mother wants to move to another ALF, which, incidentally is cheaper, though that is not mother's reason for wanting to move. She calls the staff where she is "thieves". My sis has similar mental problems to my mother and always has. A psychiatrist who saw all of us years ago pronounced me normal. my mother mentally ill, and then said he was more concerned about my sister. He had gone to see them after seeing me and they threw him out after 10 minutes,
After the fiasco of last summer, mother had settled down and was content to stay where she was. As long as she takes the antipsychotic drugs, her life is manageable. Then her behaviour started changing for the worse after my sis, (who lives in Scotland) planned a trip over. I went down to visit mother end of October and she refused to see me or to answer my phone calls. The purpose of my trip was to obtain info regarding her insurances, pension people etc and get her business mail redirected to me. She is still very bright, according to the drs. borderline competent. I work to get her agreement in these things before I do them and I had her agreement to take over her business mail. My sis planned a trip over here for the end of November without consulting me regarding dates then she and mother were mad at me for not being available. At the last minute, one of my plans fell through so I called mother that I was available and she refused to see me again. That was followed by an abusive phone call from my sister who claims that I have not been doing my job as EPA etc. I should mention that when I first moved mother my sister was visiting and literally did not lift a finger to help with the move, but sat and watched us work, and went home with the most expensive piece of mother's collectibles. The next day I had 9 phone calls, which I did not answer - each voice mail crazier than the next and begging me to come down and move furniture??? I contacted the ALF staff and mother's case manager who told me that my sister has been judgemental, demanding, and critical with them. She is trying to get mother into a cheaper ALF for which mother does not qualify, as it is for people with more disabilities than mother has, and has demanded that the case manager make an assessment that will get mother in there. It is not going to happen. All this after I told my sister that my decision as mother's agent was to keep her where she is. Where ever mother is she will bring her problems with her. In my mind keeping her where she is where the staff are good and working to get her back on meds is the only answer. Sis recognises that mother will be unhappy where ever she is. Mother’s case manager has called the mental health nurse to evaluate mother and possibly admit her to a psych ward for stabilization and treatment. The staff all see that mother has regressed since my sister’s visit. Sis has returned home and will be back probably within the month to move mother. Although she cannot move her to the place she is trying to, there are other places she could move mother. I have told the ALF not to accept any termination of lease there without my approval. That will not stop my sis from moving mother if she can. I suspect that I need to ask mother’s lawyer to send my sister notice that she does not have the authority to move mother. I am Canadian and we do not resort to using lawyers quickly, and am looking for any ideas of how to deal wi

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Bingo, Bermuda. To me that is the answer, but my mother, like yours, wants some one with whom she has emotional leverage. I have no idea if she would just fall back on my sister, who is my back up on the documents anyway. I think when you are dealing with a lifetime of mental illness, the job is better given to non family. Too many games keep getting played which are destructive - to me anyway. But how to bring that about I have no idea. If I am successful in dropping it she might, but she would never agree to as long as I have the position. If I suggested it, she would run a mile in the opposite direction on principle. lol I have found that being unavailable has brought about some changes that I didn't think were possible, so it may be the answer.
I learned that from a community group I headed. The time came for the annual meeting and I had been the president and wanted out, but no one else wanted in. A wise man drew me aside and said as long as I filled the gap no one would step forward, but if I stepped out, and left a void, someone would fill it, and someone did and it all worked out fine. I have never forgotten that. Hmmmmm!
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Do you think there's any way your mother would be willing to appoint and pay for a professional person to manage her care? Would she just appoint your sister instead? In my family too having an objective professional managing things would make such a difference but I have no idea how to ever get that to happen. My mother only wants people she's got emotional leverage on.
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HI Holy Cow – yes, sis has issues, not great boundaries and pulls power plays. Yours sounds pretty bad. I see that you understand. As mother is assessed competent again, there is nothing the lawyer can do, nor could sis’s access to mother be limited,other than by mother. I don’t have guardianship. Things are a little different here in Canada. I don’t even have the authority to decide on where mother lives or what her medical treatment is as long as she is assessed as competent. That doesn’t stop mother from making demands on me, but what’s new. I think there is jealousy with my sister too, but she would not want the work of having EPA –just the power. Both mother and sis have some form of personality disorder, I believe. It runs on the family. Lots of fun and games!

Have a great Christmas!
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HI Veronica - this is a little later than the next day. It has taken me this long to get over my “mad’ at the psych nurse. Professionals could learn a lot if they listened to the right people. There was nothing normal about mother’s upset and anger. I heard about the other side of the phone call, and it was her financial advisor, being helpful, but mother took it as an attack and responded accordingly, threatening to end their friendship if he didn’t agree with her. The only benefit of mother being declared incompetent is that I can make the decision to keep her where she is now, rather than having her move. Everything I hear points to her present ALF as being the best place for her, and the one she has chosen to move to as not as good. Part of me wants to say –go ahead and move where you want to, but I can’t, as I don’t think it is a good move for her. She would have to get a lot worse before she would be placed in a mental health facility. Her case manager has mentioned that that is the next step if she continues to decline. I think she would have to be a danger to herself or to others for that to happen – a physical danger that is. Once in there, they might be able to insist on medication.
Thank you for seeing that my only concern is for her welfare. If only she could see that –even once in a while. Yes, it has clouded my whole life and is a sacrifice. Truthfully, I think if I hadn’t cared she would have found someone else – not to care for her, but to do the things she needed to be done, Does she even know I care – it is hard to say. I would say yes, or she would not have moved to be near me, I think on some level her life has been positively impacted by me, but I do not receive that feedback from her. Right now things are quiet and I am thankful.
As I age, I have to consider my needs more and more. It is a matter of survival and quality of life. I did a longevity test mentioned elsewhere on this site and I scored 102. I would rather the years ahead be as good quality as I can make them, and for that to happen I have to manage stress in my life. My father used to use the phrase “Don’t try to teach your grandmother how to suck eggs.” That took me back a bit. He died over 30 years ago. The upside of mother being declared competent is that she can appoint another person for EPA and PD. I am going to contact her lawyer about that and see if it means I could be released easier. I think and have thought for some time that a professional, non- family member would be the best person –and someone who gets paid for their work. I know the feeling of needing to be cared for too – sometimes I wish others would see it more often.
Thanks again and have Merry Christmas!
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Emjo: It sounds like your sister not only has some mental issues but she is a person with no boundaries and is pulling a power play. I have the same issues with my older sister....my sister is so bad that if I say something is white, she will say it is black just to be difficult!

I think you need to jump on your attorney swiftly sending a letter to your sister informing her that she has no legal leg to stand on, that you are the Power of Attorney and are the sole person in charge of making these decisions for your Mom and I would also tell her that any further interference on her part could result in her losing her ability to see your Mom, due to her health lapse after she left the last time. He will know how to word everything for you, but jump on it and do it fast. If they have guardianship and your lawyer can handle it quickly for your without a great expense then I would seek it, there is nothing your sister could do if you have guardianship.

I would gladly work with my sister but she seems to relish in making everything in life more difficult and she is just plain old mad that I have DPOA and not her... I feel for you because I am in the same place!

God Bless You!
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Thanks, Veronica. Your comments are very timely. I was out and about today as finally my car is back on the road - reliably, I hope. I will write more tomorrow.
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Since I have been on this site I have come to realize just how much professionals could learn if they only bothered to listen to the caregivers,
rather than reassuring them that certain behaviors are "Normal"
Each person is a unique individual and there is nothing normal about mental illness or dementia.
Professionals,from experience and education. can advise a caregiver what to expect MAY happen in the course of an illness, they can predict the LIKELY outcome when certain drugs are tried. They can list the possible side effects to be aware of. but there is no certainty or normality.
Emjo you have had a life time of experience with your mother and you are wise enough to know when to intervene and when to leave well enough alone. So what happens if your mother is declared incompetent? How would this change her behavior? Maybe she would be placed in a secure mental health facility where she could not up sticks and move on a whim. Perhaps she would be force fed her medications and become a zombie.
From reading your posts your entire motivation in taking on the care of your mother has been to keep her safe and well cared for and to the extent it is possible content. You have done this out of duty and love because she is your flesh and blood and gave you life. It has clouded your whole life and the sacrifice has been huge. Ask yourself what would have happened to her if you hadn't cared enough to care?
As others frequently say take care of yourself first. Many hugs.
I frequently feel as though I am trying to teach my grandmother to suck eggs, then I remind myself or my body does, that I am just shy of 75 and frequently appreciate when I too need to be taken care of.
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Yes, our hands are tied, and they are far more devoted to figuring out schemes to outwit others than we are. The bottom line is that they, although not mentally healthy, and not endangering themselves or others. Actually, I don't agree with that. Mother has endangered my mental health all my life, and I struggle continually to keep the insanity from affecting me too much. When I look at what I actually have accomplished for mother, the unhealthy interactions and attention that she craves aside, it is not that much, and not things that others could not do for her. Tremendous amounts of energy and thought time have gone into dealing with her, but that has not accomplished anything worthwhile in my view. In the last 4 years I have moved her twice, taken care of her belongings. She choses her own health care still - which drugs she takes, which doctor she goes to, she manages her own money, she has arranged for a shopper to get her groceries... and now she is trying to arrange for some one to move her furniture -
Mother's short term memory is decreasing all the time, Did she forget about my sister? I don't think so, as I have seem this type of behaviour before. She told me she didn't wasn't to see me and then the next day that she did want to see me IF I would do this or that for her. I think it is the BPD/manipulation. People are black or white to her, and their position can switch quickly. You are right it is difficult to explain to the medical people..
If I am successful in stopping her from moving I may have done something beneficial for her even though she does not acknowledge it.
I know why I am so pi**ed off about the phone call with the mental health nurse She got sucked in by mother -the poor old lady is upset because her daughter (my sis) won't help her move. Oh, if the nurse's eyes could be opened to the larger context. If she deals with mother enough she will get it. People always do. Book knowledge doesn't do it, personal experience is necessary, and that comes with a price,
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Hi Emjo, oh yes I never posted about the results of that - she was assessed to be competent so the impossible situation with the impossible problems continues. I would write more but feeling a bit paranoid myself, there's potentially a person in real life who might spot me here. The problems of "competence" really ties the hands of those caring for someone with mental illness especially when it is combined with being too smart! Great point about the criminals.

About your situation I'm so glad the moving drama is solved! What you describe is familiar to me that sometimes there are problems that come up which really could be due to the dementia OR due to the BPD OR some horrible combo of both of them. Does your mother show much memory loss yet? It is remotely possible she genuinely did forget that she told your sister and you to tell her she didn't want your sister around anymore? But then again maybe it's just the BPD crazy-making machinery. It is also quite difficult to explain to an outside medical person in a way they can understand about the impact of emotional illness combined with aging issues.
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Well, it seems the original situation has resolved itself for now. Praise God for answered prayers! But the loose cannon is shooting wide. Tuesday I got an email about whether or not a senior care helper who helps mother with some things should arrange to hire movers to move her furniture into storage. I answered "No" as it would only add the cost of moving and storage on mother's regular costs. She thinks it will reduce her rent, but it won't and she won't accept that her rent is the normal charge. Yesterday I got a phone call from mother to arrange to have her banking mail sent to me so I could keep an eye on it. I keep an eye on her accounts anyway and I know if I have the mail redirected to me she will start accusing me of taking control of her money. "Damned if you do and damned if you don't" theme. The mental health worker who called today, said if I did it I would be setting myself up. I said "NO, mother is setting me up." She has had mother assessed again and mother is still considered competent because she is bright. During the visit mother got a phone call that my sister will not be coming over to help her move. This call 2 days after mother told me to tell my sister not to come over any more????? The nurse said mother was upset but that was normal under the circumstances. I said it was not normal considering that she has just told me and I am sure my sister a few days ago not to come over. It is the same way she was with me, telling me she didn't want to see me, then the next day begging me to come and being upset when I didn't. To me, that is not "normal". But again they do not have the larger picture. I told the nurse that mother has set herself up to be a victim and to get angry about being wronged all her life. The nurse acknowledges that the paranoia is driving mother's decisions, not her intelligence. What they are not considering is that the BPD, otherwise called emotional dysregulation, is factored in there too, but obviously a competency assessment does not take mental illness or paranoia into account. I know they have to use the tools that they have, but I don't have to like it. There are very bright people in jails and mental hospitals - are they considered competent to make their own decisions? Apparently not. However, in the long run I don't suppose it makes any difference. It is conceivable that mother could find people to move her, store her furniture or to accomplish whatever else she can come up with no matter what I decide. If that was all she wanted to do, it would probably be done now. She wants to involve as many as possible in dramas where she is the centre and the others in various roles from servant to golden child. The nurse said that mother agreed to start her pills again. I hope that works. However she also said that mother has changed doctors again as her old one was urging her to take the pills and mother said she was told they would cause her to get dementia. Doesn't make a lot of sense to me I will be surprised if mother takes the pills for any length of time, but we can hope. I know the pressure from mother will continue as Christmas gets nearer. A narcissist must be the center of attention, especially around holidays and other special times. I am looking forward to time away around New Year, and hopefully a cruise in February. Meanwhile I am letting the phone calls from mother go to voice mail. This all seems so pointless to me other than creating drama, and I prefer to see that in the theatre. ;p
Bermuda. beware - your mother may be assessed competent.
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Bermuda - the smart ones do hide it better, and/or score better on some of the tests. The drs in the hospital were quite impressed with mother. She is very bright, but that does not mean that she is making good decisions and doesn't have a host of problems.. I think you are right that it will have to get pretty bad before your mum will not be able to hide it from strangers. The benefit of my mother being in an ALF, is that they experience her day to day and the deficits/problems show sooner than they would if she wasn't tracked daily.

Today I got a reasonably lucid phone call (that went to voice mail) from mother asking me if I would please let her know if I agree to letting her move as she has a room to move to in mid January. I am surprised at that as the two places I contacted that I thought she was interested in had waitlists of 8 and 12 months. She doesn't know that I have no say, and I don't think that I will tell her. She also told me to tell my sister not to come over and visit as it just causes problems. I have no intention of doing that. She can tell her herself. I am sure she has, In some twisted way, I think mother thinks it is my "duty" at this point to protect her from my sister, while she invited my sister's involvement a month ago! I am still waiting for information from the ALF I think she wants to move into. My decision stands, but I want to have the info before I make that known.
Tonight I really want out of this. My life is so affected by mother's and my sister illnesses, and I am so terribly tired of it.
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Countrymouse I am so confused but fascinated by post nonetheless. How are all these people related to you? How is your SIL your SIL and how does your ex fit in? About protecting your SIL, all it seems to me you can really do is sit her down one time and tell her here is what I see happening to you, my support is here if you need it and then let it go. It may or may not be within her to step away.

And to tie this back around to Emjo's thread - my mother is a smart dysfunctional cookie too and because of it she's able to hide growing cognitive deficits better than she would otherwise. I think the doctors are still quite snowed and things will have to get Very Bad for her before she's not able to hide it with strangers.
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cm - been thinking about this. Yes many, many years – about 70, I figure. Started dealing with mother when I was about 5. It seems like a terrible waste – of her energy and abilities and mine, and yet I have to trust the bigger picture and the overall plan. I have wondered what I might have accomplished in life if things had been different.
It is that she doesn’t agree, and juju brought up a good point today –that of pride. It was almost funny in the hospital last summer. Mother had forgotten things, dates, times, what she had done when, and then in a burst of self-righteous energy over something announced “I am not confused. They are confused, but I am not confused”. If it wasn’t so sad it would have been funny. Being less that always right does not tally with her world view.
I get your drift. For some jobs there is not enough money in the world…
So sad about Anne. I wonder if the cancer was an out. I have almost finished reading a book titled “When the Body Says No” by a physician called Gabor Mate’. He writes about family dynamics and disease. I find it very interesting;
Do you not think your sil can look after herself? Especially with the help of her husband. I always try to resist the urges that I am key to saving anyone from anything. We cannot fix others – just ourselves. I think you can stand down to green alert if there is such a thing. Relax, cm, looks like hubby has got their number.
Frankly sil should have enough of a head on her to realise that no amount of attention will ever be enough, and going on these ER jaunts is a total waste of her time and worse it is enabling a narcissist and reinforcing that she (sil) is willing to be the source of the narcissistic supply (attention). Uh - uh not smart.
A couple of asides:
Mother tried to drag me into some of that. She wanted an entourage to go to the hospital in another city for her hip op knowing all the time she had decided she wasn’t going to have it just yet anyway. I got suspicious and backed out as she had a nurse/companion with her who was quite enough for mother’s needs. I would have travelled extensively for nothing except to watch my mother play her games. They are quite ruthless about using other people’s time and energy. If sil hasn’t learned that by now I doubt you can protect her.
I knew someone who refused to push her son out during childbirth until they gave her the drug she wanted. Needless to say the child became a mess. I often wonder what happened to him. She was married to a friend and they divorced. Essentially he lost his son, as well as his wife.
When she falls back on sil, it is up to sil to make some hard decisions. I don’t think anyone can do that for her. Sounds like the family are a bunch of users. I think sil’s best chance is her husband.
And that triggers something - you asked some posts ago if there was anyone mother doesn’t mess about with and I remembered there is one person, and that is part of the reason I married him - my last ex. She backed down from him every time, as she knew he could be as ruthless as her or more so. I doubt I would be going through this with her if I were still married to him, but, those benefits were not enough to offset the troubles he brought to the marriage. If you sense a hard side to me at times, it is what I have learned from him. It is not had so much as self-protective. Shields must be strong to be effective.
Don’t worry about hogging the conversation. It is an offshoot of the thread. What I don’t like is when people start making personal attacks on one another and hijack a thread for those purposes.
Advice –let her husband do his thing. He sounds quite capable. Good man!
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I love listening to you Country Mouse. What is your profession? your roar is so gentle
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Emjo, you've had so many, many years of dealing with all this. It makes me so sad. It's such a WASTE! All your mother's obvious qualities, so misdirected; and screwing everything up for everybody else as well. So frustrating. So sad.

Reading the earlier posts, I was thinking - as you say - about the meds "it's not that she doesn't understand. It's that she doesn't AGREE."

Well, I suppose - is this logical? - that she can't agree that there's anything wrong with her, can she. How would that tally with her world view?

This has also got me worrying more about what's ahead for my SIL. Her mother is still living independently in her own home, where she's lived for fifty-five years. She has a 24-hour paid companion except at weekends, when she stays with my SIL or - yes, you can imagine how well this rota is working out - my ex and his lovely wife (no, she is lovely, I'm not being ironic; but what she isn't is a pushover). I posted on the professional caregivers' thread they've got going on AC that however much the companion was paid it wasn't enough; and the darlings thought I was paying them a 'worth their weight in gold' compliment - and so I was; only there was the other side of the coin, too, which clearly didn't even cross their minds, bless them.

What worries me most is that this family has got "form" with screwing over daughters; and I think my SIL's under threat. I worry less because her fabulous husband is a past master at drawing boundaries thanks to his own mother (who I adored but I don't think anybody else did). But I'm not sure even he realises to what extent my ex's family is prepared to see my SIL sacrificed on the mother altar.

I'm looking at the generation above. My ex's grandmother had two daughters, my MIL and her younger sister, Anne. Anne was like a blurred carbon copy of my MIL. Half as pretty, half as clever, they all 'felt so sorry for her' and 'needed to take care of her.' I think you know what's coming. Anne met and married a man, against expectations, in her twenties. The family arranged a grand wedding + trimmings - I've still got the milk jug from her presentation tea service. But very rapidly it became clear that her husband was a brute who didn't care for her, apparently; or so I heard it when I joined the family, many years after. He definitely had to go. They made sure of it. Fortunately, as poor grandma suffered such terrible ill-health, there was a happy solution that Anne could have a home with her mother and never be lonely. Wasn't that lucky for Anne? And indeed she had her mother's company to enjoy, and her mother to look after, until she died at about 45 of malignant melanoma.

For me, the saddest part of Anne's story is that Anne never for one moment thought she wasn't the luckiest woman in the world. That woman had the most loving heart I've ever encountered. I don't know, maybe devoting her life to caring for her mother wasn't the worst thing that could have happened to her. It was a kind of fulfilment, I suppose; and she certainly did make herself crucial to the family, because less than a week after she died the question of who was going to care for her mother now blew everyone else sky-high out of the water: my MIL still doesn't speak to any of her aunts - her mother was the eldest of 16 children, some of the aunts are MIL's contemporaries - and this happened - oo now - 27 years ago.

Over my dead body are they repeating this exercise on my SIL. Over my dead cold body. I swear it.

How can I help her and her husband protect their cordon sanitaire? Every so often I hear rumours about how "he's very hard on her" or "he doesn't seem to understand how much she worries about her mother" or "he won't let her retire" - little hints about how she might not be as happy in her marriage as the family could wish. Usually after he's put his foot down about a short holiday abroad, or not cancelling a long-standing engagement, or not resigning her part-time post as a consultant psychiatrist (yes I know. Physician, heal thyself. Don't ask). Actually, now I've just put it like that, I think he's got their measure, no? Perhaps I can stand down to amber alert.

My MIL won't touch the drugs either. She's much better off having panic attacks and needing to be rushed to ER every couple of weeks because her heart could burst at any time, you know… and of course she can't have a mere paid companion going with her, can she? No no. Only a daughter, or a doctor, or a happy combination of both, will do… Presumably it's less satisfying to ignore the opinion of someone who isn't professionally and emotionally qualified to give it.

My MIL told me she had never spent a night alone in her life. Now then. Her husband had died two days before, so this was not the time to take her to task: I patted her hand and gave her a hug, though I may also have allowed myself a surprised expression. It is true that she married at 19 and was widowed at 75. I allow that the grief of a widow who has never known adult life as a single woman is probably in its own category. The rest of it, this portrait of helpless little wifey now bereft of all meaning in life? - utter horse shit. This is the woman who had her third labour induced early because she didn't want to miss a cruise holiday. Who travelled the world as part of a sports team. Who served as a magistrate. Who qualified as a barrister in her forties, once her children were off her hands - not, to be blunt, that the children ever were that much on her hands - that's what staff are for.

So, again, we're looking at an admirable (in many ways), vibrant, strong, gifted person. But what's she going to do with those gifts now, is what worries me. Won't see a counsellor. Won't consider meds. Won't help herself. When she falls back on my SIL, how do we collectively help take the weight?

The family thought they had the job done when my SIL got her heart broken in her early twenties by her VILE fiancé, pond-life of the lowest order who I too was very glad to see the back of. What they didn't reckon on was her finding her soul mate out of the blue in her thirties, and on his being such a tough nut to crack. Ha!

This post has been cathartic for me, but I didn't intend to hog the conversation when I started it - apologies. Any advice as to potential pitfalls, booby traps and ambushes you can all spot in the scenario would be welcome.
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Hi Carol - I see it more as treating the person than managing them. Their brains aren't working right, and the meds help to correct that. Whatever the word, sometimes meds are the only answer to a given problem. I understand about plasticity and was fascinated by it as a student many, many years ago. The concept has been around for some decades.

You had a very bad experience with the geriatrician and some other drs. I understand and have "scratched my head" in wonder at times, and agree with looking at the big picture and thinking something is wrong,

In my view, mother has not been competence since last summer. Yes, I know her, and see the difference in her that the drs do not. BTW mother does not have ALZ, but she does have Borderline Personality Disorder and narcissism and now paranoia and decreasing short term memory. No doctor has mentioned any dementia. Even if (when) assessed incompetent there is no way to force her to take meds. It is not that she does not understand that the medication would improve her quality of life. It is that, I think, she believes she is alright and everyone else is causing the problems. She has been like this all her life, needed meds and would never take any that affected her mood. She has been prescribed antidepressants but would not take them, because she says she is not depressed, though the drs observation and mine, was that she was. Yes she is egocentric and always has been - and has never cared for others, or the effect of her behaviour on them, their families, their health...
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Emjo, l absolutely agree with you that it will most likely and eventually come down to a point of "managing" a person with medication. It isn't ALWAYS true, but it is MOSTLY true because, in dementia, we are dealing with significant changes from the normal pathways of coherent thought in the brain. Because of the on going research regarding the plasticity of the brain, l personally believe that it will be discovered in the future that the brain is also trying to rewire itself in dementia patients, but that even the new pathways come out as convoluted as the ones which have already been damaged. Of note is the prior held belief that the brain was static, developed as was, unable to rebuild, breakdown and deterioration the only option. But why were some stroke victims able to relearn? With active brain scans, it was then discovered that the brain can rewire functions to other on damaged locations. Plasticity became the name for this.

Currently, however, I believe the dementia patient management problem comes in because there are too many trainee chefs in the kitchen. Too many doctors taking care of dementia or pre-dementia patients, but without the skill set to do so correctly. "Correctly" means proper assessment in the first place. If behavior is such that medication isn't necessary, fine! But if it is, let's not put it off in the unfounded fear that we're going to over medicate. Okay? Let's go into the arena of medication with the belief that we're NOT intending to over medicate. Is the fear unfounded? Maybe not...l have seen over and over again, with incompetent prescribing, how they wait and wait and wait until the behavior is so outrageous and out of control, that they almost HAVE TO over medicate at that point, and the person is zombified. Onlookers who come in at this stage are likely to believe that the stupefied patient is over medicated for no just cause. It is truly a nightmare within the dementia business.

My mother had a board-certified geriatrician who was, IMHO, absolutely worthless. By contrast, my aunt started wIth a fabulous neuropsychiatrist at a neuropsychiatric evaluation facility who gave me all of the tools I needed to manage my aunt with knowledge. When I relocated her, she didn't even need anyone other than a primary doctor for years until she had a stroke. The new neurologist at that time didn't agree with the prior diagnosis, said it wasn't even possible, even though it was right in the DSM IV and completely accurate as regards my aunt's behavior, but he didn't want to listen to ME. After, I was ONLY her niece who had been intimately involved in caring for her already for 6 years when I took her to this jerk. Other then the fact that her dementia had nothing to do with her stroke, this guy was so arrogant that he had to pipe in about everything. But, ya kno what? The first doctor had been right about auntie's dementia (alcohol), the new one wasn't. AND the new one also wasn't right about my aunt. He said it was a heart problem and that I needed to take her to a cardiologist. Instead l took her to the ER because she was experiencing breathing problems. THEY admitted her and begin testing. Turned out she had 3 different strokes IN HER BRAIN, and one area affected her ability to breathe. Hmmmm, doc,NOT the heart, but the BRAIN! YOUR specialty, and you missed it even with the aid and assistance of an EEG. WOW!

That may be enough of my rant quota for the day. It's just when you've been through this kind of incompetence over and over again, you stand back and say what's wrong with this picture?

Obviously, giving your mom anything without her permission is not a viable option as long as she retains everyones perception of competency. In spite of any declaration one way or the other, YOU already know what YOU see and feel, don't you? You just have to wait for the professionals to get on board and nevermind you're stressed in the process. With the support of the ALF evaluation, when they feel the time comes, you will then be able to do what is right for her in spite of her belief about psychotropic medication. She already isn't able to understand that the medication her Dr wants her to take would improve the quality of her life, not to mention yours.

But dementia patients overall seem to get into a stage where they are unable to care about you or your health, and many were that way long before the dementia. My aunt's neuropsychiatrist (the good! one) called it ego-centric. Yep.
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hi cm - yes 101 and still socking to me and the world in general.

Sherry is on the shopping list.I may need two bottles this year lol.

There is no way to administer drugs covertly.

Mother has always been against any drug that would affect her mood/mental processes, as, after all, she does not have any problems, it is everyone else. Agreeing to taking such a drug would be admitting that she has problems, and that may be beyond her capabilities. There is nothing rational about this, nor has there ever been.

How - I am a very patient person by nature and have a long tether. I look ahead, set goals and work towards them, expecting difficulties along the way and looking for solutions to those difficulties. It is a problem-solving approach which I see my oldest son, at least, has too.

Why - because I think it is the right thing to do. I do care for my mother and have some compassion for her, even just as another human being. If the point comes where I feel the detriment to me outweighs the benefit to her, I will do what I can to get out of it.
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Watch that bottle of sherry Country Mouse has her eye on it
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Thanks V. Actually I have unwittingly stopped the planned move for now as the ALF director where mother wants to go will not entertain an application if family members disagree. As you say if (when) mother gets assessed as incompetent I have the authority to decide where she lives. Until then I do not. Her ALF staff are tracking her and will bring in a physician when they are ready for an assessment. There is an 8 month wait list for the ALF she wants to go to, in any case. So, unless mother and sis find a new place with a very short waitlist, she is stuck where she is for now for some months, by the end of which time the assessment should be done. If she moves before that, so be it - nothing I can do.

What I am doing now is gathering information about the new ALF or any other to share with family and her, things like the lack of a nurse on the floor where she would be. Not exactly endangering to herself, perhaps, but an unwise decision.

Once I have done that, I will step back and let the chips fall where they may. I have done what I can. After one more email I should get the info I need, then I will email the family and send a letter to mother. That is all I can do.

The chest congestion is unusual. I have never had bronchitis or pneumonia. The IBS is definitely triggered by stress, It is a hangover from a condition that I have been dealing with for the last 4-5 years and from which I have nearly recovered, despite all the mother stress, (which has been worse in the last 4-5 years), so it is a temporary setback. I do look after myself. The last few days were particularly stressful as I was dealing with some past pain, which I shared with my counsellor. I had never shared it with anyone. It was the only experience that I had not shared and it stirred up feelings.

I am planning some escapes. We hope/plan to do a cruise in February. G says I will get 3-5 days notice so be prepared! I may go for a massage before Christmas - looking better all the time. Christmas plans are falling into place and dinner theatre again for New Years. Dental surgery and touch up of my permanent make up (I have eyebrows in the mornings now - woo hoo) in January. So I do not neglect myself. The family has a touchy gut. I am not exempt.

Sis will do what mother wants and believe what mother says, so she is unstable.
Here EPA and PD are taken very seriously. I have a responsibility to get mother assessed if I feel she is incompetent. It is not just a matter of waiting till it happens That is in motion. I cannot drop EPA/PD if I wish. I would have to go to court and be released - which is not automatic. I am setting up resources to back me up should I feel that is necessary, and also covering my butt, Anyone can go to the courts and complain if they feel I am not doing my job.

I appreciate what you have written. I need to pick up my annual bottle of sherry. ;)

Just had a call from mothers financial advisor who has been like a family member for 15 years now. He supports what I am doing and says he sees that mother is deteriorating. Nice to have allies! :)

Thanks all - the support is invaluable. (((((((((((((((hugs)))))))))))))
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I like the sips of sherry suggestion. Best idea I've heard all day.

I'd err very much on the side of caution before administering any medication covertly. And especially medications with that many side effects. And especially until you have it signed and sealed that your mother lacks capacity, or is caught red-handed during a psychotic episode. Get that wrong, and you'll be risking an assault charge.

Emjo, has your mother explained what she's got against the risperidone? Just generalised dislike of having her persona interfered with, or is there something more specific to it?

101 and still socking it to you and all around her. Quite something. God bless you eternally for sticking with her, but I don't think I will ever really understand how or why you do it.
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Emjo,
You have some conditions that are exacerbated by stress, you can not take care of some one else and neglect yourself, it just does not work that way.
Your situation is like the boy with his finger in the hole in the dam.
You do not have the power to stop mother moving. You know you can't stand in the doorway of her room while some 200lb man brushes you aside as he carries out her bed. Mom and sis will get around you one way or the other so you have to let it happen. I would say don't give up your POA because it will come back on you anyway when it all falls apart. Your sister can't manage it from the UK and she sounds as unstable as Mom so will act unpredictably. Take care of yourself for now and let Mom get on with it and when the time comes and she is declared incompetent do what you feel is in her best interests whether she likes it or not. As long as she can not be self destructive with her money stay out of it for now. As long as there is no danger of her harming others by her actions ie with a gun or car she has to be left alone. It's hard for you but you must keep strong. Many hugs and sips of sherry.
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Hi carol - your suggestion is unique, thank you. Mother is still in independent living. She is very well physically for her age, really very well, period. The drug she was prescribed is risperidone. It was prescribed by a geriatrician in a hospital last summer, not by her doctor. She dodges around not spending too much time with any doctor. I believe that the only solution for her to have a manageable, somewhat content, life is medication. I don't know the position in Canada (she is here) regarding what you described, but, since mother is still independent, administering meds that way is not an option. She still counts out and manages all her meds. As her short term memory is failing, this may not continue to work in future. When she was in hospital last summer, the geriatrician pushed her to accept having her meds bubble packed and administered by the staff at her ALF. She reluctantly agreed. It lasted less than a week (as I predicted) and she is back to her independent ways and not taking the antipsychotic. I have spoken to her firmly, appealing to her intelligence, about the benefits of taking the drug. She did for a while then stopped again.

Apologies for not answering your post sooner. I took a "day off" then the next day had a bit if a meltdown at having to face this mess again. It was like stepping from lush grass onto crushed glass, I had an IBS attack and some chest congestion - all stress related, I am sure.

I still am wondering what benefit to mother there is in me "doing the right thing". You cannot save someone from his/herself. If she was more helpless, others could do more, but she isn't. Am I really helping her by trying to keep her in what I and others perceive to be a good, safe environment when her "demons" say otherwise. Would she suffer less by "fleeing" and starting over again even in a less desirable ALF.. I don't know if "relocation stress" would be harder on her than the stress of staying where she is. I just don't know.
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Wow! emjo, I have seen your thoughtful and intelligent post for quite some time, so I was surprised to realize that I had never read your story before. And now, all if THIS happening to you! How despicable.

As I write this post, it is after spending quite a while catching up on 42 other entries. I think I did not run across what I'm about to say, but if I missed something in advertently, please forgive me for repetition.

In one form or another throughout several of your posts, you've mentioned something along the lines of the following:

"Her poblems are very largely of her own making and perception. What helps? Antipsychotics - but she wont take them."

I know there are several antipsychotics and I don't know which one her doctor has prescribed for her. Of course you should check with her doctor, who is the prescriber, but I do know that one is called Haldol (generic - haloperidol) and it comes in a tasteless liquid that can be added to anything they drink. The psychiatrist where my dad was said it was important to be able to get an antipsychotic into a psychotic person many times without them knowing it and the doctors weren't able to order injections at long term care nursing homes, only skilled nursing facilities. He said the liquid form was a great tool for the doctors and staff to be able to manage a patient diagnosed with psychosis.

I know you are in Canada, I presume your mom is as well, but has this ever did mentioned to you? If she got the anti-psychotics regularly or at least as needed, as you have suggested perhaps many of her problems would evaporate, her paranoia about thieving might make her less intent on moving, do you think?

I send you my best thoughts of strong energy and best wishes for a calm and reasonable outcome.
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re vision - no she is not losing. She had surgery for cataracts in 80s and her vision is quite good. Yes, she is a very bright lady - runs in the family ;p!

Off to lunch with a friend - will be a pleasant break!
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Oh. My. Goodness. I didn't realise I wouldn't be completely joking...
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Hi cm I hear you about "she MEANS well" and I agree, though with my sis in the equation I always have to keep HER ways and means in mind. It may not be evident, but I love my niece. She is a very bright and talented person and I am sorry that she has a very manipulative mother and a drug/alcohol problem. But, because my sis in in the picture I have to keep my guard up. My sis is relentless - words used by her son.
I am sure they are tempted to leave her alone. When I was last there the handyman ran from mother She was quite upset and wondered what someone was doing to cause that - to sabotage her needs being met. What plot was a foot. I gently suggested that he may have been upset by something that happened between them. She had been going on and on to me about how they had deliberated damaged her scooter in order to isolate her. Two days later her scooter was fixed. That did not change her view that "they" had damaged it, "Mother, why would they damage it and they fix it again?" All I get in response is that you don't know what it is like as you don't live there. There is absolutely no reasoning with her and according to the doctors she does not have dementia! But then, part of the BPD/narcissism is that she is never at fault - it is always someone else's fault. That has always been the case. And as you say w/regard to your mil, nothing anyone does is good enough;
No, there is no one she doesn't muck about with - never has been. People are black or white, good or evil and you can be switched from one to another. When you are in the white/good compartment of her mind you can do no wrong. Sis has lived there more than most. When you are in the black/evil compartment you can do no right. I have lived there more than most. I was the one in the family to stand up against the nonsense. It was a lonely role, but I simply could not swallow the garbage I heard about others. Could not do it. And I am the one she chose to appoint as her agent. I am the one she chose to move near to as she got older, Surprised the dickens out of me and my stomach sunk, as I knew what I was in for, and it is happening. Somewhere, she does know I have her best interests at heart. When she said she was moving close to me, I asked her why she wasn't moving to Scotland as sis and I had always figured she would. In fact it was what sis told me more than once and my thought was "Fine". I asked mother why and she said "Your sister wouldn't help me". I have stories to confirm that. So I said to mother that I would do what I could for her. She bowed her head and I saw a little moistening around her eyes. It was a very rare display of emotion and have never forgotten it. I have done what I could and will continue to. She knows me and that I will not just work to please her, but do what I think is right for her. Apparently, something in her trusts that in me.

Elope - lol! She had a "boyfriend" without too many scruples on some areas. Oh my goodness, was a ride that was. Nothing I can write about here, but let us just say he was not straight and I had to be very protective of my children. You see, nothing doesn't get tainted by this disease. You have no idea of some of what I have had to deal with. I don't hold it against her personally. She, despite all her strengths, and she has many, has a very serious disease. BPD is called a serious mental illness.
So I march on, doing the best I can.
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I expect your niece is trying to help. "…fools rush in where angels fear to tread." Or as my mother would put it: "She MEANS well, darling…"

If only they would leave her alone, hm? Gosh they must be tempted sometimes. Be a great item for Candid Camera, wouldn't it - "Quick, everybody, hide!"

Just wonder. Is there, has there ever been, one person whom she doesn't muck about? With my brother-in-law's mother, it was me; with my mother-in-law, it's her son (or mostly - except when, speaking as a Fellow of the Royal College of Physicians, he gives her medical advice; but he's given that up now); with my great-aunt, it was her son-in-law. Perhaps your mother thinks it's you. "That Joan, so cold, she's got a cruel streak a mile wide…"

This part - "She wants to be treated better, she wants home care who cook better, she wants more positive attention, she wants things fixed "immediately" and so on. She already has twice the normal time for home care to prepare her meals as she is so fussy. She thinks the staff at her ALF are stealing from her…" - makes my heart sink. Yup, that's my ma-in-law all right. My poor sweet SIL, still thinking that if she tried hard enough and made enough sacrifices all her mother's dreams would come true, and agonising about it for hours if she goes out with her husband for an evening instead of staying on call. I don't wish my MIL ill, but I do wish something would happen to shift the scene, deus ex machina. Preferably something that doesn't just give my SIL more to worry about, mind, so tricky to arrange.

Wow! Perhaps she'll fall in love and elope! Now there's a thought… Where's an agency that specialises in really good-looking male caregivers with not too many scruples?
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Bermuda and cm - the niece and others know about mother's moves and that they do not solve anything. I had that discussion with the niece on f/b a couple of months ago and she agreed. Family knows that in the long or even short run nothing will satisfy her. My sis admitted a couple of weeks ago that she knows a move will not make mother happy, or solve anything for her.

I have lived and dealt with triangulation all my life. Once I really saw what was happening I bowed out as well as I could and still do. Sis and mother triangulate all the time. It is very tiresome. More recently my niece participates, at her mother's prompting. But then she is trying to please her mother... family pattern. She stands to inherit quite a bit, since my sis disinherited her son.

Mother hopes that she will be "happier" there, or some such vague term. She wants to be treated better, she wants home care who cook better, she wants more positive attention, she wants things fixed "immediately" and so on. She already has twice the normal time for home care to prepare her meals as she is so fussy. She thinks the staff at her ALF are stealing from her, and she will carry all those problems with her to any place she goes. She had the same problems with whatever help she had when she was in her apartment 5 years ago, in the first ALF she was in and now in this one - only the paranoia is worsening. It is a combination of her BPD, narcissism, and the age related short term memory loss and paranoia. So the answer is no there is nothing concrete that can be negotiated, and even if there was, with the BPD, and narcissism, it would never be good enough. She has said to me "If only they would leave me alone", while, the truth is, more would be accomplished if she would leave them alone. Her problems are very largely of her own making and perception. What helps? Antipsychotics - but she wont take them.
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She's not losing her vision, is she, Emjo? Gosh, but she's a bright lady. My mother was a bit of a techie wizard until lately, too; but in her case she'd been around computers since the mid-70s when they were still using punch-cards - not quite the same!

Poor old Manager, the one you were speaking to. Nervous?! - Be afraid, be very afraid...
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