Common Causes of Family Tensions and Disagreements
It shouldn't surprise anyone that sensitive family dynamics can be one of the most challenging aspects of caregiving for an elder, given the tremendous financial, physical, and emotional demands involved. This doesn't mean that family squabbles are inevitable. In fact, if managed well, the experience of caring for an older family member has the potential to bring relatives closer as you help this person through this final stage of life. Here's how to avoid conflicts with family members and work through them when they occur.
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 caregiving.
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' or relatives' home you become a jealous, powerless little girl again.
- Disagreements over an elder's 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 family member is no longer capable of driving, while your brothers argue that he needs to maintain his independence.
- Disagreements over financial matters and other practical issues. How to pay for a family member's care is often a huge cause of tension. Financial concerns can influence decisions about where the person should live, whether or not a particular medical intervention is needed, 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 elder isn't 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 might assume this role because he lives near the family member, is perceived to have the fewest obligations, or has the closest relationship with the person. Whatever the reasons, the situation is likely to make him resentful.
How to Avoid Family Blowups
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 family member's care.
Hold Regular Family Meetings
As soon as the person 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 (you can search online with the term free conference calls). 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 family member 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 caregiving more efficient. The family meeting is an excellent venue for setting up a caregiving schedule and dividing up tasks.
Why Communication Is Important
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.
Talk About It
If you feel you're carrying too much of the burden, 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, or find out if your niece can regularly drive your family member to doctor's appointments.
It's also important to communicate with other family members if you're burned out and need a break. Likewise, if another sibling or family member is doing most of the caregiving, 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 family member and other relatives 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 family member'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.
How to Resolve Family Conflicts
Seek Mediation -- Especially if You Hit Trouble Spots
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, but he needs his independence. An experienced counselor can help you work through dilemmas like this one and determine what's best for your family member -- 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 relative, 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.