When Family Members Disagree About Elder Care

The realities of today's lifestyles complicate caregiving today.

Family having a disagreement.

The TV shows we grew up with often featured supportive, multigenerational households. In "The Waltons," the whole family lived together in one house, including Grandpa and Grandma Walton. When Grandma suffered a stroke, the whole family rallied to care for her. Even in comedy shows, from "Bewitched" to "The Beverly Hillbillies" to "The Simpsons," grandparents were on the scene and connected to everyone in the family.

But few of us live in a Waltons world today, so it's much more challenging when Mom and Dad experience physical disabilities or memory loss that mean they need help with the activities of daily living and managing their healthcare. Today's challenges include:

Our longer lifespan. A century ago, the average life expectancy was around 50 years. Today, the average is 78.8 years—which means that plenty of us will live into our 90s and even achieve centenarian status. But experts tell us that these bonus years may be marked by poor health and disability. It's increasingly likely that if we find ourselves needing care at age 75, we still might be caring for an elderly parent.

The changing role of women. Baby boomer women were much more likely to be employed outside the home, and they gave birth to their first child at an average later age, making them less available to serve as a full-time caregiver for an aging parent or parent-in-law. Boomers also had fewer children, so there's a smaller pool of millennial-age potential caregivers, as well.

Geographical distance. In earlier times, it was common for families to live in the same community generation after generation. Today, we are much more mobile. Families may be spread out across the country and around the world. This complicates caregiving considerably, and in many cases means that an adult child who lives nearby becomes the de facto lead caregiver as elders' needs change.

Stepfamilies. Today's higher rate of divorce and remarriage means that blended families are common—which can create quite a tangle on the family tree when it comes to caregiving! If the family blended when children were young, they may have formed a cohesive family bond, but often when parents married later in life, stepsiblings find themselves virtual strangers, perhaps meeting once at their parents' wedding and then not again until the need arises to focus on the older couple's health and care needs.

Families often have settled into a pattern of inertia. Adult children and their families visit senior parents at certain times of year, help in certain ways, and connect with siblings during holidays or perhaps more often if they live nearby. Then, a health crisis strikes, or—quite often—the sibling who over time has taken on the role of primary caregiver sends out a cry for help that might surprise other sibs and perhaps make them feel a sudden spasm of guilt. Suddenly everyone is called together, and conflicts emerge. Battleground topics include:

The right care for Mom and Dad—A daughter who lives nearby and witnesses the challenges her elder parents are facing thinks they should move to an assisted living or other supportive living situation. A visiting brother says everyone should listen to Mom and Dad, who are resisting the move and want to stay at home. No one can agree on the best course of action.

Time—When a loved one is living with disabilities, time can seem like the main challenge and source of conflict. The conversation might go like this: The primary caregiver describes the hours they're putting in to help Mom and Dad, and how their career is affected. Other siblings counter with an explanation of their own busy schedules. Maybe it sinks in that siblings who live at a distance are going to be using all their vacation time visiting Mom and Dad for the time being.

Money—Even if everyone agrees that Mom and Dad need assistance, how will the family pay for it? One sib may already be laying out quite a bit of money for care—estimates are that caregivers pay an average of $5,000 out of pocket every year. Should Mom and Dad tap their nest egg? Should care costs be divided according to a sib's ability to pay? Unfortunately, this is when accusations sometimes fly that a sibling is more interested in their inheritance than encouraging the folks to pay for care!

Family dynamics—"Mom loved you best." "The folks gave you thousands for your wedding." "You always teased me in grade school." Even more than the practical agenda items above, "old business" may be the most challenging source of conflict. If your family is on a pretty even keel, count your blessings! Not every family is harmonious. The eldercare discussion might be the first time that the family has experienced a period of proximity and intimacy in a long time—and here come the old dysfunctional patterns of communication, the long-simmering resentments and unaddressed grudges.

Seasoned caregivers and elder planning experts offer 6 tips to help families avoid the barriers to shared caregiving:

1. Start these conversations before a crisis arises. We all want to think our folks will be physically active and mentally sharp until the day they pass away, but the reality is that most Americans will need care in their later years. Sure, there are more pleasant topics to bring up as you and your brother are playing a round of golf with Dad, but the time when your folks can fully express their wishes is a good time to start the conversation. Even if the folks push back or change the subject, they no doubt appreciate that you care about their well-being.

2. Hold a family meeting. When an elder's needs change, it's time for everyone to get together to share information, mobilize resources and agree on a game plan. Having this meeting in person is best, but if not everyone can attend, videoconferencing or calling in is better than getting a later, secondhand account of what transpired. Caregiving calls for teamwork, so include everyone who's involved with your parents' well-being. Be sure all the siblings—including stepsiblings if appropriate—are kept informed. And of course, the person who you're planning for must be centrally involved if they are capable of communicating their wishes. If family squabbles continue to erupt, or if the family is overwhelmed by the planning at hand, call in a professional such as a geriatric care manager to facilitate the meeting and suggest resources.

3. Acknowledge the role of the person who has been the primary caregiver. It's almost a cliché: One sibling who lives locally has been providing the lion's share of care, only to receive criticism from a long-distance sibling who walks in the door that day with a rosier-than-realistic set of expectations. Recounts one caregiver whose mother is recovering from a stroke, "My sister arrived at Mom's house, scrutinized the easy-on slacks and sweatshirt Mom was wearing, wrinkled up her nose and said, 'Mom would never choose that outfit!'" And when Penn State University's Dr. Steven Zarit interviewed Alzheimer's caregivers about stressors in their lives, many of these caregivers said that conflict with siblings caused more distress than the behavior changes caused by their loved one's dementia! Express your appreciation of the person who is "in the trenches," and show that you value their insights.

4. Do your homework. Preparing for family caregiving can be a daunting task. Learn about services that are available to support seniors and caregivers in your area. Contact the local Area Agency on Aging or the Eldercare Locator (www.eldercare.gov). A geriatric care manager can locate and access services. If your parents want to receive care at home, look into hiring professional in-home care. In-home caregivers provide personal care, hygiene support, housekeeping and laundry services. They can prepare nutritious meals and provide transportation and companionship. For seniors with Alzheimer's disease, caregivers provide supervision and appropriate activities. And when none of the siblings live in the area, in-home caregivers serve as a liaison to provide reassurance and peace of mind for everyone.

5. Create a realistic plan and put it in writing. Include as much detail as possible about who has taken on what responsibilities and assignments. The plan should be practical, not beyond your family's financial resources—and, most important, it should be acceptable to Mom and Dad. All the family members need to agree ahead of time that they will accept the plan once it's done, even if it wasn't their first choice and even if they have some reservations. The responsibility for the plan should be shared by all. Then, going forward, create a system by which everyone can stay in touch—a family email chain, a private Facebook page, or a "phone tree."

6. Look into support groups and classes for shared family caregiving. It's worth it to focus on these issues! This time in a family's life, when in a sense the children parent the parents, often sets the stage for the relationship the adult siblings and their own children will have in the future. Working together and moving beyond childhood resentments into a more mature connection helps them create a nurturing new structure for the family's future.

Here's another great resource!

Is your family's care conversation hitting some snags? Visit the Right at Home website to download RightConversationsSM, a free resource full of innovative eldercare planning tips.

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Right at Home, Inc. is a national organization dedicated to improving the quality of life for those we serve. We fulfill that mission through a dedicated network of locally owned providers of in home care services.