Roxanne Greene's* beloved father was ill. Her mother -- a critical, difficult woman who was in the early stages of Alzheimer's disease--needed help finding him treatment and end-of-life care. Greene researched, visited and priced-out numerous facilities, finally settling on a nursing home a short drive away from her home.
Green's father died within a couple of months, and soon after, her mother's behavior became more erratic, and more dangerous. Stove burners were left on, doors weren't locked, meals went uneaten. Clearly, Mom was no longer capable of living alone. Amid alternating bouts of complacency and hurtful accusations, Roxanne moved her mother to a memory-care facility where she eventually, mercifully, suffered a stroke and died.
The entire ordeal lasted just over two years. During that time, Roxanne was chauffeur, business manager, caregiver, health advocate, insurance mediator, maid, errand-runner, legal surrogate and dutiful, loving daughter to her parents. She built relationships with everyone who came in contact with her caustic mother, trying to soften the verbal assaults with homemade cookies. She planned two funerals. She did everything an only child should do.
But Roxanne isn't an only child. Her sister, who could easily afford plane tickets, lives several states away and her brother is only a two-hour drive north. Yet both were conspicuously absent.
"My sister sent checks. My brother emailed excuses," Roxanne says. "I was determined to do the right thing by my parents, because I didn't want to have any regrets. But honestly, I never felt more alone in my life."
The Three Main Sibling Stressors
Unfortunately, that's not an unusual situation, says Francine Russo, author of "They're Your Parents, Too". Her research on siblings and caregiving shows that in 90 percent of families, one sibling shoulders more -- if not most -- of the caregiving burden.
Roles and Rivalries
"Recognizing and taking responsibility is not always in a person's psyche, says Russo." "Each sibling was brought up with a different relationship to the family, to their parents and to their own responsibilities. Sometimes, the way people behave has a lot to do with the relationship they have with their parents."
Russo and other experts say the child who felt most loved by the parents or the one who self-identifies as the "good" son or daughter might be more likely to take on the primary caregiver role. The child who took the most browbeating, or who feels like a disappointment, or who feels ignored would be less willing to extend themselves to a needy parent.
Roxanne's reward for being the "good" daughter? Her consulting business tanked, her friends stopped asking her to lunch, and her 20-year marriage fell apart while she focused on her parents. Oh, and she didn't speak to either of her siblings for almost a year after her mother's funeral.
"They both had tried to convince themselves that I had everything under control -- that I was the sister who 'handled' things. In reality, they just didn't want to face my mother. The problem is, while they were avoiding Mom, they were also abandoning me."
Care.com elder law expert Harry Margolis says when it comes to dividing care-duties, there's no cookie-cutter solution that will work for all families. "Every family is different, so every family has to work out the best arrangement for them," he says. "I think I've seen just about every arrangement. One sibling handles legal matters while another handles personal care and medical questions, while a third does the shopping and maintains the house. In many cases, the effort can't be equalized, especially if some siblings live close to the parents while others live far away."
Margolis notes that any sibling who actually lives under the same roof as elder family members will, of necessity, provides more hands-on care. In the interest of fairness, that sibling might be compensated financially. "Or, the other siblings might contribute their vacations to move in with the parents and to permit the caretaker child some respite," he says. "In large families, I've seen adult children get assigned different days of the week that they sleep over at their parents house to provide the necessary care."
Brette Sember, author of "The Complete Legal Guide to Senior Care," agrees that "shared responsibility" can mean different things to different families. She says the best way to avoid major sibling discord is to communicate; to meet in person or on a conference call and put all cards on the table.
"Acknowledge that everyone has different abilities, resources, and availability," she says. "Try to break things up into zones if possible -- medical, bill paying, cleaning, food, transportation, legal, assisted living search, laundry. Give everyone some kind of responsibility, even if it means writing a check or calling mom once a day to be her sounding board."
Spending and Needs Assessments
Sember says she's seen plenty of otherwise-rational adults torn apart by end-of-life care for their parents, and often the accelerant for the arguments is money. Siblings may disagree about how the parents' money should be spent for care -- in-home aides vs. assisted living vs. nursing home care vs. allowing the parents to move into one sibling's home.
"Money is a big, big issue, particularly when there may be enough left for inheritance after the parent passes," says Sember. "All the sibling resentment you dealt with as a kid comes roaring back at this time. This is the time when power struggles in families come to the forefront."
Sometimes, says Sember, the disagreements stem from a lack of understanding of the parents' real needs. What one sibling witnesses may be different from what another hears when talking on the phone with the parent, or when they drop by for a casual visit.
"If you can get an outside assessment of what the parent needs, you will have a third party senior care advisor recommendation of how money needs to be spent," she advises.
Russo agrees: "An outside social worker or a mediator can say 'Here's what your parent needs. Here's what's available. Now what are you each willing to contribute?' Having that outside observer can really help siblings take an objective view of the situation." (Learn more about the Care.com Senior Care Planning service.)
New Goal: Try to Make Your Parents Proud
Both Sember and Russo say the healthiest and least-conflicted families are those where the parents' wishes are known. "In the best circumstances, Mom and Dad lead the way. They set the model for how disagreements within the family are handled, and they let their children know what they want," says Russo. "When caregiving issues come up, families need to get together early and they need to meet regularly, while Mom or Dad can still contribute and say what they would like and discuss the resources that are available."
When Jeanie Herbert's* father died, Jeanie and her two sisters and two brothers mourned. Then they came together to discuss a wide range of issues. Their father died without a will, and that meant his estate--primarily the family home--passed half to their mother and half to the siblings.
"Our mother is still mentally sharp, but she can't get around without her motorized scooter. She really can't live alone," explains Jeanie. "Fortunately, one of my sisters still lives with Mom. She's on medical disability and can't afford her own place. With her disability and my father's retirement, my sister and my mother can maintain a household."
Once the siblings determined that the sister-in-residence was perfectly willing to remain in the home and help their mother negotiate her day-to-day life, there was no real question about what should be done. "We all signed our share of the house over to my sister," says Jeanie. "It was the least we could do. And, whenever she needs help with house repairs or an unexpected bill, we take turns helping out. When my mother realized what we were doing, she teared up. She said she was so proud of us. But she really shouldn't have been surprised--she and my father taught us how family is supposed to behave."
Although Jeanie's situation stands in stark contrast to Roxanne's--and to many stricken families--the end result, namely family harmony, is achievable with a little advance planning and a lot of calm reflection.
"Siblings should try to look at each other as the adults they are now," says Russo. "Everybody has grown up. Everybody has a life. Don't assume that you are all the same people you were as kids. You aren't. The oldest is not necessarily going to be the lead caregiver and the youngest isn't necessarily the one who can't function without supervision. Look at what you each have to offer today."
* Note: Names have been changed.