Eldercare can be challenging enough. Add to it disagreements between family members and the stress goes up exponentially. As one person put it, "Of course your family knows how to push your buttons. They are the ones who sewed them on!" Siblings, in particular, can find themselves at odds when there's a health crisis in the family. Following are common situations and suggested approaches for resolution:
- The primary caregiver does everything. In most families, there is one child who takes on the lion's share of the responsibility. The eldest daughter often falls into this role. But sometimes it's the child who is geographically closest or emotionally closer. Nearly half of family caregivers feel they had no choice in the matter. It was just assumed they would take on the tasks. That's a recipe for resentment, stress, and depression. Statistically, the average caregiver is already employed and puts in an additional ten hours of help a week. This is the median figure, but the range is from one hour to forty or more hours. (Typically, the older the care receiver, the greater the number of hours.) Four out of ten primary caregivers describe their caregiving situation as highly stressful emotionally. Another 28% consider it moderately stressful. One out of five caregivers reports experiencing worsening health due to their caregiving responsibilities. (Those with the highest stress and the worst health report feeling very alone with their caregiving duties.) There is also a financial impact. According to AARP, primary caregivers spend an average of $7,000 per year out of their own pocket to cover expenses for the person they care for. Thirty-two percent say caregiving has eroded their savings. As a rule, primary caregivers tend to be very conscientious. They take the responsibility very seriously. Rightly so. But they can also become perfectionists and inadvertently discourage participation by others who may not perform to the exacting standards of the primary. If you are the primary, ask yourself whether the perfect may be getting in the way of the good. Everyone has different strengths and something to contribute. You don't want to burn out. Consider allowing others to participate and to do so in their own way. It will be good for your loved one to receive help from multiple sources. All of that said, it could be that other members of your family simply don't understand everything that is involved. Calling a family meeting with a professional facilitator, such as an eldercare consultant, can help identify all the tasks and create a plan that shares them more equitably.
- Family members are shut out of sharing the care. Those who are not the "primary" frequently want to help, but geography, stage of family life, such as having young children, or a demanding career may make it difficult. Many report trying to step in to do something, only to meet with the frustration and perfectionism of the primary caregiver. If you live far away, look for tasks you can do from afar, such as handle the finances. Or use your vacation time to come care for your parents so the primary can get an extended break. Perhaps you can pitch in financially to hire respite care or transportation services for errands. Consult with an eldercare consultant to identify needed tasks so the primary doesn't have to do everything. Maybe you can do something unrelated to parent care that will lift the load for the primary (tutor their child in math or Spanish, for instance). If nothing else, you can be regularly generous with your appreciation—lots of thank-yous! And your time if the primary needs to vent or brainstorm on solutions. (It can get lonely making caregiving decisions all by yourself.) A facilitated family meeting can help you connect with your parents and support them—and your sibling—in ways that make sense, given your skills and availability.
- Disagreement about how bad things are. It's not uncommon for the primary caregiver to have concerns about problems the other siblings, especially those who live far away, just don't think are an issue. The truth is, Mom and Dad are very good at putting on a good face, especially when it's just a phone call or Zoom. It may not even be conscious. But the person on ground zero who sees them at different times of day and not necessarily by appointment will have a very different picture. To get a more objective sense of what's going on, consult with an eldercare consultant. An eldercare consultant can come in and spend several hours with your relative over multiple friendly visits. The goal is to understand your loved one's strengths and weaknesses. They will provide an assessment of everything from driving ability to memory issues, risk of falling to social isolation, medication management to follow-through with doctor's orders. You can then receive a report from an expert on aging about what your relative is handling well and areas where they need more support. Save yourselves the headache of arguments. Get the opinion of an eldercare professional.
- Disagreement about the best course of action. After an assessment, the eldercare consultant can also give you a suggested care plan. It will describe what makes sense now, with an eye to what will likely be needed within the next six months. Considering your relative's resources, aging in place might be a safe option. They may do well enough with an automated medication dispenser and someone who comes in to make meals, help with showers, and drive them to run errands. Alternatively, the person you care for may have moderate dementia and no longer be able to live alone. They may need the extra support of an assisted living or memory care community. The eldercare consultant can make recommendations for the best providers in the area, given family needs and budget. The family can implement the plan or hire the eldercare consultant to do the follow-up, potentially with ongoing oversight.
- Conflict about money. Unfortunately, money matters often become an issue with eldercare. Mom or Dad may need support services that will require some extra funds from the children. Or there may be one adult child who has always been financially supported by the parents, and now that money is needed for the parent's own care. In some families, the parents have enough money. But some siblings may be hesitant to spend it because they have been relying upon an inheritance. Whatever the issues, financial factors should be brought into the open and discussed realistically. Again, an eldercare consultant can address this as part of the assessment and plan and make suggestions for the best interest of the older adult.
- What to do about life support. These are the final decisions that adult children often need to make. It's difficult to let a parent go. One sibling may want to do everything possible to try to keep their parent alive. Another may feel it's just prolonging the inevitable, and if there's pain involved, prolonging suffering. If there is an advance directive with a living will describing a preferred approach, it will help immensely. In that document, a "healthcare agent" is probably named who will make decisions on your parent's behalf. If so, it's best to honor your parent's wishes and support the decision maker in following those requests to the best of their ability. If there is dissention between siblings, an eldercare consultant can help. So can a social worker at the hospital or through hospice or a palliative care program. If your relative is still able to make decisions but has not created an advance directive, work with an attorney now to get that in place. It's important.
Are difficult family dynamics adding to your stress?
