Are You Caring For A Declining Parent?

Scarcely a day goes by anymore when I don’t hear of one more person I know who is caring for a parent in declining health.  How ironic it is that as our medical universe gets bigger, more sophisticated and more effective we find ourselves living longer…while also we’re outliving our abilities to care for ourselves!  There’s no doubt that in most situations this is very upsetting to the ageing person.  Most folks hate the idea of “becoming a burden to my loved ones”.  However, the senior family member isn’t alone in this concern.  What sorts of demands does this place on the caregivers?  Ever consider the matter of “who’s the patient?” in situations like these?  Let’s take a moment to consider the ramifications…

After many years of practicing as a therapist, I think it’s fair to say that whenever any close member of a family gets into difficulties, all the family members wind up affected by the situation.  That means the whole family is to some degree “the patient” during this time.  Here are at least a few ways people get affected:

• loyalty issues
• living proximal to the ageing person
• resurrection of ancient family struggles
• anticipation of distribution of wealth issues

When it comes to loyalty, I’ve never met adult children who don’t want their parents to be happy and secure, and   regardless of how it might seem, family members have loyalty feelings toward them.  If you have several children, you’ve probably noticed that there is one child you simply “connect” with more easily than the others.  That sort of feeling level connection is commonly reciprocated by the child, and when the need arises for some ageing parent assistance, this child is often the first one to step up.

In many ways this is good solution, but it does set the stage for that particular adult child to get overloaded with care concerns.  We have to guard against the caregiver getting “burned out” since it’s liable to be a long haul as the declining process moves along.  Burnout can happen also if the caregiver lives fairly close to the ageing parent…they then become the “natural choice” to shoulder looking after mom or dad simply because they live nearby.  Also, some adult children are just plain better at caretaking than their brothers or sisters; once again, they’re the “natural choice” to handle the challenge.  This isn’t really fair, of course, and it eventuates in hard feelings between the siblings, but we all know it happens all the time.

Truth be told, we shouldn’t let one sibling do all the caretaking work…it’s not fair and it’s also a pathway for the others to feel guilty about “not really being there for mom/dad” during their decline.  If we tolerate this from our less-than-responsible siblings we’re “enabling bad behavior” which is liable to escalate into outright conflicts.  Everyone should take a turn staying over weekends, doing chores and running errands, and just simply staying in touch with the ageing parent.  No excuses – it’s mandatory to show up for the game!

Caretaking involves developing a somewhat “special relationship” with a parent in that it’s a reverse of what’s usual…usually we have parents taking care of the kids…and now we have the kids taking care of the parents!  Technically, this is called a “hierarchical reversal”, which much of the time is not a helpful phenomenon in family life, although in this situation it’s much more understandable.  However, it may open the door to the reemergence of long-held issues and grievances which have been dormant for a long time, resembling the matter of “mom/dad loves you more than me”.  Looking carefully at this, one can easily see how a “special relationship” intimates that one child is more special to the parent than the others, triggering old competitive feelings and affection/closeness inequalities to get resurrected after a long period of dormancy.  This can happen innocently enough and without any particular intention on anyone’s part, but activating powerful feelings and resentments that have been sleeping inside the adult children for a long time is a recipe for blowups.  Blowups like this can really add to the feeling the ageing parent may have about “becoming a burden to my children”.

Lastly, the caretaking of an ageing parent naturally brings up the matter of their death and managing the estate issues which inevitably arise.  How do the siblings organize discussions about this?  The primary caretaking sibling is often seen as having the most information about these matters, has also been designated as Power of Attorney and perhaps also named as executor.  Since the possibility of some siblings feeling excluded is high, care has to be taken to include everyone in the information stream routinely.  Without comprehensive communication, struggles can develop between the siblings.  See how we’re painting a picture of possible caretaker burnout due to lots of challenges being placed at the feet of the primary caretaker?  That’s why, in best-case scenarios, there will always be multiple caretaker siblings.  Old issues that have never been handled properly, like one sibling receiving monetary gifts of support periodically throughout his/her lifetime, or another sibling receiving heirlooms of furniture, automobiles, or other valuable household items over the years are seen as “early inheritance distributions” by the other siblings and create feelings of inequity.  It’s up to the caretakers to get these issues of unfairness handled as a part of their caretaking tasks.

The bottom line – be careful about taking on the job all by yourself.  Include siblings so you get a break, insure involvement by all parties, and promote fairness and sharing.  Have regular sit-down meetings with siblings to discuss important decisions regarding the parent’s care, and steer clear of making snap decisions without everyone affected having time to consider the options.  This time of life can be immensely creative and meaningful for both the parent and the siblings, and can set the stage for positive adjustment and solid relationships between folks as life moves forward.