Capacitous, but not able to get necessary things done

[roundaboutthehillsareshining]

Any advice or even just handholding welcome. I have an elderly relative (mid-70's) who has struggled with mental illhealth (probably BPD) for most of their life, but was "protected" from services or support by their family due to stigma. They are now living alone, and it's clear they aren't coping. There's no medical concern for memory, and no deterioration in medical mental state or cognition.

The house needs work, they have a (self-constructed) complex financial situation (exacerbated by the MH issues) which requires extensive ongoing input which they cannot maintain indepently and regularly results in them completely running out of money - blocked bank cards, empty instant access accounts, money tied up in inaccessible investments, etc. They are definitely capacitous - they are able to describe all the steps they need to do to solve the lifestyle problems they're having, but are just completely unable to execute them. So they can explain in detail to a social worker how they'll go about finding, booking and paying for an electrician (for example) but won't do it. Then they'll concoct wild stories about how the work has been done, when it obviously hasn't been.

They are extremely hostile to any form of help and support, and older adults MH will not see them as they don't deal with functional mental illness post 65. They had a care plan in place for a while, but this was discontinued when they were abusive to the carers, refused to fill out the financial assessment or make any payments. They also refuse to undertake a benefits assessment or claim any support of that nature.

As they are capacitous, paranoid and hostile, POA is definitely off the table.

Is it just a case of stepping back and letting the inevitable disasters happen?

That sounds very difficult.

Would you be able to go to their place and "watch" them while they sort something out?

Maybe with the promise of going out for a cup of tea afterwards?

Sounds silly but it's a reward to them for doing this.

"I'll come over on Tuesday and we can do a boring bit of admin then we can go out for tea".

I don't think there's anything you can do, sadly. Yes, step back and let the crash happen, particularly if there's no poa. If they are deemed capable then there will be little you are able to do

I know of a not dissimilar situation. An older friend's brother, who came to live with him during COVID, but eventually was booted back to his own house because he was difficult to live with. House didn't have working heating. He could have sorted that. Didn't. Grew frailer and ended up in a care home. Died there.

Society decided it didn't want to go to extraordinary lengths to help people who don't want to be helped. I think if there was treatment which worked well, it would be different - but right now there isn't.

If they can talk through all the steps but not actually excute the things they say they are going to do because they lack the functional or executive ability to do so then they possibly don't actually have capacity.

Any social workers assessing capacity around finances etc should be considering the person's executive functioning as part of the assessment.