Caring for Your Elderly Parents: How to Handle Family Conflicts

Quick summary

Caring for an elderly parent is hard work, and it can also be hard on family relationships. The strain of the situation can heighten old resentments and create new conflicts over everything from medical decisions to finances. Here's how to avoid conflicts with family members and work through them when they occur.

Navigating tricky dynamics

It shouldn't surprise anyone that sensitive family dynamics can be one of the most challenging aspects of care giving for an elder, given the tremendous financial, physical, and emotional demands involved. The job is by turns tedious and transformative, poignant and just plain hard. It brings out the worst in people as well as the best, and it causes old grievances to flare up -- as well as sparking new ones.

This doesn't mean that family squabbles are inevitable. In fact, if managed well, the experience of caring for your parent has the potential to bring family members closer as you help your parent through this final stage of life.

Common causes of family tensions and disagreements

Even the happiest family has its own internal culture -- as well as its own history of grudges and disagreements. Jealousies and gripes won't disappear when your parent's health begins to fail. On the contrary, being forced together to care for your parent will likely bring these issues into sharper relief.

Typically, disagreements arise because of:

• Roles and rivalries dating back to childhood. Mature adults often find that they're back in the sandbox when their family gets together. This tendency can grow even more pronounced under the strain of care giving.

If your sister was the favored child, for example, you may find that -- no matter how successful and capable you are now -- in your parents' home you become a jealous, powerless little girl again. Your older brother, the bossy one, may start issuing orders like a drill sergeant.

• Disagreements over your parents' condition and capabilities. It's common for family members to have very different ideas about what's wrong with a loved one and what should be done about it. You may be convinced that your father is no longer capable of driving, while your brothers argue that he needs to maintain his independence. What makes these situations tricky is that everyone comes to the table with subjective fears, anxieties, and wishful thinking -- not to mention major doses of denial.

• Disagreements over financial matters and other practical issues. How to pay for a parent's care is often a huge cause of tension. Financial concerns can influence decisions about where a parent should live, whether or not he should have a particular medical intervention, and whether he can afford a housekeeper. These conflicts are often fueled by ongoing resentment over income disparities and perceived inequities in the distribution of the family estate.

• Burden of care. Experts say the most common source of discord among family members occurs when the burden of caring for an elderly parent is not distributed equally. "Usually one of the adult children in the family takes on most of the care-giving tasks," says Donna Schempp, program director at the Family Caregivers Alliance, a national nonprofit organization that provides information and support to caregivers.

The primary caregiver may assume this role because he lives near his parent, is perceived to have the fewest obligations, or has the closest relationship with his parent. Whatever the reasons, the situation is likely to make him resentful, while other family members cycle through a range of feelings -- from guilt for not doing more to resentment at being left out and uninformed.

How to avoid family blowups and resolve them when they occur

The following steps can help you recognize and avoid some of these common land mines so you can keep the focus where it belongs -- on your parent's care.

• Hold regular family meetings. As soon as your parent begins to have health problems, initiate regular family meetings with your siblings and other family members who will be involved in her care. The goal is to share information and make decisions as a group; the meetings can also be a source of support and provide a forum for resolving disagreements.

If all or some of you live in different parts of the country, the meetings can be held by conference call. There are now many free conference call services available. Set a regular time for the family meetings that's convenient for everyone involved -- it could be once a month, or whatever suits your family -- and if you can, do so before a crisis occurs, so this tool will be in place when you really need it. If possible, reserve a little time at the end of the meeting or conference call to chat and catch up.

• Divide the labor. Rather than insist that all of the care-giving tasks be divided equally, consider a division of labor that takes into account each family member's interests and skills, as well as their availability. Your sister may find it difficult to get away during the day to take your father to his doctor's appointments, but perhaps she can handle his finances or take the lead in finding an appropriate long-term care situation. A far-flung sibling won't be able to help with day-to-day care but may be able to come for a visit every few months to give you a break. A fair division of labor can mitigate resentment and make care giving more efficient. The family meeting is an excellent venue for setting up a care-giving schedule and dividing up tasks.

• Communicate, communicate, communicate. Most families have taboo subjects that everyone avoids. Sometimes the topic is a sensitive one, like a drinking problem or a family tragedy, but often family members avoid speaking up because they are afraid of hurting feelings -- or simply because openness has never been part of the family culture.

If you feel you're carrying too much of the burden for a parent's care, consider discussing it with siblings and other family members. They may not realize that you're feeling overwhelmed -- or even know how much you're doing. In a calm, quiet moment -- perhaps at the next family meeting ? explain how you feel in a matter-of-fact, nonconfrontational way. Try to be concrete and specific when you ask for help. For example, ask your sister if she can take over the grocery shopping for your parent, or find out if your niece can regularly drive your parent to doctor's appointments.

It's also important to communicate with other family members if you're burned out and need a break. Conversely, if another sibling or family member is doing most of the care giving, offer support and encourage her to express her frustrations and talk about what would make it easier for her.

• Offer help even if you live far away. If you live far from your parents and other family members are responsible for most of the care, be sure to offer support. Check in often to see how things are going and to offer whatever assistance you can. Ask about how the caregiver is doing and be a sounding board for frustrations and concerns. Be patient if the caregiver needs to vent.

The National Caregivers Alliance advises relatives who live far away to let the caregivers know how much you appreciate what they do and to make sure that primary caregivers get regular respite. Visit regularly and take over your parent's care if you can, and if you can't, find other ways to make sure primary caregivers get regular breaks. Perhaps you can pay for some additional care or offer to hire a housecleaner for the caregivers.

• Seek mediation if you hit trouble spots -- or even if you don't. A counselor or mediator can help you and your family resolve disagreements or manage particularly difficult care-giving dilemmas. Schempp, who regularly counsels siblings and other caregivers, says, "It helps families to have an outside facilitator who can offer advice and support."

Even if your family doesn't have specific disagreements, you may want to see a counselor on an occasional basis, because experts like Schempp can help you tap into options and resources that you may not be aware of. Many problems facing caregivers have no easy answers. Take, for example, your argument with your brothers about whether your dad can still drive. In a sense you're both right: He might well be too infirm to drive and he needs his independence. An experienced counselor can help you work through dilemmas like this one and determine what's best for your parent -- and for you. To find a counselor, contact your local senior center or area agency on aging.

• Be part of the solution. If you find yourself in conflict with another family member when caring for an elderly parent, take a step back and get some perspective. Consider your own role in the conflict, and ask yourself if you're acting out an old family role or resentment. It might help you to see a therapist for support and insight.

Make sure that you're taking care of yourself by getting regular sleep, nutritious meals, and exercise. If you're the primary caregiver, you also need to have regular breaks to avoid burnout. These steps won't make the conflict disappear, but chances are they will help you manage and resolve it in a more honest and clear-headed way.