Dear Family Advisor

My sister's refusal to communicate with me about our father's care has brought back to mind years of mistreatment by her. What can I do?

Last updated: Oct 06, 2008

My sister is 14 years older than I am and has full power of attorney over the estate of our father, who has Alzheimer's. I live 6,000 miles away, in the U.K. She doesn't communicate with me about anything and hasn't rung me in the 15 years since I moved there. She and her husband remortgaged Dad's house twice so they could fix it up as a rental property, without telling me. Now they want to change my father's accommodation, and my sister finally asked my opinion.

She says that "God" showed her a home for Dad to live in, but it's not safe for Alzheimer's patients. She asked me if I thought Dad's spiritual or physical needs were more important. When I e-mailed that I thought Dad's safety was more important, she stopped communicating with me. I offered to fly out to help, but she said it wasn't necessary. When I replied that it sounded like she didn't need or want me there, she wrote back, "Don't upset me with your hurt feelings when I've already got so much on my plate."

This has brought back 43 years of being treated like my feelings don't matter, I'm not a valid member of the family, and I'm invisible. Although I read an article that says we need to involve all siblings, I'm the only other sibling, and I am not involved in -- or even kept in the loop about -- anything. I don't even know if my sister has given my father any of the cards I've sent him. How can I hold my sister accountable, or at least get someone -- anyone -- to communicate with me about my dad?

I can see that you care deeply for your dad and his safety, but caregiving from a distance is a great challenge. Long-distance caregivers often feel helpless and unneeded, and even guilty for being so far away. It's difficult for you to feel like part of the equation and just as difficult for others to see you as part of it.

Since your sister has proceeded this long without including you in her decisions, you're going to have to fight to become involved in your father's care.

Visiting your father and sister regularly and calling often are the clearest ways for you to show that you're serious about becoming involved, so I urge you to consider if these things are possible. Can your dad talk on the phone? Even if he doesn't know who you are, you need to speak to him and those who care for him if you want to be in the thick of things.

If you can't be in touch or physically present enough to keep up on the issues in his life and care, it will be difficult for you to be included in any meaningful way, and your sister will have freer reign to make decisions by herself.

The most important thing for you to do now is to come home for a week or more. Don't ask your sister if she wants you to do this. Tell her you're coming back to see her and catch up on your dad's care. A visit home is an opportunity to talk with her intimately and to see for yourself how your father is doing.

Your sister may have already moved your father by the time you get arrive or before you've been able to work through any issues with her. Don't let that keep you away. Care facilities don't always work out, and you may be facing the same decision again soon. At the very least, visiting your father will let you assess his new living situation.

It's critical that your father be in a facility that's licensed to deal with the complex needs of people with Alzheimer's. If you feel that his new residence is inappropriate or unsafe, you'll have to bring this up with your sister. There's no reason why you need to get tangled up in a religious discussion, though. Keep the conversation focused on your dad's physical needs and safety.

If your father's Alzheimer's is severe, he won't be aware of his spiritual condition. Still, if it's important to your sister, she can arrange to have a clergyman or church members visit him regularly in a residence where he's cared for properly. And you can encourage her to get the religious support and guidance she needs through this difficult period, which may be the real issue for her.

If you haven't seen your father for several years, be prepared that his mental capabilities may have deteriorated quite a bit. He may not know you or be capable of appreciating your efforts, but your reward will be the knowledge that he's well taken care of.

Next, try to plan a few "alone time" sessions with your sister while you're with her to talk about your difficulties communicating about your dad's care. You both have grievances: You feel pushed out, and she most likely feels alone and overwhelmed. Make that the starting point for your talks.

Try to see her side. She may romanticize your life in another country and both envy and resent that you are that far away. She may interpret the sheer distance between you and your father as evidence that you don't care.

Likewise, your sister doesn't seem to understand your side of things. She's so focused on her own situation that she doesn't see that you miss your dad and want more of a relationship. Paradoxically, caregivers often feel both overwhelmed and reluctant to share responsibility -- as a caregiver for many years, I can say that they're usually pretty controlling!

You probably hadn't realized that your decision to live in the U.K. would isolate you from the family so much. If so, tell her that. If you feel that you slacked off and left most of the work to her in the past, apologize for your neglect.

Have you been contributing financially to your father's care or her efforts? If not, even a small gesture could make a difference. Being the primary caregiver for someone with Alzheimer's is an extremely demanding job. For your sister's birthday, you might surprise her with a gift, like a spa certificate. Or offer to come over for two weeks so she can take some time off.

You may think she doesn't need or want these things, or that she has your father's money to spend at will. But this is about showing that you recognize the responsibility she's taken on as primary caregiver. If you can do these things both from home and when you visit, I bet that she'll begin to welcome your involvement.

I don't mean to suggest that your grievances about your family dynamics aren't important. You may someday reach a point when you can resolve some of them with her, but for now, don't get stuck rehashing your past. Being clear and firm about your feelings and desire to participate now will help resolve some of your lingering resentments about being invisible and unheard in the past. If you feel yourself slipping into old habits, remind yourself that it's time to forge a new relationship.

If you try these things and still find that you're getting nowhere with your sister, enlist the services of an eldercare advocate in the community where she and your father live. Bringing a mediator into your talks with her will show her that you mean business. It can also keep heated exchanges to a minimum and focus on resolution.

If you feel that your father is not getting adequate care or that your sister is abusing her role as power of attorney and you can't resolve the situation on your own or with a mediator, you'll need to hire an elder-law attorney.

Your relationship with your sister may ultimately be unsalvageable, but if you've made this effort, you'll be at peace knowing that you've done all you can. Standing up for yourself and giving voice to your concerns and needs as a sister and a daughter can only benefit you in other areas of your life as well.