Looking Ahead by Johanna Kind for the Journal
April 27, 2008 Boomer Section of the Albuquerque Journal

Stop your squabbling - Parents’ failing health can cause siblings to regress

An aging parent’s declining health can be the catalyst for stirring old sibling rivalries, experts say.  When faced with difficult decisions about a parent’s care, adult children often find themselves lapsing into childhood roles, which can ignite sibling rivalries and unresolved emotions.

“We never outgrow our childhood,” says Dr. Mary Johnson, a private counselor in Albuquerque specializing in grief and loss.  “The dominant child, the one who always wanted to pick the game, who always made the rules, that’s the child who will probably want to come in and make all the decisions when it comes to mom and dad’s care.”  During this stressful period, jealously among siblings often resurfaces, says Johnson, as do buried emotions that have been glossed over in adulthood.

Sharon Miles, a social worker and geriatric care manager, says she quickly picks up on family dynamics when she meets with siblings who are discussing their parents’ health-care options.  “Often what happens when decision time comes, depending on that dynamic, is there is a power play,’ says Miles, who helps with family planning through her Albuquerque business, Senior Care Options.  Fueling the contention are such emotions as guilt, regret, denial and different values and expectations, says Miles.  Finances and distance only add to the quagmire.

Most families have a designated caregiver who may or may not want the role, says Miles.  Often, the caregiver is the child who lives closest to the aging parents.  In other cases, it’s the oldest child.  And often it is the child with the most nurturing personality.  “Unfortunately, those personality traits also can make the caregiver easy to take advantage of,” says Miles, which can lead to resentment.

Also, the local sibling feels pressure to make decisions that may conflict with the wishes of brothers and sisters.  “One sibling might want to keep mom and dad home when another thinks they need to go to a facility,” says Johnson, who also is the community sales director for Atria Vista del Rio assisted living in Albuquerque.  “A facility might relieve the local caregiver of having to provide constant care.  But if you feel like it’s your responsibility to take care of mom and dad, you might feel guilt about taking them to a facility.” 

Taking Part

To help diffuse the situation, the experts recommend offering support to the care-giving sibling, even if it simply comes in the form of words.  “It’s stressful for the locals, but it’s also very stressful for the siblings who live out-of-town because they’re not there to oversee and make sure your parents are OK,” says Johnson.  “There’s guilt, and they may compensate by giving more input so they feel they are part of the process.”   Johnson says out-of-town adult children can offer support.  She says financial assistance is appreciated, but not always necessary.  “If they just stay in touch and express appreciation, that is very helpful.”

Miles says relieving the caregiver also can be helpful.  “If possible, pay for respite care or a home care agency that will provide the caregiver with some relief,” she says.

Also, the experts strongly urge adult children to stay in touch with their parents.  “You don’t want to make mom and dad feel like a burden or like their care is causing a conflict,” says Johnson.  “Communication is a wonderful thing.  Sometimes, we’re not as good about it as we should be.”

Many sibling battles can be averted if parents talk to their children about how they want to live as their health begins to fail.  It’s best to have that conversation when parents can participate in the discussion, instead of waiting until a crisis such as a stroke, fall or illness. 

“Pre-planning is so much better than crisis management,” says Miles.  “It’s better if you’re talking about the future and it’s still ‘what if.’  The parents need to be part of the discussion and share what their preferences are.  Where do they want to live?  In a facility?  With one of their children?  In their home?  And how are they going to pay for it?  Those discussions don’t happen often enough.” 

Johnson adds:  “It’s a hard conversation to initiate.  It’s hare to bring up: ‘Now Mom and Dad, if your health deteriorates, what do you want us to do?’ 

Not only is it important for children to talk to their parents, it’s also important to have the appropriate legal documents drawn up, including a life care plan, which is a document that summarizes medical, psychosocial, educational, vocational and daily living needs and desires of the parent as he or she ages.

“Families can get professional help if they aren’t sure where to start,” says Miles.  “Also, there are support groups and organizations that can provide support and guidance.  The Internet can be great resource; especially of you know where to look.”

A third party

If longtime family issues resurface when trying to help parents, the experts say consider family counseling.  “Parent issues can bring other issues to the surface and this might be a good time to get counseling, to work through some of these longtime issues,” says Miles.  She says a professional counselor or social worker can serve as a facilitator who helps get the conversation started. 

“Getting it all out on the table is often a great relief for families,” agrees Johnson.  “Airing old issues can be helpful.  When you talk about the issues and are more open, you are able to make more grown-up decisions.  Sometimes you have to go back to the fifth grade briefly to air out emotions before you can get back on focus.” 

The experts say not all families are torn apart by crisis.  In many cases, a parent’s failing health can bring brothers and sisters together.  Says Cindy Brown, a colleague of Johnson at Atria:  “If you encourage siblings to act like they’re getting, eventually they may actually get along.  Attitude follows behavior.”