Negotiating Senior Caregiving with Siblings
10 steps for making it manageable.
A 2009 study by the National Alliance for Caregiving (NAC) reveals that almost fifty million Americans have served as an unpaid caregiver to an adult, often a parent. Sixty-six percent report that another unpaid caregiver helps with the role. Sharing caregiving responsibilities with family members alleviates the demands of assisting a loved one, but agreeing on who does what, when and how, can sometimes add to caregiving stress.
And when siblings are the caregivers, things can become even more chaotic. Sibling rivalry and decades-old arguments don't always go away because of an aging parent. Sometimes you can all work together harmoniously, but sometimes it takes a little planning and compromising.
Mary Stehle, LICSW, Senior Care Advisor at Care.com, acknowledges that "caregiving is a journey full of challenges and rewards. One of the challenges can be working with siblings to provide the best care for your parent."
But organizing this caregiving system doesn't have to be stressful. Stehle suggests an easy step-by-step approach to manage the process.
Dr. Alexis Abramson, noted expert on aging, television personality, speaker and author of several books, including the Caregivers Survival Handbook, remarks, "The time to plan a family meeting is before your parent(s) has a crisis that requires immediate attention."
Stehle recommends broaching the subject well before there seems to be reason, so the groundwork has already been laid, rather than having to react quickly during a crisis.
Start with Just Siblings
Keep it simple to begin with. When you need to start talking about your parents' future caregiving needs, schedule a meeting with your siblings. Try to plan it when everyone can physically attend. Especially if you have siblings who live in another state, maybe tack it on to a holiday weekend when everyone is nearby. But make sure you have enough time -- and privacy -- to discuss the issues.
You want your brothers and sisters to get on the same page and develop a team mentality about caring for your parents. Fold in other family members and professionals as needed along the way to fill gaps or address specific issues. If siblings' spouses are close to your parent, include them too.
Take time to consider what your parents' needs are right now and how best to meet them. Know that this is not a single conversation, but an ongoing dialogue between you, your parents and your siblings -- among others. The more people you discuss this with, the better. Each person may notice different things about your parents and areas where they need help.
Kathy Sutton* of Berkeley Springs, West Virginia recalls when her ailing 89-year-old mother needed dialysis. "We held a family meeting of the five of us siblings and decided we wanted more information on how it would affect her," says Sutton. Since she and a brother held power of attorney for her mom, Sutton was designated to consult doctors for the facts and talk to their mom about what she wanted to do.
"Siblings may each have a different impression of how their parents are functioning," says Stehle. "Getting together to share these perspectives is critical." Take a minute to review the many tools Care.com offers to help you determine a plan that makes sense right now, recognizing you'll need to update that plan as needs change.
Include Mom and Dad
Talk to your parents early on to get their input and then make them a part of ongoing conversations. Stehle recommends being selective about who initiates the topic if this is a sensitive issue. "You'll want to consider who will be the most successful at starting the conversation in a non-threatening and compassionate manner. In some families it is best if the doctor or a trusted friend broaches the topic." Gradually broaden the discussion to include other siblings.
Divide and Conquer
Once you've talked with your parents and outlined their needs, you can start dividing responsibilities among your siblings, based on availability, proximity, skills, interest and common sense. For instance, one person should be the point of contact for medical care to minimize confusion, while providing meals or transportation for a homebound senior can be rotated on a monthly interval.
Jane Cooper, from San Francisco, California, is one of four siblings and the natural organizer, take-charge personality of the family. When her mother was diagnosed with cancer, she put together a calendar detailing all of her mom's care needs and doctor appointments, then called a family meeting.
"This is what our mom needs and what has to be done," Cooper recalls saying. "What can everyone do?" She then summarized what everyone had agreed to in a follow-up email.
If one sibling has more money than time, Abramson suggests discussing some financial compensation for what another sibling is doing. It may seem awkward, but can go a long way towards offsetting the cost or time involved.
The NAC study found that 66 percent of caregivers are women, but Abramson cautions not to discount men.
"Do you bypass your husband, brothers-in-law, sons and nephews when it comes to caregiving requests?" she asks. "If so, you may have a wealth of untapped resources right at your fingertips."
And don't forget the kids in the family. Older children may enjoy helping out grandma and grandpa by visiting regularly, running errands or even taking grandma to the hairdresser. Giving older children a role can make special memories for everyone.
Plan to Communicate
Schedule a regular phone, Skype or face-to-face meeting with your siblings, if only for a few minutes. "It is incredibly helpful to regularly communicate about your experiences and observations of your parent so that everyone remains in the loop," says Stehle. This can also help build your relationship beyond caregiving, and that's good for everyone.
In general, be honest and direct. If you're already feeling overwhelmed, share it openly to head off worse problems down the road.
Support One Another
Caregiving can seem like a thankless job. So assist and encourage one another often. Be willing to recognize that siblings may sometimes do things differently than you would, but that's okay.
Abramson notes, "You'll have a lot better luck with praise and thanks (honey) for steps in the right direction than by criticism (vinegar) of what you don't like."
While having a plan and task assignments is helpful, try to remain as accommodating as you can. Be ready to cover if your brother is out of town for vacation or your sister has the flu.
In Cooper's case, each sibling was responsible for making alternative arrangements if they couldn't fulfill their commitment, making it less stressful for everyone else.
Often a parent's preferences and changing needs can be overshadowed by the routine demands of daily living and competing priorities. Maybe mom is struggling more with preparing meals or shopping for groceries, something that was not previously an issue. Talk to your mom about having groceries or meals delivered. Pay attention, monitor changes and talk about it.
Set Aside Baggage
Don't let sibling conflict interfere with your parents' care. If you have a longstanding rift, consider counseling or resolve to set it aside in the interest of your loved one...and yourself. Stress often triggers old unproductive family patterns. Be aware and stay focused on the priority: caregiving.
If the conflict is over caregiving itself, check out our story on Sibling Strife: How to Resolve the 3 Senior Care Issues Siblings Fight About Most. It may help you address and solve the issues.
Understand that It Will Never Be Even
"Unfortunately it is impossible to split caregiving tasks up evenly," shares Stehle. The reality is that some responsibilities may never be comparable. Additionally, some siblings may never do anything at all. You may try to work with them using different strategies, but at some point you have to consider the possibility that you will never get the help you’re looking and hoping for. Sometimes you have to move on to find other resources that will be less stressful for you.
Donna Lamlin of Tampa, Florida has been the primary caregiver for her mom Ethel for more than five years. Ethel now requires a great deal of care, which mostly falls on Lamlin and her husband, with extensive help from hospice. Lamlin's sister lives in Maryland, so sharing the day-to-day caregiving responsibilities isn't practical. Even so, she has stayed with Ethel while Lamlin and her family took a much-needed vacation.
Lamlin acknowledges that even though it's sometimes overwhelming to care for her mom, she feels that no one can really care for her as she does and it's a special privilege. "My mother is such a blessing. We hope to keep her here with us just as long as we can."
Recognizing that it's a special privilege to care for an aging parent can also help you feel better about being the primary caregiver.
Talking about and organizing caregiving responsibilities with your siblings may seem thorny, but these tips will make the conversation -- and the caring -- a lot easier for everyone involved.
* Names in this article have been changed.
Longtime caregiver to her elderly mom, Isabella Yosuico has two young boys of her own, including one with Down syndrome. Formerly in communications management with a Fortune 1000 company, Isabella is now a freelance writer, specializing in health and wellness, and is completing her master's degree in PR. She resides in an arts colony in Berkeley Springs, West Virginia.
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