Caring for your aging parents may put you in more frequent and intense contact with family. You may have had strained relations in the past. You may have intentionally moved away. But now your family member needs help. And you and your parent and your siblings may find yourselves coming together again, perhaps after decades of only light contact.
Historic tensions will likely reemerge. Perhaps you and your mother never really got along well. Or, your father may have abandoned the family when you were twelve. And now he is sick and you find yourself understandably resentful being asked to look after him.
Old rivalries may arise between you and your siblings. As you try to coordinate care for your aging parents, familiar themes may bloom yet again. Issues of favoritism, bossiness, and not listening may dominate your emotional landscape.
You are not alone. As the circle closes in the chapter of elder care, families come back together to reorbit. Of course unresolved issues will emerge. But this is a chance to revisit them with more years of maturity and self-knowledge behind you. Many families are able to find positives in coming back together and reframing their old relationships into new, healthier interchanges. A nurse care manager can help you, and your family, prioritize issues and reduce friction in family dynamics.
Most caregivers report that they come away from caregiving having learned they are stronger than they thought. They also report greater patience and compassion. Perhaps this is the gift of elder care. To bring us back to our roots and allow us to view and cultivate our progress.
It may not be easy. And your family may never become the loving clan you wish you had had. But the elder care journey is a chance to rally round a cause and find new ways to work as a team for something that is bigger than all of you.
If you have a history of strained relations with the person you care for
Conflicting emotions are common in this situation, no matter what issues exist. If less contact with Mom or Dad has made your life better, you might feel resentful about his or her needing you now. But you also might feel guilty about staying away.
Here are some tips for navigating between the “rock and the hard place” of caregiving in a difficult relationship.
Accept your feelings. It’s natural for renewed contact, or the thought of increased contact, to trigger a resurgence of feelings. Your 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 learned some things over the years. No promises. But time does have a way of adding perspective for everyone.
Think of your feelings as 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.
Make conscious choices. Before jumping into a caregiving role, think about why you are doing it. Only you can decide what is right for you. Many family members jump into helping because they hope now they will receive the 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 that 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?
There are many 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. (See our article on finding help.) Or, if you place your family member in a care facility, your role might be to oversee his or her care and make health decisions. Sometimes the wisest choice is to hire a nurse care manager to handle your parent’s needs while you stay involved as the money manager and decision maker.
Aim for a balance between your needs and theirs. You may not get it right the first time, so allow yourself to make new choices as the situation changes. Validate yourself for living with integrity.
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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.
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.
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
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- 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, as well as 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 he or she may or may not be able to change. Look, instead, 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 elder care 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. Use the forum of a “family meeting” for discussion and decision making. Consider hiring a facilitator if problems among siblings persist. A nurse care manager is trained to lead discussions in a way that enables everyone to have a chance to voice their concerns. Then together you can generate a workable solution. A professional can save everyone a world of grief and regret. Especially in the context of a parent’s failing health, you do not want to be wasting precious days or weeks in conflict.
- Get support. You may not ever receive the love, forgiveness, or recognition you want from your parent. Your siblings may not budge from their old patterns. The wisest course is to accept these realities if they occur and find connection in other places. A support group for family caregivers can be helpful. 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- and community-of-choice.
If you are the primary caregiver of your aging parents
If you are the person most involved in helping Mom or Dad, you are the “primary” caregiver. You may live far away. You may be a daughter-in-law, not a daughter. It’s not so much the family position that defines you as “primary” as your level of involvement and whether tasks are shared by others.
Even if “all you do” is lend a sympathetic ear, take Dad shopping, or mow Mom’s lawn, you are a family caregiver. And, if you are providing the lion’s share of whatever support your aging parent needs, then you are the “primary.”
As the primary caregiver, you are the person who knows the most about your family member’s needs and conditions. And you are the person most apt to feel stressed by those concerns. Caring for an aging parent is a process that lasts many years. You need to learn to pace yourself.
Several factors can greatly affect your ability to “go the distance” with your relative: your relationship to the role, the availability of help, and your self-care.
- Is this a role you decided to take? There can be a special joy in assisting a loved one through his or her later years of life. But if you are involved simply because no other family member was available or willing, you are at extra risk of stress and burnout. Indeed, every aspect of your role may seem a burden. You need to be especially mindful of strategies for coping with stress. Changing how you think about your role may bring some emotional relief. For example, you might consider it an opportunity to deepen connection to your religious or spiritual practice. Or as a trade-off with time you might otherwise spend in community involvement. Try to monitor your participation so it feels appropriate to what you can reasonably do. Give, but know and set your personal limits. Whether your role is voluntary or involuntary, give yourself some strokes for “walking the talk” of your values and ethics. Then pledge yourself to the tasks, but set a future date for a personal check-in to assess what’s working for you and what needs to change.
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- Do you have help? You may be lucky enough to have family or friends nearby who help. Or, if they are nearby but not assisting, you may need to master the art of asking for help. (See our article on finding help.) A surprising number of family members say they want to help but that the primary caregiver does not make room for their efforts. This is worthy of some reflection. Perhaps your competence makes it look like you’ve got everything handled and don’t want “interference”! The first step in getting help is letting go of “shoulds” about yourself and about others. For example, let go of the expectation that you should be able do it all yourself. No one can! And let go of the idea that others should know when to step in. When you ask for help, be specific. Ask for assistance on a particular day or with a particular task. (You might use a free Internet-based calendar, such as Lotsa Helping Hands, to help coordinate participation.) And then accept what others give and how they go about their task. If you’ve tried asking but still don’t get enough family help, you may need to hire assistance. A nurse care manager can often save you time and money because they know the local resources and can help you find programs that are a good fit based on your relative’s eligibility.
- Are you taking care of yourself, too? When a loved one is ill or just plain fading with age, it’s natural to focus on his or her needs. But balance is required or you will undermine your own health. Stress changes your body’s chemistry. It won’t make you sick right away. But when it goes on chronically, as it does in caregiving, over weeks, months, and years, it adds up to make you more susceptible to disease. The remedy can be quite simple: Take time out for regular exercise. See your friends. (Laughter is especially healing!) Consider a caregiver support group. Stay involved with your church or spiritual community. Don’t forget to keep your own doctor’s appointments. And be sure to get enough sleep and eat well, not just on the fly.
If you are not the primary caregiver
If you are not the primary caregiver, you may wonder how best to fit in. Your parent may seem to prefer the attention of another sibling. Or that sibling may seem to have it so together, there doesn’t seem to be “room” for you. If you live far away, it may be hard to imagine a role for yourself. Or, it may be that “giving care” is not really something you feel comfortable doing.
The good news is, you still have opportunities to participate. Even in the most democratic of families, there is usually one sibling who takes the lead. This seems to be the natural order of families. But even if you aren’t the primary, you can still play an active role in your aging parent’s care.
The best way to contribute is to listen to the primary caregiver. Even if you would like to see the primary caregiver change how she or he is handling things, the primary is on “ground zero.” It could be that you do not have the full picture. And telling someone what to do is only likely to win you resistance, not the change you desire.
Your second most important task is to help the primary caregiver. Working together as a team, you can be of profound influence. As you support the primary caregiver, trust will develop. You will likely get a more 3-dimensional view of the situation. And, over time, your insights will carry greater and greater weight.
Task 1: Listening.
Primary caregivers are often stressed. They are juggling a lot, yet feel guilty that they are not doing enough. They are not usually good at asking for help. And, they are especially sensitive to anything that sounds like criticism. They frequently “shut down” if they perceive displeasure on the part of others. Showing interest and demonstrating that you are a good listener will develop trust and encourage further conversation.
To be a good listener requires intention and skill on your part. Listening is not a passive activity.
- Pay attention. Eliminate distractions. Find a quiet place in the home. Or go for a walk together. If you are on the phone, sit down and focus on the conversation. Don’t try to simultaneously finish the dishes or watch a TV show. If it’s not a good time for you, say so and arrange another time. Otherwise, your hurried or displeased tone may be mistaken as criticism.
- Let them vent. Sometimes the best way to help is to be a sounding board where the primary caregiver can express pent-up emotions and concerns. It may be hard to just listen. And even harder not to feel guilty or get defensive. But providing care for an aging parent is stressful, and family caregivers, especially those on the front line, need a way to relieve the stress. Do not underestimate the value of a patient, sympathetic ear and a shoulder to cry on.
- Respond empathetically. Do your best at paraphrasing back your understanding of what’s being said. Most important, ask questions with compassion. The primary caregiver may be very sensitive and quick to feel criticized. If you can show that you understand the stress and care about the primary’s issues, you will be that much closer to being able to work together to resolve them constructively.
- Don’t fix. If the primary caregiver has had a tough day, your supportive listening may be hugely relieving and all that’s wanted. Hold off on offering up your own opinion or ideas. Remember, this first task is about listening. If you sense your input is desired, ask permission first: “I’ve had a few thoughts as I hear more about the situation. Would it be helpful to you if I shared them?” Then you will know if the primary is in problem-solving mode or still needs simply to vent pent-up emotions.
Task 2: Helping.
- Ask the primary caregiver directly what you can do to help. You may have a list of ideas, but start by finding out his or her priorities. If the primary is not offering suggestions, think broadly. Even if hands-on personal care isn’t right for you, there’s much you can do, either yourself or by paying for a professional service. Consider house and yard maintenance. Shopping. And meals. Perhaps you could be the person who handles health issues, such as visits to the doctor and keeping track of prescriptions.
- If you live out of town, look for tasks that can be accomplished via telephone or Internet.For example, you might switch the bills to automated payment and take over banking. Or volunteer to do research when new information is needed. Or simply pay for someone to give the primary caregiver a break now and then.
- The tasks you choose do not have to be directly related to your parent. Anything to lighten the primary caregiver’s load will be helpful. Maybe you can take your sister’s kids to their piano lesson. Perhaps you can rake the leaves in her yard, or take her car to the mechanic’s. If you make the primary’s To Do list shorter, you are liberating time and energy that can then be available for your parent.
Once you have an idea of the types of tasks you can realistically perform, make the offer to the primary caregiver. Work with him or her to develop a new system that fits both your needs. If no one else has been involved up to this point, the primary may need to practice “letting go” of control. Along those lines, realize you may need to “prove” that you can be reliable. It’s not a reflection on you as much as it’s a sign of how seriously the primary caregiver takes his or her responsibilities.
At the least, if you can let the primary know you appreciate the time he or she spends attending to your parent, it will help your parent get the best care possible under the circumstances. Everyone likes to be noticed. Periodic remarks of gratitude cost nothing and they can go a long way to supporting all family members as they rise to the tasks before them.
There’s no doubt about it: sharing the care of an older adult is complex. Siblings are often thrust into roles they did not expect and may not want. But elder care does provide an opportunity for personal growth and for a new relationship to develop. Learning to come together as adults and work as a team is one of the potential gifts of caring for aging parents.
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A family meeting is a useful format for sharing observations and brainstorming ideas. It’s ideal for making decisions and dividing responsibilities. And with today’s technology, it doesn’t matter where family members live. You can have everyone “meet” via conference call. (Open a no-cost conference account at www.freeconferencecall.com.) Or, you can even videoconference using a free Internet service called Skype.
Sometimes families assemble to address an urgent issue. Better yet, they meet on a regular basis. This can help nip problems in the bud. Keep in mind the goal is to be a “team in care” for your aging parent. Even if team members don’t otherwise get along, this is a time to set aside differences for a larger goal.
Following are basic guidelines for productive family meetings:
- Who to invite. Include everyone who might be considered “family.” All your siblings, even if they live far away or are “difficult” personalities. And your parent’s spouse or partner. Everyone who plays an active role or who might be concerned about your parent’s care. Carefully consider inviting your parent. In most situations, he or she should be included. It may, however, be helpful to meet without your loved one. This is especially true if you need to discuss a sensitive issue. If your parent has dementia, you can still involve him or her. Just be mindful that the meeting may cause more confusion or distress. Bear in mind that people with dementia often respond more to the emotions of an interchange than they do to the topic of conversation.
- Format and process. Identify a meeting organizer. The organizer’s tasks include sending out invitations. He or she should also send a rough agenda. Ideally, you will all agree on a final agenda before the meeting. Hold the meeting in a quiet, neutral setting with few distractions. Ensure that everyone has time to speak. It may seem overly formal. But it’s important to call on each person to state his or her questions and concerns. Tackle decision making as a separate function after everyone has had a chance to voice their issues.
- Communication strategies. As you take turns speaking, consider the following guidelines: Give your opinion. Avoid correcting or criticizing others’ feelings or behavior. Remember that it is wiser to make requests rather than demands. Try to stick with the current topic. (Rehashing old issues becomes a murky swamp.)
- It may help to have someone take notes. After the meeting, they can provide a summary. This ensures that each member’s ideas are captured. At a minimum, it’s essential that everyone have a record of agreements that were made. If nothing else, the notes should include who is responsible for which tasks and by what deadline.
Having a neutral, third party facilitate the meeting is one way to ease the stress. If your family has little contact, or is highly volatile, a facilitator can have a stabilizing effect. This option is especially useful when crucial decisions must be made quickly. A facilitator helps keep everyone focused on the task at hand.
Nurse care managers are experienced facilitators for family meetings. They can provide calm and objective guidance and make sure everyone gets heard. They can also offer suggestions regarding elder care resources. Having a professional lead the meeting can save everyone time and distress. When dealing with a sick or ailing elder, time is limited. You don’t want to spend precious days or weeks mired in family conflict. You can save everyone years of regret by enlisting the help of a professional as soon as you realize there may be discord.
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The healing of torn relations
If you have had difficult family relationships, you may be wrestling with unresolved issues or harsh feelings. You may also feel stuck. This is especially common if the person you care for has dementia or is in a coma and unable to participate in a discussion to resolve the past.
Fred Luskin, Ph.D., the lead researcher of the Stanford Forgiveness Project, says the way forward is to “practice forgiveness.” Forgiveness can be one sided. And it brings with it many personal benefits:
- Improved heart health and blood pressure
- Reduced anger and depression
- Increased self-confidence
Forgiveness does not mean believing that no wrong was ever done to you. Instead, it means choosing a less stressful life for yourself. It means living in the present instead of the past. For example, in the practice of forgiveness, you
- Spend less time ruminating about what’s gone wrong. Instead, spend your time appreciating what’s going well.
- Accept that every life involves some hurt. Learn to manage healthily rather than feel victimized.
- Focus on the “big picture” and living your noble values. In the end, this will serve you better than dwelling on others’ behavior.
In essence, forgiveness is about taking control of your life story.
One helpful task is to create a positive statement of your role. You can then use this affirmation as a starting point each day or when old feelings get triggered. Some examples:
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- “Every life has challenges. I am determined to live my life without malice or blame. I find satisfaction in dealing patiently and skillfully with my [mother, father, sister, brother …], even when difficult situations arise.”
- “Life is full of opportunity for wonder and joy. I look forward to noticing what is beautiful today. I won’t dwell on what’s missing.”