Will your brothers and sisters help care for your parents?

sibling-hands Sometimes, sibling rivalry never really goes away, it just goes underground. And when it resurfaces in adulthood over the care of aging parents, the stakes are much higher than who has the best report card or plays with the favourite toy.

Friends and relatives provide an annual $522 billion in informal care for elderly Americans, according to a study released Monday by the Rand Corp. Often, adult siblings at least nominally split the care of aging parents.

Occasionally, a shared-care arrangement proceeds smoothly. More often, experts say, it doesn’t. “This is a serious, serious problem that is under the radar,” said Jeanne Safer, a psychotherapist who specializes in adult sibling rivalry and the author of “Cain’s Legacy: Liberating Siblings from a Lifetime of Rage, Shame, Secrecy and Regret.”

As with other aspects of sibling rivalry, proactive moves by parents today can help mitigate future discord. Parents can help by clearly communicating their wishes about where and how they would like to live in older age, any end-of-life medical treatments they want or refuse, and their funeral or other memorial preferences. This will leave their children less room to disagree when the time comes.

Another way parents can help is through careful consideration of whom to name as agents under power of attorney. A financial agent will make financial transactions on behalf of a person who can no longer act for himself, while a medical agent will make medical decisions.

Avoid naming co-agents who must agree before they can act, many experts agree. That can be a recipe for discord and paralysis. Instead, parents can name a primary agent and a secondary agent to act if the primary is no longer able to fulfill her duties.

Parents should also consider practicalities. Generally, the child providing the hands-on care should have access to funds, expert say. If parents name their geographically distant daughter the agent with financial power of attorney since she works for a bank, they’re complicating matters for the local daughter who tends to their daily needs.

Yet even with the best-laid plans, some degree of disagreement is inevitable when it comes to caring for aging parents (and, of course, parents may not have the foresight or the opportunity to make those plans). It’s difficult to watch a parent grow old and frail. The stress can be compounded when siblings unconsciously fall back into their childhood roles.

Here are some ways adult children can address conflict.

Talk early and often
There’s a general perception that caregiving responsibilities should be split equally among siblings, said Jody Gastfriend, vice president of senior care for care.com, which provides workplace solutions for pet, child and elder care. Yet it’s nearly impossible to split duties 50/50, or 25/25/25/25 for that matter, and a perfectly equitable burden should not necessarily be the goal, she said.

While the division needn’t be even, it should be as deliberate as possible, experts advise. Too often, adult children fall into their various caregiving roles by default, and that can lead to resentment and burnout.

Instead, siblings should talk early—ideally, before the need arises—about the duties each is willing and able to take on. It’s best, if possible, for the duties to play to each person’s individual strengths and interests.

If one sibling takes on a disproportionate share of the hands-on care, the others can make sure the primary caregiver is supported. Some ways to do this include coordinating respite care to give the person a break and handling tasks that can be done remotely, such as online bill paying and communicating with the insurance company.

Many siblings also band together and pay the primary caregiver, which can supplement lost wages and affirm the person’s effort on the family’s behalf. Consult an elder law attorney and an accountant over the tax and other considerations of paying a family member.

Expect parental resistance
To the extent possible, adult children should present a united front when discussing sensitive matters with their older parents, experts say. For example, it’s best if all agree that it’s time for mom to stop managing her finances and decide together on the best way to broach the topic with her.

Agreement among siblings will make it easier to handle their parents’ likely objections. No one likes to think about losing independence, and “resistance is normal,” Gastfriend said.

Instead of expecting a parent to agree to a new plan on the spot, think of that first talk as a way of planting a seed that could grow into acceptance over a series of conversations, said Gastfriend. Avoiding orders like “you have to stop writing checks” will help your message be more positively received, she noted.

While parents should be consulted on matters of their care, children may have to circumvent those who are resisting help and are at risk of hurting themselves or others, Safer said. She knew of a situation where an older man had poor vision and dementia, yet he and one son insisted he was capable of driving. The other brother acted unilaterally to take his father’s license away, and in the process found out that the license had expired 10 years earlier.

Stay focused
It can be hard for siblings with a long history to stay focused on their parents’ needs. It’s all too easy for discussions to get derailed by old, unrelated baggage.

It helps to set some ground rules before any group conference calls or meetings to discuss a parent’s care, said Amy Wachholtz, director of health psychology and assistant professor of psychiatry at the University of Massachusetts Medical School. Set an agenda and distribute it beforehand. “Until you define the problem, it’s hard to come up with a solution,” Gastfriend said. One way to help keep people on track during the discussion is to allow all participants to interrupt and say “off topic” when someone strays from the issue at hand, Wachholtz said.

One sibling acting as the designated scribe can send out a follow-up email after the call, with a summary of the points discussed, agreements reached, and items to act on for each.

Engage a third party
Siblings often disagree over what the parent needs. Those who reach an impasse may consider engaging a third party to help. Geriatric-care managers, for example, can provide an objective assessment of an older person’s situation and help address the resources available to meet them.

Care managers can also smooth relations between siblings, Gastfriend said. When siblings have very different perceptions of a parent’s needs, the care manager might reassure them that it’s not a matter of one being right and the other wrong: many older people have good days and bad days, and certain strengths despite their declining functioning.

Psychologists can also help siblings who have trouble communicating. Safer often recommends that siblings write letters to one another—not a hastily written email, but a real letter. “If you put it in writing, you get the person’s attention,” she said.

Adult children often engage in “pre-emptive grief” when they see their parents decline, Safer said. When siblings process this grief differently, it can lead to disagreement. Sometimes, just recognizing this as an issue can help siblings understand one another better.


Posted in Caring for Mom & Dad, General Information, Psyche, Your Health

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