Dealing with Family

Sibling rivalry revisited

It used to be that you squabbled over whose turn it was to clean the dishes or rake the leaves. Now you are mature adults negotiating the care of your aging parents. But it may feel just like old times. All the old rivalries are revived as if they’d been frozen in time.

Why now?

As author Francine Russo points out in They’re Your Parents, Too!, what’s happening is that we hear the clock ticking on our parent’s life. As Mom or Dad’s time runs out, so does our chance of getting some particular kind of parental attention. Attention that would resolve some long-held, unconscious need. Perhaps it’s a need to feel as important as another sibling. Or to feel forgiven. Or to feel capable.

When old issues such as these get scrambled into the process of negotiating a parent’s care, the result can be a confusing tangle. Lots of emotion and little progress. And a lack of understanding about why the process is stumbling.

What to do

• Check in with yourself. Are you overly engaged in caregiving out of the hope Mom will finally approve of you? Or perhaps you shy away from an active role because you expect everyone still sees you as “the baby.” Recognize how your beliefs may affect your role in your parent’s care and influence your response to your siblings.
• Don’t blame your sibs. If you are feeling that Mom or Dad overlooks you, you may be right. Your parent may, in fact, be unfair. This is not the fault of your siblings, however. Similarly, if you are the “favorite child,” try not to abuse that privilege. Your parent may or may not be aware of the impact of their actions. And they may not be able to change. Instead, look for opportunities to join together with your siblings. As adults—perhaps parents yourselves—you may be able to acknowledge your parent’s foibles. If you can communicate amongst yourselves, even make a joke of “Mom liked you best,” you will be well on the way to a more sane and comfortable eldercare journey.
• Treat your siblings as adults. If you don’t operate according to old family patterns, your siblings are less likely to do so as well. Meet them as they are today. At a minimum, agree to put aside sibling issues to focus on the care of your parent.
• Call a family meeting. Use a “family meeting” forum for discussion and decision making. Consider hiring a facilitator if problems among siblings persist. A care manageris trained to lead discussions in a way that enables everyone to have a chance to voice their concerns. Then together you generate a workable plan. A professional can save everyone time and regret. Especially in the context of a parent’s failing health, you do not want to be wasting precious time in conflict.
• Review the advance directive. If your parent has prepared paperwork concerning end-of-life care and who will be their healthcare decision maker, find those documents now. As a family, each sibling should read it through. This represents your loved one’s thinking at the time. If they are unable to communicate now to update it, assume this is what they want. Support the decision maker and honor your relative’s wishes.
• Get support to move forward. You may not ever receive the appreciation, love, forgiveness, or recognition you deserve from your parent. And your siblings may not budge from their old patterns. A support group for family caregivers can be very helpful in coming to terms with these realities. Hearing from others in a similar situation can make you feel less anxious or alone. Or consider individual counseling. A counselor can help you grieve and let go of the hope for a different kind of relationship with your parent or siblings. And of course, invest time in your own family-of-choice.

Common conflicts

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 a care manager, 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 a care manager 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 a care manager. A care manager 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 care manager 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 care manager can make recommendations for the best providers in the area, given family needs and budget. The family can implement the plan or hire the care manager 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, a care manager 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, a care manager 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.

When you don't want to provide care

You may have decided long ago to keep your parents at a distance. Perhaps Dad left the family and was largely absent. Or Mom may have been an alcoholic, “absent” in a different way. There may have been abuse when you were growing up. Or a parent with mental health issues.

But what to do now that your relative needs help in their elder years?

Conflicting emotions are common in this situation. If you had negative experiences with your relative, you might feel resentful about their needing you now. But you also might feel guilty about staying away.

Similarly, you may have a parent who has become quite difficult in their elder years, perhaps even nasty and demeaning. There is such a thing as older adults emotionally abusing their adult children. Frequently, it’s a matter of dementia or misplaced anger at the losses, pain, or debility of aging. Sadly, it’s often the child who has stepped forward and is giving the most and sacrificing the most who receives the brunt of the negativity.

Caring for an aging family member can be a multiyear project. Not something where you can buck up and just tolerate your resentment for a short while. It eats at your soul. You absolutely deserve respect, and you absolutely need to set boundaries so you do not come away feeling drained and defeated.

Here are some tips for navigating caregiving when you don’t really want to do it (and it may not be in your best interest to do so):

Accept your feelings. In the case of abandonment, it’s natural for increased contact to trigger a resurgence of feelings. Those feelings are not wrong or bad. They simply reflect the history of your relationship. There’s no need to deny your feelings. But there is also no need to live in the past. Change does happen. It’s worth allowing for the possibility that your relative has grown and has learned some things over the years. No promises. But time does have a way of providing perspective to everyone. While you can’t change the past, you may have an opportunity to create a better future.

In the case of a difficult parent, there are probably old hurts that are being triggered within you as you extend yourself trying to do the “right thing.”

Pay attention to your feelings. They are warning signals. They can alert you to possible dangers. But they do not have to steer the ship entirely. Honor your feelings, but be cautious about letting them dominate the situation.

Consider counseling. The desire to withdraw is a natural response to pain. You may have been carrying around hurt or anger for many years. This situation may be an opportunity to take a fresh look at your parent through an adult’s lens. You have choices now. You are not at their mercy. A counselor can help you decide whether you want to participate in their care, and if so, how much. It’s not an all-or-nothing proposition. A counselor can also help you set healthy boundaries and define the limits of what you are willing to do.

Make conscious choices. Before jumping into a caregiving role—or continuing one—think about why you are doing it. Only you can decide what is right for you. Many family members hasten to help because they hope to receive the appreciation, love, or affection they missed as a child. That can be a slippery slope. You will likely end up bitter if you expect gratitude. It may never come.

Make choices that reflect your values and create a level of involvement that is acceptable for you.

• Where do you draw your personal boundary?
• What kinds of tasks are you comfortable taking on? Finances? Meals? Dressing? Bathing? Toileting?
• How much direct contact will be healthy for you?

There are different ways to be involved. If hands-on care is not right for you, hire others to do that piece. You can stay involved as the coordinator. Or if you place your family member in a care facility, your role might be to oversee their care and make health decisions. Sometimes the wisest choice is to hire a care manager to handle your parent’s needs while you stay involved as the money manager or decision maker.

Aim for a balance between your needs and theirs. You may not get the perfect balance the first time, so allow yourself to make new choices as the situation changes. Validate yourself for living with integrity.

Keep your “personal well” replenished. The added stress of caregiving in an emotionally difficult relationship puts your overall health at extra risk. Expect yourself to need emotional recharging. Develop a conscious strategy for coping with stress. Whether it’s a caregiver support group, a spiritual or religious congregation, or meeting with other family members, find a community that supports you.

Be mindful of maintaining your own well-being with good food, adequate sleep, and staying away from unhealthy habits. And rejuvenate yourself physically and mentally with activities such as art or music or exercise. Consult with a professional counselor if you notice lasting negative changes in your mood or your pace of life.

Consider guardianship for a Plan B. If you find that it’s just too painful to be involved or that you honestly are not able to provide the care your relative needs, create a plan that allows you to back away but does not leave a vulnerable elder unattended. Consider finding a guardian for your relative. Consult with an elderlaw attorney to learn more about this process. It may, indeed, be the wisest and even the most appropriate given the circumstances.

The healing of torn relations

As we near the end of our lives, it’s common to reflect and try to come to terms with the past. Many hospice patients, for instance, strive to reconcile with estranged family members. Perhaps they need to ask for forgiveness. Or they may need to extend it. In most cases, the other party is willing. In the face of such limited time left, the two parties often lament that they didn’t mend the relationship earlier. All that time gone that they can’t retrieve!

You don’t have to wait for a relative to have a terminal illness before you take steps to heal a breach.

According to the Stanford Forgiveness Project, when most people consider forgiving a wrong, it’s not because they’ve decided there was no harm done. What they find is they need to leave the past in the past and move forward. Reclaim their lives. Carrying the weight of pain and anger takes away from the energy they could have to build an uplifted future.

Forgiving doesn’t mean you have to stay in contact with the person who hurt you. Nor do you have to excuse what they did. It just means letting go of the pain, of wishing it were different. Recognize that the person who hurt you was not able to do anything differently at that time—that they were doing their best even if it was selfish and not very skillful or mature. Accepting that life involves pain and that you don’t have to hold on to that pain gives you the opportunity to move forward. You don’t even have to talk with the person who hurt you, or tell them you forgive them. It’s something you do inside your heart because you want to proceed in your life with dignity and peace.

If you are the person who wants to be forgiven, consider these steps:

• Accept that you did something that caused another person pain. This takes both honesty and humility.
• Admit responsibility to the person you hurt with no defensiveness in your heart. If you need to justify your actions, you aren’t ready. They will not trust the sincerity of your remorse. An “I’m sorry” isn’t enough. Describe what you did and how you understand that action hurt them.
• Expect to listen a lot. They may need to tell you about the full impact.
• After some time of deep listening, once they seem to have said what they need to say (for instance, there are long silences after they talk), offer to make amends. Great if there’s something physical you can restore to set things right. Buy them a new car because long ago you did something that ruined their own car. If you ask what you can do to repair the relationship, listen openly. You are not obligated to do everything they might request. You have a right to have boundaries also. If you are unsure, you can thank them for their suggestions and ask for time to reflect before you make a decision.
• Thank them for their forgiveness. If appropriate, let them know that you look forward to a less burdened relationship.

Asking or granting forgiveness can be one-way. The person may not want to talk. Or they may have died. You can do all this in a letter and not even send it. The primary reason to partake in forgiveness is to liberate your heart so you can reclaim your life and focus on the future.