How do my sister and I come to an agreement about whether my parents should move to an assisted living facility?

12 answers | Last updated: Jan 13, 2012
A fellow caregiver asked...

My mother is having an increasing number of mobility issues, and my father is her primary caregiver. My sister wants them to go into an assisted living facility immediately, because she thinks the burden is getting to be too much for my dad. My parents have no interest in moving, and my dad says he likes taking care of my mother. I feel the decision is up to them. Still, my sister is angry with them for refusing to consider it -- and furious at me for not backing her up. Am I right or is she -- and is there any way to resolve the issue?

Expert Answers

David Solie is an author, educator, speaker, and thought leader in geriatric and intergenerational communication. His book How to Say It to Seniors: Closing the Communication Gap With Our Elders is a landmark text that has been read and reread by legions of baby boomers searching for a better approach to working with their parents and other older adults.

The struggle between siblings over their aging parents never comes down to right or wrong. It always involves a clash of agendas that quickly degenerates into a battle of wills. In most cases, both adult children have a valid point of view about how to deal with their aging parents.

In my experience, the best place to start is by talking with your parents. What do they want? If you and your sister ignore the need for your parents to retain some element of control in their lives, you'll wind up seeing your best-laid plans vaporize as one good idea after another is rejected.

Does this mean that you're right in this case? Yes and no. Yes, in that you understand how important the issue of control is for your parents. At the same time, your sister has a point when she argues that your parents may not be able to "age in place" indefinitely. Your family needs a backup plan for the day when your parents can no longer manage on their own. The solution may not be assisted living, however. Rather, it may be extensive in-home services, if that's what your parents prefer and can afford.

I recommend that in a quiet moment when your parents aren't there, you let your sister know that you want to be her ally in taking care of your parents as they age. Make sure she understands that while you think they're OK for now, you share her concern about their long-term living situation. Suggest that you both sit down with your parents and encourage them to develop a backup plan. Remember that your parents are more likely to be receptive if you let them take the lead in the decision-making process. Your whole family will feel better if you have a backup plan in place -- which should make your family-get-togethers a lot more enjoyable.

Community Answers

Elderesolutions answered...

Sometimes, siblings are able to engage in this type of conversation, sharing concerns and agreeing to work together with their adult parents. A family meeting may actually work when the group sits down together to honestly address their thoughts.

Other times, siblings (and their parents) may have difficulty having this type of discussion without a facilitator. Elder mediators have the skills to help the siblings find common ground, and to assist the family to develop a workable plan. As neutrals, elder mediators create an environment that provides everyone an opportunity to talk (and to listen!) Creative solutions may result that wouldn't have happened otherwiseI

Other professionals may also be of assistance to help the family understand the issues and move forward appropriately, when they disagree. However, other experts typically take an advocacy role which could seem like they are taking sides. Most other professionals have other ulterior motives (i.e., a lawyer has legal issues to prepare, a counselor aims to help people have a healthy outlook, and geriatric care managers' focus is on maintaining the independence of the older adult, providing assessments, care plans and resources.) Mediation (or a facilitated conversation) works because of both neutrality that makes everyone feel heard and acknowledged and a defined process that keeps everyone "in check".

A fellow caregiver answered...

First and most important. Are your parents able to care and pay for all their needs without help or money from you and your siblings? If they are you and your siblings have no right to get involved without being asked and from what I read of your comment, it seems like you and your siblings are trying to make choices for your parents without being asked. It is their right to do as they please if they are capable in mind and money/etc. Try visually to put your self in their place and remember you will be old one day if you live and have children would you want them to do this to you?

A fellow caregiver answered...

As I watched my mom care for my dad who has sinced past away. He was a diabetic who had multiple amputations of his foot and then his leg, and was becoming blind. I watched as she struggled with bathing issues with him, in their small bath. She insisted to remain in their home.

1) I tried to find out as much as I could about their financial situation.

2) If they insist to stay in their home, plan to have adjustments made to handle their disabilities. Such as a ramp, bath rails, lighting, etc. To make their home as safe as possible. How about a life-alert alarm? Start making these adjustments early. These make nice birthday, holiday gifts. Remember it is their home.

Also, if your parents belong to a senior community center. Usually they have meals on wheels and other services available.

3) Also, have a Plan B. Consult your parent's doctor about their medical care. Then both you and your sister shop around for assisted-nursing care. Every facility is different, with different levels of care, in different depending on the type of care requirement. Plan ahead so you have an idea what is available. Should your parents require hospitalization, the hospitals kick you out so fast you don't have time to think what to do. Usually there is a case worker to help, but if you have some idea what to look for, it is only to your advantage.

Most important talk with your parents about Power of Attorney and medical advocate. Good Luck!

A fellow caregiver answered...

I had the same problem in my family and in some cases one person has to become the voice for the parents. I have the entire load on my shoulders now. I went to court and now I have guardianship. I do not regret it at all, it will be 3 years in November's I can tell you as time goes by you will need to be able to come together or have just 1 person to make the decisions for them. It is very hard and is a job you can not take off work and expect everything to be done by someone else when you go back to work because every day they change. Some days it's as if she remembers you the next its work for her to know you. Harder to walk or bath and so forth. Be ready for it and do not take it personal. Loving care will make the parent feel as if they know you, at the end of the day all is well. She has problems with memory and walking and bathing. But fighting in front of them will make it worse on them and hurt your family unit. So if you can have a family meeting and everyone understands the problem it will work for all. After taking my mother to the doctor and had testing done , we had a family day at the doctor's office and the children that did not want to admit there was a problem had to face facts by the doctor's word. They also had question and answers with the doctor. When we left the office everyone was informed and ready to take action for the best outcome for mom.

Bethkent5 answered...

Support is what they need at this point. All the above comments are great but remember you can only do what your parents are agreeable to. In my family, I'm a nurse and became the primary manager. Mom and Dad and I made a plan about what to do as they aged. They wanted to stay home and had the money for supportive care. When it came time to impliment the plan Mom wouldn't let anyone in the house. MANY challenges!! It was a constant struggle but with patience and joint decision making you can find some creative solutions.

Marly26 answered...

If your father is caring for your mother and enjoying it, let it be. Your sister shouldn't be telling you that your not taking her side. Ask your sister how she would feel if one of her family members' wanted that done to her. If at some point your father is unable to care for your mother then yes, Assisted Living is the way to go. If your father doesn't feel pressured, is still able to live a normal life then why move both of them to somewhere you father doesn't want to go. This itself will put him into a deep depression. Is this fair? No! If your father were complaining 24/7 things would be different. As well your father can get Homecare for your mom if need be, just so he can get out and have some me time, either that or you or your sister give him that time. My mother who wasn't well decided she wanted to go into a Manor, I as a Healthcare Provider gave her a list of what to ask them. My sister took her to the Manor, she asked the questions that I gave to her (me already knowing the answers) she phoned when she got home and said simply I'm not going. I applauded her. She found a girl from the High School (Grade 12) who needed somewhat of a p/t job, we interviewed her and it was the greatest gift we could have given mom. She was happy, she could live in her own home, if she needed help this girl was there for her. If something was needed during the day my sister took care of it. I was living out of town and my sisters' employment was just around the corner. My mom is now gone (R.I.P. Mom) but I feel that this was the greatest gift we could have given her. You may mention this to your sister. Even with your mom not being well and they moved their could be repercussions on her medical issues', when those dont' want to leave their home, they are doing okay, leave them to be. They wouldn't do it to you or your sister unless absolutely necessary, so why would your sister want different than what your father wants. That is so unfair. Your sister should be happy that she doesn't have them both living with her rather than Assisted Living. I look after my father in law, have been for and its not easy. I have to make sure I take "me" time out or I'm sorry but I would lose it. I thank my Homecare for coming in and giving me that 4hrs.per wk. I can then do what I need done for me. Even if its just driving around. I'm away from home and dont' have to worry. My prayers are with you and I do hope that I have answered your question. Good luck my dear.

Rfbrownpe answered...

My first principle is; "Honor thy father and thy mother." in part, this means their well-being is as important as yours.

If your motives and actions regarding your parents are based in love and adheres to this principle you will be miles ahead and have a relatively easy time of choosing what to do as circumstances change - and you can be sure they will.

Protecting their personal inalienable right to pursue their own lives as they freely choose is one essential way to do this.
a] Ask them. b] Listen to them. c] Evaluate their ability to effectively understand their own abilities and limitations; physical, mental, emotional, and their ability to mitigate limitations. d] Obtain professional assistance in making this evaluation if you have any doubt or if you want meaningful support for your assessment. I used a neurologist working in this field. An MD can provide physiological data that a PhD can not.

This step is essential - while lawyers may have a few things they do to assure themselves of a person's competence, this is for their protection, not yours or your parents. Lawyers are not competent to assess the competence of another; appropriately trained and experienced MD is needed. When competence is questioned, assessment should be repetitive, as in at least every six months. This accomplishes two things: 1. It provides evidence as to when they were competent and 2. narrows the window of when they were no longer competent. This is critical to deciding when any document they signed was valid, and especially the time, after which they could not sign for themselves.

If you demonstrate your respect for your parent's right to independence, and they are of reasonably sound mind, there is high probability they will bring up a need for a change of arrangements when the current arrangements no longer work for them. If you set up a conflict of wills with them, no good can come of it for them or you.

If your sister will not cooperate with you, you may need to arrange medical and legal visits for your parents between you and them in order to have you and them fully informed. If your sister takes the route mine did, and acts unilaterally in secret, you may need to assist your parents without her participation.

Of course no one can 'age in place indefinitely', we all will definitely die at some time. Where we die, and under what circumstances are questions best answered by each of us for ourselves, as long as we are competent to do so. More important to us is where we live, and the circumstances of our living. In our case, both of my parents were clear and firm that they wanted to be at the home they built and lived in for 60 years, for life and death. Both considered 'nursing' homes and 'assisted' living as places to go to die. We have honored their preferences, long after they were seemingly capable of knowing where they were.

While it would be beneficial to you and your sister to reconcile and work together for your parents' well-being, this matter is secondary to honoring your parents and the choices they make for their lives - for after all, it is their lives.

Lets be thankful we are in a free country where they still have the right to choose for themselves - at least until the muslim clerics or Obama's socialist minions have the power to choose for us.

Howard3 answered...

I would add that this situation (siblings fighting over how to best care for a parent), is very similar to how a family fights over any inheritance. A lifetime of relationship issues is always in the background i.e. "mom always liked you best cause you were the "baby" of the family and people have to realize how that effects how they are dealing with a sibling. My wife is 8 years older than her brother and basically raised him because both parents travelled a lot and left them at home with a grandmother. My brother in law, in every conversation will bring up that he has a business degree so he should be in charge of any money decisions, however he is so frightened about being cut out of the will that he will not do anything that might 'confront" his parents. My wife is always the one who has to bring up topics like "gee, you're 90 you really should have a living will and "we are a little concerned that your housekeeper has moved in, all the family photo's have disappeared and now she is living there full time"

Dc409 answered...

When you say your mom has mobility problems do you mean a wheel chair? If that is the case then there is no discusing assisted living facility. They don't allow wheel chairs. They feel that if a person needs a wheel chair they donot give that level of care.A person needs a nursing home. And if your dad is takeing care of her, than he does not qualify for a nursing home. Maybe both you and your sister must speak to their doctor to see how much care each individual needs It seems like they both have different levels of needed care.Your father might know that and is overworking himself so as not to be seperated from her.

Jane f answered...

There were a lot of helpful suggestions here, but I'd like to add that in some cases (like ours)it seems that the most important issue is not being addressed, and that is what is best (and safest for several folks)for the loved one. I speak of our situation only. Over 4 years ago my husbands brothers quit communicating with him totally. It was because they disagreed about their moms care needs. At that time she was falling and injuring herself, hitting parked cars and leaving unaware, accusing everyone of stealing, calling police on neighbors, ordering stuff with credit cards and reporting identity theft when items were delivered because she didn't remember. She is diabetic (we were told by her doctor), she denied saying he was in a conspiracy. She was diagnosed with demntia over 5 years ago at age 80. She has had a quad bypass as well in the last 4 years, and knee and hip surgeries too. She takes tons of herbs and supplements with are contraindicated with her prescribed blood pressure meds. Doctor told brother in law to take them all away from her and throw them out (he told them in front of her and she agreed). When they got her home she went into a rampage about her "pills", and he caved and let her keep them all. She is scammed by mail order doctors with cancer cures but she never had cancer. She has been paranoid for many years and has delusions of smelling things at times and homeless people sleeping in her car, she still drives. The fence post in her drive has been hit several times my husband saw the dings recently. She is again calling the police frequently and they knew who she was when I called to question a report she made, even before I mentioned her name or mine! This in a town of over 100,000 people hmmm. We got a letter from her today stating the neighbor is picking her dead bolt lock and climbing in her laundry room window and stealing her vegetables and checkbook. She stopped payment on a bunch of checks which is likely to cause her legal and financial issues. She is on a low fixed income. She found the checkbook and claimed the neighbor broke back in and returned it. She also stated the neighbor got a loan in HER name without her knowledge and then didn't make payments FIVE years ago, so the bank called her. That neighbor did not live in that rental then, some man did. She chased him off with her delusions as well. She is causing the current neighbor great stress and filing reports of theft against her. We feel it is time for the power of attorney to step in and help her. She needs medical work up, he needs to take the car for safety reasons and stop her from harming herself financially. She has been left to be in control of everything to give her "independence", but there has to be help when there are mental and physical, and safety issues such as ours. The neighbor has said she is reporting to the Division Of Aging. If durable power of attorney chooses to ignore the problems can he be legal held accountable? Or be made to get help at least? Or should we do as he wants and just let her be? Sorry so long.

Emily m. answered...

Hello Jane F,

Thank you very much for adding to the conversation. In addition, if you'd like to post your own question, you can do so here:

Take care, Emily | Community Manager