What to Do When Siblings Can't Agree on a Parent's Care Needs

Siblings! For some lucky families, having a bunch of adult siblings gather around and plan how to take care of Mom and Dad as their parents' health begins to fail is a great comfort. For some families, siblings who never got along as kids and have had little to do with each other as adults being thrown together to make touchy decisions is disastrous.   

For most families, the journey through the mine of elder care decisions falls somewhere between the two extremes. Elder care has a way of sneaking up on people. Generally, if there is an adult child living in the same town as the aging parents, it is this child who becomes, at the first sign of need, the default caregiver. That usually makes sense. You live in town. Your folks need some help with their Medicare forms, so you stop over. They need help with the yard, so you start taking time away from your family to help out. Then its grocery shopping and then, well, you're on your way to taking on a second job.    Ideally, before things get to this stage, you've had conversations with your parents about how they want their needs met during their later years. They've made out the papers naming a Power of Attorney for Health Care (a health directive indicating who will make health decisions if they can't and detailing their preferences for treatment) and a Power of Attorney for financial affairs. A will should be part of this, as well as other personal papers. Ideally, as well, all siblings are aware of these papers, what they contain and all are in agreement. Ideally – taking care of the elders becomes a family affair. However, life is seldom ideal.   

Even in seemingly harmonious families, the person who slowly became a default caregiver can start to feel resentful. The out-of-town siblings can conveniently slide into denial. They aren't around to see how much help is needed. They see Mom and Dad occasionally, talk to them on the phone, and all seems well. The fact that you, the in-town sibling, are the reason everything is going so smoothly doesn't really register with them.  

 This is a red flag for you. It's time to stop and consider how you are, as a family, going to handle the spiraling needs of aging parents. Most experts would suggest a family meeting. I agree. You, the hands-on caregiver, would explain all you do and give your siblings a chance to help. You'd find each other's strengths and weaknesses and work with those. You'd regularly check in with each other and update the whole family as needed. I would suggest this, because it is ideal, and many families can do this with a little work. If this works for your family, congratulations and you can quit reading here.   

Those of you who read the posts on the AgingCare.com forum will see the cold hard facts. You will see that, for many, the chances of a civil family meeting where you hash out the needs of your elders and agree who does what are, well, nil. You will see caregivers stressing over siblings accusing them of spending too much of their parents money to care for their parents. You will read the pleas for help from the one sibling who has quit his or her job to care full time for an ailing parent being either ignored by siblings, or worse, being accused of predatory intentions because they are "running the show."   

Option 1: Geriatric Care Manager  When these ugly scenes pop up, there's usually no way to go but through a third party. It's nice if you can agree on hiring a geriatric care manager, if you can find one in your area. This person would do the managing, get the help set up, and offer a cool head to work out problems, since the manager is not emotionally involved and doesn't carry family baggage.    Geriatric care managers are not available in every part of the country, and there is no over-reaching licensing, so you will want to do your homework. But sometimes, these people can make siblings see the light. They can help the ones in denial realize that the one doing hands-on care is "really working."   

Option 2: Counseling  Family counseling is also a good route, if siblings are willing to work on sibling relationships for the sake of their parents. Talking through the issue with an objective third party, who can guide the conversation and keep it civil, can help families work through the challenges associated with caring for an elderly parent. It helps everyone involved to better understand the other family member's views, frustrations and challenges, and can sometimes offer a fresh perspective.  


Elder Care Mediation  Unfortunately, many family relationships are beyond that point. This is where elder care mediators come in. These people are trained to mediate family disputes. Likely you can find one through your local court system or in the phone book.    Two online places to search for elder care mediation services are Eldercare Mediators at http://www.eldercaremediators.com/ and the Association for Conflict Resolution at http://www.acrnet.org/.    This is certainly worth trying before going to court over guardianship rights, which some families end up doing. It would be lovely if people didn't bring their baggage from childhood into adulthood, but we all do to some extent. If people could at least put sibling rivalry, greed and other undesirable behaviors aside for the sake of their elders, that would also be lovely.    But sharing the care of elderly parents doesn't always bring out the best in people. Add to that hopes of inheriting something from the estate, and it gets worse. This is when third party help is often a good option. For, if the hands-on caregiver doesn't get help somewhere, the damage done can reach far beyond the elders. Resentments nurtured at this time can poison family relationships for generations. If you are the default family caregiver, ask siblings for help early on. Let them know they are wanted (drop the martyr act).    If they have been given a chance and they refuse, try an agency designed to solve family issues. It could be one of the best investments you've ever made.

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How to Convince Your Parent to Move to Assisted Living

Conventional wisdom says that we all want to stay in our own homes for as long as we can. That is likely how most of our elders feel; however it's not always in their best interest to do so. How do we talk with them about the realities and dangers of staying at home once their health is failing, and how do we convince them that a move to an assisted living center could be a very good – and positive option?  I believe that part of the problem with convincing elders, and many younger people for that matter, is that people haven't been inside a modern assisted living center. Deep inside their gut, they harbor the outdated image of an "old folk's home." They consider a move from the family home one more step away from independence and one step closer toward death. They think a move to assisted living signifies to the world that they now have the proverbial "one foot on a banana peel and one foot in the grave." This image and mindset is stubborn.  For many elders, some in-home help and a personal alarm can be enough. They are able to stay in their own home for years with a relatively small amount of help. Then, a spouse dies. The survivor is now truly alone. There's no one to get help for them should they fall and can't set off their alarm. There are few opportunities to socialize. Meals become a chore, so they don't eat well. Memory is failing, and the stove doesn't get turned off. The single elder, stubbornly clinging to the idea that their familiar home is best, can often be a sad and lonely sight. Contrast this life with living in a good assisted living center, whether it's a stand-alone building, one connected to a nursing home or a small family operation where only a few seniors board. In any of these situations, seniors can thrive because: They don't have the responsibility of keeping up a home, so they are relieved of the need to hire help or let the house deteriorate. They have people around should they need medical help or other assistance. They have choices of food and snacks with nutritional value and, in most cases, good quality. Perhaps most importantly, they make new friends and have an abundance of activities to choose from.  Okay, you are convinced. You know that you can't keep providing the constant oversight for your parent that has been taking over your life, and by extension, taking over the lives of your spouse and children. How do you go about convincing your parent that it's time think about moving to assisted living?

1. First, plant the seed. Don't approach your parent as though you've already made the decision for him or her. Just mention that there are options that could make life easier and more fun.
   
2. Next, offer a tour of some local assisted living centers, if he or she is willing, but don't push it. Drop the subject if necessary, and wait for another day.
   
3. Watch for a "teachable moment." Did Mom fall, but escape getting badly hurt? Use that as a springboard. You may want to wait a bit, or immediately say something like, "Wow, that was close. Once you're feeling better, maybe we could go look at the new assisted living center over by the church. We'd both feel better if you had people around." Go with your gut on the timing, but use the "moment."
   
4. Again, don't push unless you consider this an emergency. It's hard to wait, but you may need to. Wait for, say, a very lonely day when Mom is complaining about how she never sees her friends anymore. Then, gently, try again.
   
5. Check with your friends and friends of your parents. See if any live happily in an assisted living center nearby, or if their parents do. Just like your first day of school when you looked for a friend – any friend – who may be in your class, your parent would feel much better if there were a friend already in the center.
   
6. Even if they won't know anyone, you can still take your parent to watch a group having fun playing cards or wii bowling. Show off the social aspects of a good center. Keep it light and don't force the issue. Tour more than one center, if possible, and ask your parent for input. Big center or small? New and modern or older and cozy?
   
7. Show interest in how much privacy a resident has. Ask about bringing furniture from home and how much room there is. Take measuring tapes and visualize, if you can see some rooms, how your parent's room(s) would look. Show excitement, as you would do if you were helping your parent move to a new apartment, because that's what you are doing.
   
8. Stress the safety aspects.
   
9. Stress the fact that there's no yard cleanup, but flowers can be tended to. There's no need to call a plumber if the sink breaks, but there are plenty of things to do if people want. There's plenty of freedom to be alone, but company when they desire it.

Then wait. Let it all sink in. Sorry to say that if you want your parent to make the decision, you could have to wait for another fall or something else before they will be willing to take that step. However, if your family is close-knit, have a meeting with the parent at this point and tell him or her how much better the family would feel if the move were made.

Enlist a family friend or spiritual leader to chat with your parent and state the case for this move. Third parties often can make headway when family fails.

Be sensitive to your parent's feelings. Leaving a home where he or she lived with a life partner, raised kids and once had friends among the neighbors is emotionally difficult. Whittling down a lifetime of possessions is hard. Be kind, be sensitive and try to make it be about your parent and not about you.

However, if you must – let your parent know that it will help you to know that he or she is safe. Play the "we are worried about your care." It's the truth. It's just easier if you can swing it, to let the parent make the decision.

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Moving Elderly Parents Into Your Home

10 Factors to Consider Before Moving Elderly Parents In

 

 

The benefits and drawbacks of moving someone in with you

If you decide to move a parent or other relative in with you, you won't be alone: One out of every four caregivers lives with the elderly or disabled relative he or she cares for. This arrangement can have many positives. If your parent or other loved one is still relatively healthy, he may be able to babysit or otherwise help around the house, contribute financially, and get to know your children in a way that would never be possible with only occasional visits.

But it's not right for everyone. It may be cheaper than putting the person in a nursing home (which costs about $60,000 per year on average) or an assisted living facility (about $30,000 per year on average), but you could pay a heavy price in terms of time, stress, fatigue, and strained relations.

Take the time to consider the following 10 questions when deciding whether to have someone live with you.

1. What kind of care will the person need?

What is the person's physical and mental condition and what chronic illness does he or she have? These are the first questions you need to answer.

If he's still relatively healthy and independent, this may be the ideal time to move him in. He can become accustomed to his new surroundings and will initially require little care from you or other family members. Your kids will get to know him while he's still healthy.

Most people don't consider moving a parent or other family member in until he has some sort of health setback or crisis. In that case, it's very likely you'll be coping with the person's chronic illness. "Know the illness very well," says Donna Schempp, the program director for the Family Caregiver Alliance in San Francisco. "And not just the illness here and now. Where's this illness going to be six months, a year, two years, and five years from now? What are his care needs going to be now and in the future? You need that information."

Even if an aging family member is just slowing down and there's no specific illness such as Alzheimer's or cancer to deal with, you still need to anticipate his future condition based on family history or his personal history. Bringing someone to your home as an interim solution is another viable solution. It may be that he can live with you until his condition deteriorates to a point where he needs assisted living or memory care .

 

2. How much assistance and supervision can you provide?

Caring for an aging relative is a great way to give back some of the love, care, and nurturing he gave to you.

When you take care of someone, you provide a model for your children that shows them what caring and commitm ent are about. It prepares them for the time when you may need care from them and eventually when they may need care from their own children. It's good for children to learn how to nurture and to assist in the care. "Children can be very sweet and kind, even to a demented grandparent," says Schempp.

• Be realistic about what you can and can't do. Realize, too, that the level of assistance needed will most likely increase over time.
• Know your limits. If the person needs help with bathing, dressing, or going to the bathroom, are you comfortable helping? If he's incontinent and the idea of changing a diaper makes you uncomfortable, you might need to find an in-home aide. On the other hand, maybe he's just becoming more forgetful, and you're really good at organizing his medications and helping him make sure to take them. Or perhaps you're good at paperwork and can cut through red tape and help with his Medicare or health insurance forms.
• Consider your schedule. If you have a full-time job and young kids at home, consider the impact of taking in someone who needs a lot of assistance. If, for example, he needs help getting to the bathroom several times every night, you could soon be suffering from a major case of sleep deprivation. You may be reacting to a health crisis he has recently had, or thinking about the move as a preventive measure because he's slowly losing the ability to take care of himself. In either case, think about whether you have the time and energy to take this on.

 

3. How well do you get along?

Look at the history of your relationship with your family member. If you enjoy each other's company and can successfully resolve your differences, that's a real plus. That doesn't mean you can never argue or you have to be best friends.

All families have some conflict, and if both of you can get over it quickly or simply agree to disagree, then you've already done much of the groundwork. You may also be able to bond with him in a new way and forge a happier new relationship as an adult. Your children will have the opportunity to get to know their grandparent or other family membe r better, or perhaps for the first time.

If the two of you have never really gotten along, don't expect the relationship to change magically now. When he visits you, if you're grinding your teeth after an hour and feel like running out the door, then having him move in may not be a good idea. You may feel you're doing the right thing, but if you're both going to be miserable, it's probably wiser to pursue other options first.

Certain ailments, like Alzheimer's and other forms of dementia, can change someone's personality. This change can be for better or for worse. Will you be able to handle what happens when an illness like dementia progresses? The two of you may have always had a good relationship, but dementia can make him angry or paranoid in ways you've never seen before. On the other hand, a difficult person could become very sweet. "You just don't know," says Schempp. "When you move someone in with you, you have to know what the backup plan is: If this doesn't work out, what's going to happen next?"

 

4. Is your home older-adult-friendly, and if not, can you make it so?

Ideally, place an older adult on the first floor so he doesn't have to climb any stairs. If that's impossible, and he can't handle stairs, you can consider putting in an automatic stair lift. For sources, search online for electric stair lifts .

Similarly, if you have steps leading up to your front door, you may have to put in a ramp ($400 and up, plus installation). For sources, look online using search terms such as adaptive access .

Here are some other things to consider:

• Is there a bathroom available on the floor the older adult is on?
• Is the bathroom big enough to handle a wheelchair or walker if necessary? For a wheelchair, the doorway needs to be at least 32 inches wide, and preferably 36 inches.
• Will one of your children have to give up a bedroom? Could a child share his or her bed room with the older adult?
• If there's no extra bedroom, can you convert a living room or den into a bedroom? Can you convert an attic or basement into a bedroom for you or a child and have your parent or relative move into an existing bedroom?
• Will everyone have a level of privacy they're comfortable with?
• What renovations will be necessary to make your home older-adult-friendly, and how will you pay for it?

A good source for a variety of suppliers selling a wide range of home modification products is the National Resource Center on Supportive Housing and Home Modification .

 

5. Will your family member contribute financially?

Moving someone into your home can be a financial drain, but it can also have financial benefits.

• Lighten your financial burden by having your family member contribute. Older adults often want to contribute to the household and can pay more than a nominal amount for food. Many pay rent if they can afford it, or pay for some or all of the renovations required to prepare your home.
• There's no single right or wrong way to handle finances. Your family needs to decide what will work best for everyone. Come to a financial agreement with your family member before making the decision to have him move in. This won't necessarily be easy, because money is an emotionally charged subject in most families. To avoid problems or resentments later, have open discussions about this up front.
• By pooling your resources, you might come up with a better living arrangement for everybody. Using the financial resources of both of you, you may be able to get a home that's much more comfortable than either of you could afford alone. "I know a number of people who bought a bigger, better house for everybody to live in together," says Schempp.
• Include siblings in the money talks. If you're receiving money from your family member, will your siblings agree with this, or will they object or resent it? Will your siblings help pay for the cost of care? Big financial issues often arise between caregivers and their siblings. "How are your siblings going to feel about you getting paid money that was eventually going to be their inheritance?" Schempp asks. "There's no simple answer. It's really about families talking and deciding what the agreement is going to be."

If you move someone in, it will probably cost you, both in dollars and lifestyle. A recent study by the National Alliance for Caregiving (NAC) and Evercare found that caregivers spend on average about $5,500 a year out of pocket to care for an aging relative. A smaller study by the NAC showed the numbe rs may be much higher: Those who lived with their parent spent almost $15,000 a year for care.

How do people afford it? The study found that most make sacrifices elsewhere:

• Almost half cut back on vacations and leisure activities.
• One-third dip into savings.
• One-quarter cut back on groceries and spending for their own health or dental care to help pay for their aging parent's care.

 

6. How do your spouse and children feel about the move-in?

This may be a great opportunity for your children to form close ties with their grandparent or other family member. The United States today is such a mobile society that children often don't get much chance to be around older members of the family. Some children barely know their grandparents, especially if they live far away. If the grandparent is still relatively healthy, your children could benefit from the stories Grandpa or Grandma can tell, the oral history and life lessons they can pass down, the arts and crafts they may be able to teach your children, not to mention the babysitting services that benefit everyone.

When you take in an older adult, you're modeling how to take care o f your own family and teaching your children the meaning of commitment, responsibility, and sacrifice. Children need to be prepared for the extra chores that might be necessary to take care of Grandpa and to relinquish some of the spotlight, since their needs will now sometimes take a back seat to their grandparent's. A child may have to give up her bedroom or share it with a sibling or with an older adult, and she may need help adapting.

Do your spouse and older family member get along, or do they bicker? An older adult who's in decent health may not require a lot of attention. But if he needs a lot of help and supervision, you and your spouse will get a lot less alone time and your social lives may be put on hold. Make sure you're both prepared for this sacrifice before proceeding.

 

7. Will your family member be able to live by the rules of your house?

When someone moves in with you, it creates a sea change in your relationship. You're now the primary caretaker and decision-maker, not your older relative.

It's an opportunity for your entire family to reassess current rules, decide which ones work, and make new ones where necessary. If everyone is willing to adapt and compromise, you can create household rules that work for the entire family and give your older relative a chance to adjust gracefully to his new dependent role.

These are some of the issues:

• Will he be able to adjust to the loss of some of the independence and perhaps the space and privacy he's used to?
• Will he respect your values with regard to your children and how you live your life?
• If he smokes or drinks, is that going to be a problem in your home?
• Will he respect the levels of cleanliness and orderliness you're comfortable with in your home?
• Does he have a pet you're taking in? If so, will he respect your boundaries with regard to pet behavior and cleanliness?

Some older adults adjust to their dependent role easily. Others fight it, or are de pressed or angered by it. In the case of a parent, will he accept your assistance? Will you be thrust back into your old role of son or daughter, with your parent constantly telling you what to do? Will he make you feel as though you never get it right and can never do enough to satisfy his needs? If so, you may just grin and bear it. Or you could take this as an opportunity to set some new boundaries and forge a new relationship.

 

8. Will you and your family be able to adjust to the lifestyle changes involved in having an older adult in the house?

Think about meals, noise levels in the house, wh at's on the stereo. Will everyone's preferences and styles be compatible?

This may be an opportunity to try some new foods that everyone can enjoy. If your older relative needs to eat bland food and your family likes spicy food, you can put the extra salt and spices on the table to add individually to plates.

If you have a teenager who's used to making noise and playing loud music but Grandpa needs quiet at night, perhaps your teen can adjust by using headphones after a certain hour.

If he moves into your home and quarters are cramped, it may take a while to adjust to the loss of privacy and personal space. On the other hand, if you're able to pool your resources and move everyone to a new, larger home, it can be a win-win situation for everyone.

Your family may have to put off some vacations and leisure activities to take care of your parent or relative. If so, this is a chance for your kids to learn the importance of making sacrifices, however difficult, for the greater good of the family.

 

9. Do you have the time to take this on?

If you're working full time, seriously consider the time it takes to have a dependent older adult at home.

• Aside from personal care, there are many logistics to take care of. An independent older adult can make his own arrangements, but otherwise the burden of making phone calls for services and medical appointments will fall on you. You may have to fill out medical forms and deal with insurance companies. If he doesn't drive, then a family member has to take him to appointments and meetings. Can you do that given your current work schedule?
• I f he requires full- or part-time supervision, who will do that while you're at work? Can you afford to cut back your hours at work when someone moves in? Or you may need a more flexible schedule to care fo r him. Does your job provide that option? These are things you need to discuss with your employer before you decide to move someone in. More than a few caregivers have lost or given up their jobs because they couldn't juggle the competing demands of work and taking care of an older adult.
• Take the time to take care of yourself. If you take soemone into your home, you'll want to figure out how to balance your care giving with some care receiving. Caregivers are more prone to illness due to stress and exhaustion, the so-called "caregiver syndrome." And because they're taking care of others, they often forget or hesitate to ask for help themselves. To replenish your mind, body, and spirit, you'll want to think about taking a yoga class, getting a massage, or going to the spa. There are also many support groups for caregivers, either in-person or online. It helps to realize you're not alone in what you're going through. Several organizations offer support groups and classes for caregivers, including the National Alliance for Caregiving , the National Family Caregivers Association , and the Family Caregiver Alliance .

10. Will your older relative have a social network available?

If he's moving a long distance to live with you, he's leaving his social network and friends. Most caregivers drastically underestimate how hard it is and how long it takes for someone to adjust to a new environment in a new tow n. "It's huge," says Schempp. "How are you going to deal with their loneliness issues? They're going to look to you for their socialization. How are you going to either integrate them into your life or help them create a new life for themselves?"

If you and your spouse are at work and the kids are at school, that could mean a lot of alone time for your older relative. Rather than have him just sit around and watch TV all day, you'll want to find out whether there's a senior center or adult daycare facility nearby. Does he drive or will you or another family member have to provide transportation? Is he healthy enough to use public transportation?

Are adult daycare facilities available near you? They offer personal care such as exercise and even transportation, and provide cultural activities such as art or photography classes or trips to museums. Likewise, senior centers can provide a great social network and generally are free or have very low annual membership fees.

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