WTF do I do here??

[MrsRussell]

So my DM is the town drunk. Been in and out of rehab, in and out of hospital, everybody knows that she's an addict, so that. She's 81.

Current binge is reaching the end of its cycle, which is normally the point at which I get delusional paranoid phone calls saying "my legs have gone" and asking me to come down and deal with her incontinence pads etc again.
Anyway, she has three sets of keys to her flat, and she's got all of them in the flat with her. She has a safe keybox outside, but there's no keys in it. She walked up to my house on Friday saying she'd got locked out and I gave her my own set of keys. I can't get into her house.

Because she's still drinking, we're coming to the endgame - some point in the next week she will start vomiting blood or lose the ability to walk (sorry if TMI) and she's going to need an ambulance.

I can't get in. They won't be able to get in. She's too drunk to give the keys to one of the other people in the flats - she says she expects me to come down and ring everybody's doorbells till someone else lets me in, which is...not likely - and I'm all out of alternatives.

Nobody is going to be able to get in, without breaking in the front door. Not me, not the police, not the ambulance, not her key worker. And I'm out of ideas....

I work as a nurse and although it’s been a while since I worked on the wards the story is the same. Patient refuses care or carers or input. They have capacity at the time they are assessed (would your mother have capacity once she has withdrawn from alcohol, or when she is at usual intake rather than binge?) If a patient has capacity they can make bad decisions. You are allowed to refuse treatment/self discharge/ do whatever if you have capacity. We would discharge these people. They would fall/call an ambulance etc and the cycle would begin again. Maybe one time they would agree to carers. The carers would turn up and the patient would send them away and cancel them. They would refuse placement or rehab. They would bounce back to hospital over and over, blocking a bed but taking no responsibility for their situation.
I really, really feel for you. The hospital can’t sort the problem because your mother doesn’t want to change or have the help offered by social services- she wants everything her way when she wants it. Why would she not accept a nursing home-is it because they wouldn’t let her drink as much as she does now?
Unfortunately unless she looses capacity or gets evicted from her flat the situation is unlikely to change. Tbh at the minute community care is so short staffed even if she accepted carers it would be weeks before a package could be set up. It’s a shit situation. She should not being putting this on you. I am sorry

I haven’t got anything constructive to say other than to agree with what has already been said by the other posters.. but I just wanted to say you are strong and to make sure you keep being kind to yourself.

My mum is an alcoholic too (although she’s actually stopped drinking now, but for many years it was just horrendous and honestly I felt like I had lost my mum altogether and felt more like her carer) and it’s just shit. I’m so sorry you’re having to deal with this and the emotional and psychological impact on you must be at an all time high. Your mum absolutely shouldn’t be putting you through this but unfortunately this is the reality of addiction and it’s horrendous. Do you have any other relatives that can support/share this? It’s a lot to carry on your own.

I was thinking the same as P.P about a care home
Or getting her into something like that, at least then she wouldn’t be a law unto herself and it would be monitored in a care setting and actually might help to get her better as she wouldn’t have free rein like she does now. Unfortunately if she’s got capacity it’s so difficult to get that sorted. Anyway..probably not helped much but just wanted to say you are doing so well in a really crap situation.

No advice except to say I think you are doing the right thing by disengaging and prioritising yourself and your family. I'm so sorry that you are going through this I've had a tiny insight into your world through the alcoholic in my family although absolutely nothing compared to your experience.

Thanks all. There is such a lot of kindness in the world, isn't there?

So the thing, as @AluckyEllie said, she's an alcoholic and that does mean she can dip in and out of capacity. My argument though is that her behaviour is not the behaviour of a mentally well person - not the drinking, but the other stuff, the hoarding and the self-harm and the paranoia and the delusions, which are continual, even when she's sober - eg that my dad was a murderer and that her next door neighbour is a paedophile. She's not in any way a stupid woman - she's a damaged one and mentally unwell - and she's perfectly functional on the level of who the Prime MInister is and what year it is. But the thing with the vomiting blood - and why she's massively unlikely to get as far as having a consultant - she'd been drinking, she wanted to manipulate a situation where I came to her rescue (classic co-dependency stuff) and it didn't play out how she wanted, so she got herself hospitalised. Most people will just ring up and say this has happened or that's happened, I need an ambulance, blah blah. She was actually physically seen by medical professionals at about 3 and assessed as pretty much fine. Gone from sitting up in a clean bed, drinking water and eating biscuits and keeping it down, to vomiting blood in the space of a couple of hours. Really? Really really? Without some serious self harm effort?

I would love her to be in some sort of sheltered accomodation, but she doesn't want to go.....

Munchausen’s Syndrome, that’s what I was thinking of - deliberately harming yourself to get medical attention.

Sorry you are going through this.

My situation with my mother was sort of the same, and I’d endorse pretty much all the advice you have been given on here.

But I can add two things that might just help you in terms of understanding the situation. Alcoholism can cause brain deterioration v much like fronto-temporal dementia which may account for some of her behaviour, in particular the loss of inhibition which is v typical.

Also, look up Diogenes Syndrome. It’s not a name used that much these days - although I personally prefer it to Senile Squalor Syndrome- but it basically describes difficult and stubborn people who have ceased to give a fuck but still have capacity. Which was also my mother.

Happy to talk about any of this as I know that it’s almost impossible to do that in real life

@MrsRussell This sounds exactly like the last crisis with keys on top.

As @AluckyEllie said so well, if they accept no responsibilty for their actions then nothing will change and the cycle will begin again. It must be bad enough for you living through it once without knowing that it will come around again.

Yup yup, @Knotaknitter.
One of her previous key workers - the one who was apparently a predatory lesbian, not the one who was trying to groom her for money - said to me "the more you disassociate yourself from her, the angrier she gets" and you can see that playing out. The whole intention of this behaviour is that I should be made responsible for her - that the authorities should force me to care for her.

And obviously they can't, but the thing that really scares me is that it's escalating, this bollix with the keys could have ended really badly. It's like "See what I can do to myself if you don't look after me!" and that's the thing I'm worried about, not that I'll have to step in (I won't) but that it's not the reasoning of a mentally healthy person to actively act out those threats.

She's becoming dangerous, both to herself (her choice) but to other people, and nobody seems to want to engage with what I keep telling them about that. Whether it's alcohol related dementia, an underlying personality disorder (also suggested) or what...

Not the same by a long way but my gran was old and vulnerable and lived alone. She kept having falls and being admitted to hospital and then released home where my mum had to care for her full time until she was stable again. Mum's mental health was shot to shit with the stress.

The last time she fell, mum said she couldn't do it anymore and they would have to find her a care home. SS basically said she didn't meet the criteria and unless my mum found a home for her by X date, she would be discharged into mum's care. Fortunately, my mum found a home, but it was an incredibly stressful time. They didn't give a shit.

I really feel for you OP, this is a nightmare. Social workers tell a pack of lies to get the patient out of hospital so not their problem. The only way to force them to do anything for your mother is to withdraw all your support. Easier said than done I know xx

@MrsRussell
Sounds like you DM's obsessive behaviour to get you to care for her has overtaken everything in her world. Undoubtedly the cocktail of alcohol and potential dementia and personality disorder is only on a rapid downward trajectory.

You don't need to answer this but I don't quite understand. Can you quantify what makes you scared?
Is it that you are scared she will kill herself, perhaps not intentionally, before she moves into full time care and that you will feel guilty that you haven't done enough to have her needs treated?

@Mum5net no, I won't feel guilty about her at all.

What I'm more worried about is that she has the capacity to do other people harm. She's had at least one member of staff involved in her care actively suspended for financially abusing her (turns out mum insisted on buying her a pot of yoghurt) she's made allegations of sexual and professional misconduct on a number of occasions about people working with her. I work in a similar field. I've seen people suspended for similar (false) allegations, I've sat through Serious Case Review investigations. They are horrible, traumatic things. I've known people's mental health permanently affected by the worry of an investigation like this, not because they've done anything wrong but because they start to doubt their own professional judgment.

What she does to herself, is her own business. It's the impact it has on other people - whoever finds her dead in her flat, for instance: the letting agent rang me a few months ago in an absolute panic because there was blood all over the walls and the bed when they came to do an inspection while mum was in hospital, thinking - literally thinking - there had been a murder. Mum's attitude was "well there hadn't, what was she worried about?" but it doesn't stop that poor woman from having gone into a flat to do what she thought was a routine lettings inspection and finding herself on the set of "CSI".

Does that make sense?

Is she under the mental health team, if she is a danger to others she should not be living alone and putting herself and others at risk. I would contact the safeguarding team and her landlord, if the flat is a health and ssfety risk then I wonder if they can evict her which could lead to her being in more secure accommodation.

Is she buggery, Paws. She refuses to engage with them.
She's referred in to the safeguarding team every time she's hospitalised and they reject the referral because she has capacity.

I think I may have finally got it into someone's head that "danger to others" doesn't have to mean "physically attacking people", it can mean exposure to trauma.

That makes, total sense; I couldn't square in my head that you would be, but, I didn't want to assume.
So, I get it fully now. You want her to choose a route where she does least collateral damage. But as she is so hard wired to put her needs first, and doesn't give a , she won't choose any route or be co-operative, it will just be drama llama misery fest all the way...
I have seen a 90 year old resident being weaned off alcohol in my DM's care home. [She was taking taxis twice a day to buy champagne
to her local Asda and had no family.] However, your DM's case would need a much tougher response.

No ideas to contribute but in your camp...

Wow, was your mum like this growing up?
You seem very aware of her behaviors and its refreshing as my DHs mum is narcissistic and he gets in a spiral with how she behaves. Right now he seems to be in a 2 week depression from something that his mum has done.

I've been the sw for someone with so called Diogenes syndrome, I've never seen such squalor. He technically had mental capacity, in the end it was only housing law we were able to use to get him out of his flat as council evicted him. Mice, shit, maggots. Got him in a care home but they then wanted him out too.

@NecklessMumster I had to laugh last time they discharged her - she's only in now because the place is insanitary, she's one of those bed-blockers, so hopefully she will shortly get a consultant and all the things simply by process of attrition - an ambulance had to bring her home cos I refused (as usual) brought her up the stairs and said "we can't leave her here! there's a rat infestation!"

There was no such thing (unless rats can a) chew through a fire door and b) have very low standards of living - she's upstairs) It was a mother infestation.

In all seriousness though, she doesn't choose to do this to be an arsehole. She's mentally ill and an alcohol addiction doesn't help. She does choose to refuse help, and that is her responsibility, but she's not a dreadful bad person.

No I know. I also worked with a man with alcohol addiction who lived in very poor conditions, he was lovely when sober (rare) but his supported living wanted him out due to the mess, no care home would take him unless he stopped drinking even specialiat ones and hospital let him discharge himself every time. You have my every sympathy, I also have a close family member with alcohol issues. It's that tension between human rights and duty of care.

I know you know (...you know!) - I just thought reading back over the thread, there's a lot of me kvetching about how dreadfully she's behaving but not a lot of me saying to people who don't know her, that she's not awful.

I didn't think on reflection, that that was fair of me.

She is in a safe place now and its good that the crew didnt leave her there. Social services and the landlord will need to arrange an inspection and deep clean. Hopefully the hospital will get her assessed by all the right people and moveher into more suitable accommodation and she agrees with the plans. She is mentally and physically unwell and getting angry with her is understandable but you need to step back for both your sakes.

I think the only thing you can do is take a massive step back. Tell them to stop calling you as you will be doing no further care for her if that’s what you want.

She’s not going to change and you are allowed to protect yourself from her behaviour.