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83 year old mother in rehab after breaking her hip. She has dementia and narcissistic personality disorder. Hates my dad and hates my sister. My dad is 88 in bad health so can’t visit and my sister is refusing as mom has told her she wished she was dead etc. She has always been jealous of my sister who is extremely close to my Dad and has favored me as the youngest. She cries nonstop, is fearful, paranoid, delusional and has never been honest. I just need advice on how to handle her. Trying to validate her feelings without agreeing with her is a difficult line to follow. I am empathetic with her but angry at the same time. I’m trying to be a good sister as well as a good daughter . Any advice?

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"She cries nonstop, is fearful, paranoid, delusional and has never been honest."
"Hates my Dad and hates my sister."

You could ask her Primary Doctor to get her calming meds, or see a geriatic psychiatrist...probably 70 years too late at this point.

You don't need to visit her or "validate her feelings." Stay away from hateful people. You don't get that time you wasted back.
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You are not required to visit her. Let rehab deal with her.
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You do need to tell the Social Worker that its an "unsafe discharge" to send her home. Dad at 88 can notcare for her. Time to make the decision to place her in LTC on Medicaid if Dad does not have the money. He needs to see an Elder Lawyer to split assets. Moms split going to her care and when almost gone, Medicaid is applied for. At that point Dad remains in his home, has a car and enough or all of their monthly income to live on. With a married couple things aren't cut and dry.
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A11iek Jan 30, 2025
Thank you so much for your advice!
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Petitioning for emergency temporary guardianship is a step you could take, so you can get her in a facility that is equipped and qualified to care for her with these behaviors. The courthouse is where you would go to do that. While the emergency temporary order is in place, you will be able to place her in a memory care secure unit. While the order is in place, the judges will send out 3 qualified evaluators to evaluate mom. They are going to determine if she is able to make sound and safe decisions for herself and her medical care and finances. They’ll either deem her of sound mind and decisions, or they will deem her incapacitated or incompetent. If deemed the latter, the temporary guardianship will transfer into most likely plenary guardianship (guardianship over person and property)

when you go to petition be ready to address a list of concerns- frequent falls, making decisions that could cause harm to herself or self neglect (like refusing medications, doesn’t bathe regularly, any memory problems, delusions, hallucinations, paranoia, suicidal ideations, physically and/or verbally/emotionally abusive, if her husband isnt physically and emotionally capable of caring for her- any health problems he may have acquired from her behavior, if she has a history of refusing doctors appointments. If this broken hip she has is a result of a fall, definitely include that)

even though mom has always treated you guys so terribly for so long, getting her qualified help is the right thing to do. If not for her, but for the rest of your family and yourself.

if you’re blessed with enough finances to hire a good elder law attorney, that’s going to be the best way to petition. And if mom has money saved up, it’s actually required that her funds pay for the attorney and court costs once guardianship is granted. And her funds will be used to pay for the memory care or nursing facility she goes to (unless mom was smart and has longterm care insurance) so really you’d have to come up with the initial lawyers fees at first and once guardianship is granted, you don’t pay anymore, mom will be paying. I really hope your situation gets better. This is tough. BUT, it will end one day I promise!
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A11iek Jan 30, 2025
Thank you so much for your advice. This has been by far the most helpful I’ve received. This entire forum has been one of the best things I could’ve done to get quick and solid answers! Again thank you and everyone else for your responses!
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Boundaries, boundaries, and more boundaries. My mother in law is EXACTLY like this- and because of the delusions and paranoia it gets pretty unbearable. There is a lot of abuse she put my husband and sister in law through while they were growing up. She is especially mean to my sister in law- telling her to die- even saying she isn’t her daughter, attacking her about her weight…. (For some reason she is not like that with me and I’m able to keep her “calm” or she has good behavior while I’m present) My sister in law has been able to create healthy boundaries with my husbands and my support. She doesn’t visit her every day anymore, but will visit when she knows she is mentally capable of tolerating mom’s behaviors that day. If mom becomes abusive or mean while she visits, she ends the visit. When it comes to needing to take mom to an appointment, if my sister in law needs to take her (she’s moms guardian) then we try to schedule it for when I can go too as a buffer. Or if mom is in major behavioral issue period, my sister in law will avoid going or taking her at all. My sister in law has come to some acceptance with a lot of it, but of course she still does become hurt but it’s impossible not to. My sister in law now knows what she can and will tolerate, and what she absolutely will not tolerate. She still feels bad if she has to avoid mom, but really she has to take care of herself first.

so maybe creating a visit schedule that works for YOU could help. Leave when she starts being nasty, and if you are not mentally and emotionally equipped to go see her on your normal visit day, skip going that day. It’s totally okay to do that!

never feel guilty for missed visits. Mom will be okay I promise. Sometimes probably won’t remember you hadn’t come, or even if you had come. Mom has lived her whole entire life- you still have the rest of yours to live and you need to put yourself first! You deserve to put yourself first! Good luck, I hope you find your peace in all this. It is possible
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Reply to JooFroo
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Is anyone POA or can your dad make the decision to place her in MC?
He needs her placed where she can be cared for so he can take care of himself.
Your mom also needs medication for the anger, anxiety, delusions....
If you, or your dad can talk to the rehab facility and have the doctor prescribe or have her PCP prescribe that might help.
No one needs a toxic person making their life miserable.
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JooFroo Jan 30, 2025
I just wanted to add to this comment- where we live (Florida) POA does not have the power to choose where someone lives. The only way to do that here is to petition for plenary guardianship (full guardianship over person AND property) I don’t know if it is this way in other states as well or not. POA here can have power over finances and/or healthcare surrogate. I would double check this for where you live
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Consider using POA to move her from rehab to memory care, minus any discussion with her. She needs medication to calm her extreme behaviors, this would be a gift to her. She doesn’t need unreasonable or cruel feelings to be validated. Limit your exposure to her anger, it’s poison to your well being
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If you let yourself into a narc’s life, they will drown you. Tread carefully and it’s ok to walk away and let the state handle her.
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BlueEyedGirl94 Jan 30, 2025
Amen and Amen!
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Why would you have empathy with this unless it is a manifestation of her dementia?
She sounds in quite bad shape. I would see to it that she is assessed mentally for depression and for an update on her dementia.

If this is the illness speaking then one must feel very sorry for her indeed, and must attempt to get her medical help and medications to calm her.
If she has ALWAYS been this way, I can't imagine how you would think there was anything that you could possibly do. Has there EVER been anything that ANYONE could ever do about her?

So, for whatever reason you have a quite out of control person in in-facility care who requires assessment and medication from the medical community. Until that is accomplished I would keep visits VERY short and infrequent. Your visits seem not to calm, but only to cause more agitation? If so, why would you do it with any frequency.

Best out to you. Difficult for us to assess your mom and whether this is illness or personality. You would be by far the better judge of all that. One requires medical help; the other requires avoidance.
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She definitely needs medication ASAP for the fear, paranoia, and delusion. Have the rehab facility get a specialist in immediately to address those. No one should have to live in that mindset. It won't take away her dementia or narcissism but she can be calmed down from the fears.

What is the plan for her post-rehab? Will she be going home to your father who is in bad health and who she hates? That does not sound feasible for either of them. Your family should be considering facility placement for her safety and your dad's.

As for the NPD and dishonesty, that's up to you to decide how much of it you can tolerate. Don't sacrifice your mental health or physical health.
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What horrible words to say to your own child.

I've dealt with plenty of old narcissists as a paid caregiver, and they are the worst of the worst. These people are in a protected class, and they are horrible towards caregivers and certain family members.

Best to leave these types to the facilities to care for.

They will eventually end up turning on their golden children.

Keep your distance.

I agree with everyone here.
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BlueEyedGirl94 Jan 30, 2025
True narcs are evil in my humble opinion. And quite a study in contradiction - they literally cannot control how their brains work - it is a genuine personality disorder - but at the same time they KNOW that their behavior is unacceptable because a narc will be the FIRST to call out another narc for their behavior (but not for altruistic reasons - usually because they want to be top dog and are jealous that someone else is getting attention)

And the things they say. I should have washed my hands of my FIL right after MIL passed away- but I attributed his behavior to grief. I know now that he didn't feel grief for MIL's passing - he felt grief for losing his narcissistic supply

I can remember sitting with him at the funeral home - planning her funeral. He was telling the director about where we were going to bury her (her family had a set of plots at their family church).

Between my SIL who is the oldest, and my DH who is the youngest, my MIL had a stillborn baby boy. He is buried next to MIL on one side. FIL was supposed to be buried on the other. From what I understand, my in-laws only intended to have two children. (that MIL could bring herself to let my FIL touch her is a miracle to me, but I digress).

My DH is sitting next to FIL at this oval table, I'm next to him but sort of off set so I can see his face. FIL says "we lost a baby boy, he's buried next to my where my wife will be buried. But look what I got STUCK with" and he jerks his thumb at my DH.

My DH's face (he swears today he doesn't even remember it, he's totally blocked it out) broke my heart. The funeral director literally started coughing and said he needed to get a water. I immediately excused myself from the table and ran to the bathroom because I felt sick. I had to call my mom to talk me down and as I said, at the time, I felt like he just made an a-hole comment because he was grieving because what kind of father says that about his child???

But I think that was the beginning of the end for me. I was laser focused on how he treated my DH and his sister after that -something we had managed to avoid when MIL was alive because she used a lot of redirection and misdirection to manage him.

The more I learned about NPD and watched his behavior, the more I wanted to avoid him. I made sure our kids never had to deal with him. And unlike other people who seemed to think "that's just who he is" I could no longer stomach it and didn't tolerate it.

My FIL had a love hate relationship with me. He needed me. He hated that he needed the help of a woman. He didn't value his son or daughter. We were all there to make sure his needs were met. I avoided him as much as possible and only helped him for my DH.

There are still days that DH will say something self-deprecating or even self-loathing and I want to bring FIL back from the dead just to smack him - that's a VERY violent reaction for me - I'm a non-confrontational person at heart. There has only ever been one person that I believed I was close to hating - and that was my FIL.
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You mention NPD, which sends off all kinds of red flags to me. My FIL had NPD and dementia only made it exponentially worse.

Honestly - even when someone get older and becomes more of the "protected" group of people, if they have NPD, you would be better off following the protocols for dealing with a narcissist. In other words, limit visits, be non-committal and change the subject if they go down a path you don't want to deal with.

In my experience with FIL his NPD just got more convoluted and dangerous as the dementia progressed. The lies that he could come up with would make your hair stand on end. And NO ONE was safe from his lies. Even if we managed to get into his good graces, it was only temporary and we would be on his hit list again.

Remember, someone with NPD doesn't see YOU as an individual. And a narcissistic parent sees you as an extension of themselves and sees you only for what you can do for them. They will use manipulation, triangulation and out and out lies to get you ensure their needs are met. And that's WITHOUT dementia.

You can't reason with someone with NPD. And you can't reason with someone with dementia.

Your mother "favored" you - which makes you in all likelihood the "golden child" and your sister the "scapegoat".

You can't validate a narcissist unless you agree with them, support them blindly and ensure that anyone who DOESN'T is removed from their lives.

"She cries nonstop, is fearful, paranoid, delusional and has never been honest. " - this could be dementia or narcissism or both. But I agree with Barb, I would explore the idea of medication.

The only peace we EVER had in our lives with FIL was when he was medicated.

Frankly, as sad as this sounds...your mom not seeing your father or your sister puts them in a better position than you who continue to stay in her good graces and visit. Tread carefully, when narcs eliminate the rest of the circle, they turn on whomever is left no matter how much they do right.

We had to establish a titanium united front to deal with my FIL.
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Scampie1 Jan 29, 2025
Well said Blue-eyed girl 94.
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She needs a psychiatrist, pronto. Meds may help.

SHE doesn't get to bos you around and insist you visit. Visit when you want to and leave when she starts with the drama.
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I would speak with the doctor about medication.

Did she wish your sister dead after dementia set in? If before, I don't think I would be around her but, that's my boundary, I don't play with people that are hateful enough to wish their children dead.
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