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My father had delirium following a surgery last October. After months of hospitalization and a recent major setback, he was diagnosed with dementia with behavioral disturbance, epilepsy, and panic disorder. I am my father's POA, and after a brash (cruel, 100% inaccurate) accusal re: bill paying this past February, I turned his finances back over to him since he'd mostly recovered. However, with these new diagnoses, I have had to step in to pay his bills once more. This is along with finding an appropriate facility, purchasing furniture for it, communicating with family members, and monthly travel (I live 1100 miles away) has completely wiped me out. I'm exhausted, and his first week in MC he called several family members to pick him up, take him to the house, take him to the bank, etc. For now, I've requested that only family members be allowed to sign him out as he has threatened to:
-take all of his money out of the bank and give it away;
-kill a man in MC with a pistol;
-drive;
-cross the major highway to shop at a local grocery store; and
-punch my brother.


This is especially challenging given his narcissism--he's great at making himself a victim. On the good side, he's planned well for his care and financially has the means, long-term care insurance, etc. However, he does not want to spend $ and I am concerned that another accusation may mean that I give up altogether. You can imagine that he often guilt trips, speaks ill of people, accuses, and gaslights.


I have a brother who marginally supports and little other family assistance.


Help!

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A few ground rules need to be established with family and friends to help you and your father:
1 - Listen but do not offer help.
2 - Everybody may report aberrant behavior to you via text or email - you do not need a million phone calls.
3 - Work with the staff in the facility, his neurologist, his geriatric psychiatrist, and his medical doctor to provide the best physical care and control of his impulsivity.
4 - Make decisions that support the rules above - whether it comes to finances or medical decisions.
5 - Every and any time your father contacts you and rants, remember that he needs to live where he is for his safety. Then, call staff and let them know he may need a sedative.
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I see you have only gotten one response so far - perhaps an indication of how difficult your question (your situation) is. My late father with significant mental health issues had to be in assisted living during COVID and called me frequently with complaints, unhappiness, and threats to do reckless things - it doesn't make for a calm day or evening when that sort of call could be coming at any time! I suggest a couple of things to remember. First: "stress brings out latent pathology" is a biggie. Your father is stressed by the move and being in an unusual setting where he has to rely on others to help him, etc., so he lashes out at them and at his close family to try and get them to take him back to a more comfortable, "normal" life, which you know he cannot function in. So you see his entitlement, his anger--all his worst--coming out. If there's any chance he might have bipolar tendencies (this can make people SEEM narcissistic) you might see a change with a very small dose of mood stabilizer or atypical antipsychotic - you'd have to request evaluation from an experienced geriatric psych provider and you'd tell that provider everything you've observed and experienced. Beyond that, are there things your dad could have at the ALF that he's missing from home - a small pet (many places will allow cats or small dogs)? Or a very good stereo system? A hobby table that he used to work at and the model airplanes he loved? I'm just imagining. For my father, the third portable stereo system I got him was the charm, the earlier two weren't high enough quality or fidelity (you see the narcissism there), but he enjoyed listening to classical music and that was important to him. Medication also helped him sleep better and be more calm and reasonable when he was frustrated with staff(whereas he had been berating them and not making many friends of the poor overworked aides!)

In addition to the above, and telling your other family members that your dad is not safe to be alone at home, etc., turn off your cell phone or put on "do not disturb" at a certain time at night until morning - give yourself a break overnight. You may get a big voicemail during the night, but the next day will dawn and you'll deal with it then. Try to empathize with your dad's unhappiness but then redirect after a moment or two to another topic or tell him you're sorry but you have to go now. Don't waste time trying to argue or convince him that he's in the best place or things are fine.

Wishing you luck!
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Jaxon2020 Sep 2021
My mom has a similar disposition. Your answer is reassuring that I've done the right thing. She's in assisted living and makes a good argument for going back home, but she is not aware that her memory and thus her decision-making is not as reliable as she believes. I've learned slowly that I can't convince her of anything and that she'll never be satisfied.

It's sad to know that people are being stressed out by these behaviors, but it's comforting to know that I'm not alone.
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If he has the money, I would let him live at his own home and hire whatever is needed up to 24 7 Care using Caregivers doing 12 hr shifts, that's what I'm doing for my dad or you can hire a Live in.
Set all Dad's Bills on Automatic Bill Pay where it's taken directly from his account. Make sure your name is on all his Bank Accounts with him.
Keep him in the loop of what's going on.
Or
He stays in Assisted Living, let that be his choice.
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Daughterof1930 Sep 2021
You actually want a man this unstable to live alone?!?!? What home caregivers would stay or even sign up for his abuse?
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My mom has a similar personality type. She even called the police to go to the house she just moved from to check on my dad who has been deceased since 2013. She's quite the handful but I've been in contact with the staff to make sure that they are addressing her needs. This is week 3 for my mom and she has been engaging in the activities offered, yet she still complains and continues to call family members and friends to complain about me punishing her by putting her in this place.

Personally, I'm seeing a counselor to help me process this transition. I don't know if you are a parent yourself, but someone said that this process is much like leaving your toddler at daycare. They will fuss, fight, and cry, but ultimately, it is better for them to interact with their peers.

I haven't slept well this entire time, but each day gets a little better, followed by a few days that are bad. I do believe that it will ultimately get better overall. At least she is too busy during the day to call me. I am an only child, so I have all of the responsibilities and accusations. It's tough, but sometimes I just don't answer her calls. I know she's being watched by others, so I just have to leave it at that.

Good luck to both of us. (sigh)

Also, I got guardianship/conservatorship of my mom, so all of those money issues are over. She still complains and accuses and wants to be involved, but she can't touch her money and mess it up now. It's still hard work with all of the reporting that I have to do, but at least she can't move it (which she has done) and her bills are being paid.
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NightHeron Oct 2021
You have helped me so much with this statement: "...each day gets a little better, followed by a few days that are bad." I'm pretty new to all of this (also a guardian, also just placed my mother in her first AL), and today I really needed to hear that it gets better.
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I agree, only immediate family members should take him out, if at all. I think for now he needs to get adjusted to his new environment. With his comments, maybe better he does not go out. He may talk someone into doing something for him.

With his diagnosis you are now in charge of his finances. He can no longer make informed decisions concerning money. It is no longer what he wants, its what he needs. As his POA you can tell the AL he is not allowed out of the building on his own. The one Mom was is I think actually made the decision on who could go out and who couldn't. Its their responsibility to keep residents safe. There is usually an area set aside for people to go outside but has no outlet.
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This man has dementia and serious mental issues - nothing you say or do is going to make him stop - it will get worse. You must immediately contact an eldercare attorney to advise you how someone has to take control of him with the proper legal documents - and don't wait - and also contact social services for help. This man has dementia and must NEVER COME HOME INTO YOUR LIVING SPACE - he need to be placed in a proper place at once. And I don't think you can or should expect help from others when dealing with someone like this. He should be placed where he can be monitored and watched. YOU need to get tough and say NO - and tend to living your own life and caring for yourself.
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PhiLee: Imho, you should not be using your financials on your father's care, assuming "bill paying this past February" and "you've had to step in and pay his bills once more" was your money.
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Ok there must be some elders out there, content to roll on with life however it is - accepting slowing down, mobility & health issues with grace & fortitude?

But also fiesty, firm-willed folk, clutching on to their (perceived) independence with vice-like grip.

Well PhiLee, all I can think to say is "what can't be cured, must be ensured".

With hx of stroke, risk of dementia increases. Look up 'anosognosia' (lack of insight).

Living far from him I would consider hiring (his funds) what he needs to oversee his care. Eg a Geriatric Case Manager. If he has lost legal capacity it may include ensuring a legal Guardian is in place (not sure if POA is enough - I not legal). Maybe a Financial Manager to handle his bills too?

You really only need to be his whole world if you want to be. If not, step back from what is too burdensome.

Let him be - to adjust to his new surrounds. He will be angry. That's normal. He may call family, threaten, demand etc. They are adults - they can take it, ignore or block his calls as they see fit.
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There are professional guardians and elder care lawyers that can help an a family member manage his care or take over. It is very hard for a relative to distance themself from such behavior. I am 78, in good health for my age, failing eyesight and hearing. I worry about the future. Of course, it is very scary to become dependent on people, family or caretakers. Life is even scarier for most of the people in the world, including children, who may have had no part in causing the disasters they endure. You will be in a difficult position, most likely, as you age and decline. It seems so many posts here mention how difficult the individuals they care for have always been. If nothing seemed to make them happy then, it sure isn't going to get better as they age and decline. If others are unwilling to help with their care, they may have reasons which due to their past relationship with the patient needing the care. I say decide what is reasonable and possible, tell the parent/patient that, and stick to it. Let someone else manage in any way that improves things for you and them. Get on with your own life.
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No one should be taking him out during his adjustment period. It makes it that much more difficult for him to acclimate to his new surroundings. I'd say he needs peace, consistency, and routine right now. Let the caregivers do what they know how to do and step back for a few weeks, if need be.

Epilepsy?? That's a pretty drastic diagnosis, and with that goes some pretty strong medications. Get the doctors on the same page on his meds, because that one diagnosis has me really scratching my head.

Your job should be to get his finances locked down. Take your POA and the letters from his doctors indicating incompetency, and do what needs to be done to prevent him from giving all his money away -- or any of it.

Just deal with the money for the time being and take as much of a break from Dad as you can for a bit.
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So, after a rough 12 months you have successfully:
found a suitable placement for your father
furnished it
moved him in
been given a professional assessment of his mental condition which authorises you to manage his finances (you do also have all the appropriate legal documentation, yes?).

Well done! "To a good port hast thou rowed..."

So there actually isn't a problem. Or, rather, the only problem is that your father is making threats and accusations, none of which poses any actual risk to anybody, yes?

Assuming that this MC knows what it's about - and presumably that's why you picked it - then if any of your father's behavior becomes a problem the staff will let you know. Meanwhile I should let them get on with it. Your dad has only been there a week, and they'll need another month or two to establish a good working relationship with him. When are you planning to visit next? Is anybody else going to see him meanwhile?
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When I placed my father with vascular dementia in MC he was angry and "acted out" in ways similar to your father for about 4 months, then it began to tone down a bit, but the "acting out" behaviors never completely went away. He was always "mad" at me for placing him and selling his home BUT even Dad came to appreciate it was a good place to be (according to my cousins who Dad talked with during visits). Dad (age 85) had been at home with my Mom (aged 83) as the only 24/7 caregiver as he developed a few mobility problems to go with his mental challenges. I lived across the street and could get to their house quickly and my brother visited Dad a few hours most every day, but Dad increasingly needed help. I found an MC that had a 24/7 kitchen because Dad liked fixing a small snack in the middle of the night. Dad found he liked being able to get a pretty caregiver to bring him his snack at 3:00am. Dad found he liked being able to call for help just by pushing a button and someone always came. Dad liked sitting in a rocking chair on the facility's porch and having someone come and help him get to his feet. Eventually, Dad felt more secure and began to worry about if the money would hold out so he could stay in the MC. But he still gave me a hard time over "sticking" him in there almost every Sunday when I visited.

Hang in there. You've done the right thing by placing him in a facility where he can get the help he needs. Depending on where he is in his dementia journey he made eventually develop an appreciation for being there but don't count on it. His "acting out" behaviors will diminish some over time but they may never go away completely; you may develop a thicker skin and they will not bother you as much. Tell yourself Dad is where he needs to be getting the care he needs. If he needs to tell you how much he doesn't like being there to maintain his sense of independence, then let him talk.
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You know, its interesting - as we prepare for the inevitable transition in the near future, I've been trying to prepare my husband and his sister for this very thing. I've seen so many posts on this site about the transition period. My FIL is a severe narcissist (not just an elderly person who has become self-focused as he ages but a true always has been, always will be narcissist who just gets worse as he ages) and I've literally been talking to them about how to deal with the fall out of when we are eventually able to move him from his home to a skilled nursing facility. We are currently in that "waiting with baited breath for the inevitable emergency" where we can cry out "unsafe discharge" because FIL categorically refuses to consider that he is not safe in his own home and is currently considered competent to make those decisions for himself, so we wait.
But I think there is so much good advice here.
That transition period where they will beg and plead to anyone who will listen to take them out and back home has got to be the hardest time for everyone involved. I'm resolutely not looking forward to it and at the same time am anxiously waiting for it because I know we will be moving in the right direction finally. They DON'T want to be there. They DO want to be home. But they are in the right place. Home is not safe anymore. They need to be where they can be safe and where there is someone 24/7 that can look after their needs. More than one someone. Where the environment is set up to accommodate them. Where there are plenty of eyes. Where there is always help.
It is uncomfortable. Unfamiliar. It isn't home. But it can be. That takes time. And they are angry. Confused. Unhappy. They want to blame anyone who won't fix it for them. They don't have a lot of options. So they call anyone who will listen. And the complain and rail and blame and cajole and do whatever they can and guilt anyone they can.
And if anyone gives an inch they think they've won.
And as I sit here in my infinite wisdom having never done this before LOL...my own mantra becomes, if you give in to any of it you lose. Because you work so hard to go forward and do what is best for them and make them safe. And they make you feel like you ruined their lives. And if you give in when you've come so far and you bring them back home, you lose and worse they lose because they are no longer safe and you are no longer safe and no one wins.
So I keep telling myself - all of it, all of the complaining, and guilt tripping and threats and anger and badgering from well meaning family who have not dealt with what we have for the last 5 years will all be worth it because he will be safe and well cared for. Plus...he is already unhappy and miserable at home anyway. He'll just miserable and unhappy somewhere else now!
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Smile1 Oct 2021
I’ve been there and you are right on target
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consider getting his medical chart & review the many medications he has been put on.
You will find that the side effects of the medication given for both and dementia & seizure disorders match to the aggression, hallucinations and disorientation you describe
Additionally review the side effects of morphine and other narcotics in the same drug class usually given after surgery for pain management. Know as narcotic psychosis. I am sure this accounts for delirium post surgery.
Particularly as he had no previous history
In the elderly poly medicines lead to toxic levels in the blood in the majority of cases...due to reduced elimination with aging. Also due to lack of movement/exercises the drugs accumulate in the system
In summary the elderly persons mind becomes confused and disoriented due to the build up of highly toxic medications in the system
You can google medical studies on this situation
You might consider speaking with his case doctor after you have reviewed the above.
I would recommend that you strongly request the dr to reduce medications he is on to an absolute minimum. His health physical & mental will improve.
With all due respect narcissism is a spectrum, not a condition. Most men who are strong & capable I find fit on this spectrum. Some higher on the spectrum than others.
Perhaps he is self centered & 'playing the victim'. However he may also be trying to communicate the frustration and fear he is experiencing that his life is now completely out of his own control

Having less medications in his system will allow him to think more clearly & recover his balance.
This would defiantly be a major step in the right direction.
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Daughterof1930 Oct 2021
Can you share these medical studies with us?
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