How can I resolve the conflict with my sisters around mom's care?

4 answers | Last updated: Oct 01, 2016
A fellow caregiver asked...

My mother has been living with one of my sisters since January due to increasing dementia. My mother is a very strong willed and negative person. I have another sister close by, but she is no longer allowing mom to stay with her. I live 12 hrs away and am of no help. Both sisters work full time, so my mom is alone all day. They would like her to go to an assisted living community that is 15 minutes away from both their homes, but she refuses to go. They are both very frustrated with the situation and their anger is often directed at me and each other. I have made suggestions such as bringing someone in each day who could interact with my mom and do some housework for my sister or seeking the help of a mediator to facility moving my mom to assisted living. According to my sisters such services do not exist in their area. However with 2 simple phone calls I was able to speak with a representative from the Alzheimers Assoc. in their area who relayed that he can act as an mediator/advocate. Did I mention both of my sisters are nurses, however refuse to investigate or utilize available resources. I sent the contact info of this representative to my sister and of course the responds I received was very negative. One sister is not speaking to me and the other just yells. I need to go spend some time there, but dread the angry/dysfunctional environment. How can I be helpful and bring some peace to this situation.

Expert Answers

Linda Adler is the director of Pathfinders Medical in Palo Alto, California. She has dedicated her professional life to helping patients and their families find optimal ways to deal with medical challenges. She has worked in all facets of the medical establishment, including primary care, research, and policy settings at UCSF, Stanford, and Kaiser Permanente. Her current focus at Pathfinders includes crisis management, mediation, and advocacy.

My sympathies, as it sounds like this is a difficult situation and one that is placing a lot of stress on you. However, I believe there are some good solutions that are relatively easy to implement, and are one's that will not only address your mom's needs, but will also minimize the wear and tear on you. Let's consider a couple of ideas for moving forward.

First, I'd like you to find a caregivers group in your area. Even though you are not the one who is actively caring for your mom on a daily basis, I think meeting with others with personal experience in this area would provide a great community for you. They can listen and support you, help you to better understand your sisters' challenges, and assist you in feeling less guilty and angry at yourself for not being able to be there physically. Furthermore, they can provide suggestions, based on their own experiences, about specific strategies to help in this situation.

Second, you seem to have a talent in terms of organizational skills and resource gathering. So let's build on that. I think you can accomplish a great deal, even with the distance at hand, once you figure out exactly what services you think would be most crucial. Try not to pay too much attention to your sisters' resistance. Just move forward with your search to get some supportive help for your mom. Your idea to bring in a mediator is a terrific one, and I'd suggest that you get back in touch with the person from the Alzheimer's Association to schedule an appointment with your sisters. The mediator will be experienced in dealing with the resistance they are mounting and can guide you as to how to schedule the meeting.

Third, it might be helpful to devote some time to better understanding why your sisters respond to you in the way that they do. Even though they are nurses, first and foremost they are daughters, and they are overwhelmed. I'm guessing that they are very frustrated at their inability to handle the situation, especially since they are medical professionals, which probably makes them feel even worse about their lack of success. Given their state of mind, they probably take your well-meaning suggestions as criticism, even though you didn't intend it as such. It's going to require a lot of understanding and deep breaths on your end to understand that their resistance is most likely evidence of their underlying sense of failure and frustration. Perhaps you can be present when the mediator makes a visit so you can all get some help in sorting out your feelings and frustrations.

Last, difficult as it feels at the moment, it's going to be critical to remind yourself that getting this process back on track is going to take time, as unfortunately, there is no easy, quick fix. If you can exercise patience, with yourself, your sisters, and your mom, while implementing a carefully executed plan, things will improve. In the meantime, remember, your primary goal is to take care of yourself so that you can be in the best shape possible to take care of others.

Community Answers

A fellow caregiver answered...

Wow - It sounds like you have truly tried to help your family situation, and you've done some excellent research. I am a geriatric mediator - but mediators can't help unless the parties are ready to talk.

I love nurses - but they make the worst patients! In this case, I think your sisters may feel that moving your mother into a care facility represents failure on their part. The gentle suggestion I would propose is that this situation is not about their feelings but about what is best for your mother. Staying in a house all day, alone, every day, is not an ideal situation for anyone, especially not a person with dementia. The assisted living community sounds like the best solution.

A locked (secure) unit, might be the best temporary solution. It is illegal to lock someone up against their will unless they have been convicted, but it is legal to put a demented person in a unit and not tell them the way out. You or I would find the way out quickly by watching. Most dementia patients cannot. Staying there until she adjusts to no longer being at home is a solution, and then she can move into a less restricted area.

People with dementia lose the areas in the brain that help us make reasonable decisions. We all need to be able to see the effect of our actions on others and ourselves and adjust accordingly. Dementia patients lose that part of the brain early on. Therefore, you cannot ask your mother to make the decision to move. It's best not to even tell her. Just move her furniture while she is on an outing, and bring her back to the community where her new apartment is located. This it difficult but avoids a lot of anxiety on the part of the demented person.

As for your personal feelings, set limits on what you will listen to from your sisters. Explain once only that you are trying to help but that yelling at you or refusing to talk to you is not helpful in the long term solution for your family. You might arrange a meeting with the three of you to discuss priorities and goals, and divide responsibilities.

Good luck

Jade1961 answered...

Hi, I am so sorry for your situation and I would like to preface what I am about to say with you, your mom & your sisters will be in my prayers.

I am a two time cancer survivor who is severely disabled and wheelchair bound. I was looking at having to be placed in a semi-independent living environment when my doctor found a program through my state (PA) that helps people like your mom & myself stay in their own homes with the help of licensed caregivers and companion aids. In PA it is called the PA Independence Waiver Program. I am certain, after talking to my case supervisor that these programs exist in all of the States. She was unsure what they are called elsewhere, however, she did state that they are available throughout the US. What happens, I would call your local center for aging or your local welfare office, your Mom would have to be certified by her physician that she is not capable of living alone and needs ... insert number of hours per week here... in order to stay in her own home. That would allow your sisters who are close by to visit but would also allow for additional hours in the form of respite hours. Once you have an agency monitoring the hours they will help you find an agency that provides caregivers. It is your Mother's right to interview the caregivers to find someone that is a good fit for her. She may go through several before finding the right one. This is normal, I have been in the program for 7 years and have had 5 different caregivers. Sometimes it just doesn't work. As a matter of fact I am about to fire the one I have and start fresh as she does not take good care of me and some of the things she does border on neglect.

I wish you the best in finding the care your Mom deserves. This is the wrong time for quarrels between siblings in regards to your Mom & who will care for her. She has the right to stay in her own home, provided she has the caregivers that she needs.

NO ONE should be shoved into a home because it is inconvenient for a child or other family member to care for them.

Perhaps your sisters should take a look at how their behaviors are affecting your Mom. Do they, or you for that matter want regrets when all is said and done? Most people do not.

Again I will keep you in my prayers & know that God will find you the right program for your Mom. God Bless, Jade

Finolady answered...

My mother recently went to live in the Alzheimer's wing of an assissted living facility. I am on of 6 children and my father passed away several years ago. Only 2 of the 6 of us live near my mother. For a long time we didn't realize she was having problems but it became evident late last year that she could no longer be alone even with my brother coming over to check on her several times a day. The first attempt at keeping her at home was for my adult niece to move in with her. That worked for about 2-3 months. Then she moved in with my sister which lasted about 2-3 months. The problem is that her disease had progressed to the point that she neede a lot of care. We did everything we could to keep her at home but she mostly slept off and on in about 2 hour increments around the clock and disrupted everyone constantly even though many, many things were tried to regulate this and stimulate her mind through activities, but it didn't work.

I guess what I am trying to say is, having a disease and being wheelchair bound is very different from a mental disease where someone cannot think clearly, make decisions or even function independantly. Alzhmier's patients forget where they even are, they forget that they have put a pan on the stove to cook, they go outside and get lost, they open the door to strangers, they cannot get in or out of the bathtub, they cannot, in later stages, understand that they need to go to the bathroom. There comes a time when they must have constant professional care - not due to a physical handicap but due to the fact that their mental abilities are so impaired they cannot function.

Fortunately my family was able to discuss this and agree. The most important thing for you now is to get together with your sisters and decide if your mother can even take care of herself in a limited way when she is home alone while your sister is working. If not, it really is time for her to go into professional care as difficult as that decision is. Believe me, she probably won't even notice at that stage, will be just as happy there as at home and will be cared for by people trained for the job. Just make sure you visit the home first to satisfy yourself and sisters it is a good place.