Sibling conflicts over care of elderly parents

Protecting elderly parents from siblings

As a psychotherapist specializing in working with seniors, I’m sometimes called into situations where middle aged children have descended into an all-out war over how best to care for their aging parents. Often the children are so focused on their own conflict, that they can’t see that their intransigence is interferring with their parent getting the care they need.

Siblings fight over elderly parents. The same old battles

When I first engage with the family, the disagreement is usually framed as being about money or quality of care. But in my experience, these arguments are much more likely to be about emotions than financial planning. Every retirement facility can tell stories of how they’ve had separate siblings in the midst of screaming matches in the hall outside their parent’s room.

These are not easy conflicts to resolve, because the root of the conflict often dates back over half a century ago. These disputes are often reenactments of the roles, relationships, and conflicts that existed when the kids were children growing up together. When faced with this highly stressful situation, and being forced to make decisions for their parents, these old roles reemerge, and suddenly these 50 year olds are back to fighting over who sits in the middle seat.

Some of the emotions that are often driving the conflict include:

Jealousy

This is the classic “Mom always liked you best”. One sibling is perceived, true or not, as always having gotten the lion’s share of the love and approval from the parents. The other siblings have been carrying a resentment, for three or four decades, over feeling second. They bring that pain to the conflict, and it feels as if they aren’t willing to compromise, and can’t be made happy, no matter how hard everyone tries.

Caretaking

One child takes takes on 90% of the work and resents the other siblings for not participating more. And, while they complain about their load, they often refuse to let others help because they are the “only one” who can be trusted to get things done. The other siblings feel shame and guilt, and resent the caretaker sibling for lording it over them.

Competition

In some homes there really isn’t enough love to go around, and the kids feel as if they have to compete for Mom and Dad’s affection. As a result, even as adults the siblings can’t seem to help but to squabble over who gets credit for taking care of Mom and Dad.

Payback

Having felt slighted as a child, an adult child sometimes gets their revenge by ignoring or being highly inconsistent in their attention to their parent’s needs. Or they may constantly try to cut back on the expense of caring for the parent, feeling that every dollar spent is being take out of their future inheritance.

Dealing with difficult feelings

In addition to this replay of family dynamics, siblings also differ in their emotional ability to accept the reality of their parent’s declining physical and/or cognitive condition. Common feelings that contribute to the conflict include:

Denial

Watching Dad’s growing dementia can be so painful that a sibling may resist moving Dad to an assisted living facility, insisting that “he’s not that bad off” and try to keep him in his home even though Dad obviously needs more support.

Grief

The pain of grief may prevent a sibling from being able to accept that Mom is close to death. The sibling may insist on trying every possible medical intervention even though Mom would clearly like to end medical treatment and die in peace.

Shame

Children may fear that friends and relatives might think they are bad children for moving a parent to an assisted living situation. This sense of shame can motivate children to keep their parents from going into a skilled nursing facility or retirement home, even if its clearly the best thing for the parent.

Caregivers upset with siblings

There is no simple solution for these difficult family dynamics. But the conflicts often bleed into the care situation and result in caregivers feeling they are stuck between the patient and the child. This leads to high caregiver turnover and the parent receiving sub-par care.

Working together to find a solution

Because of the potential for conflict, it’s often a good idea for siblings to work with a therapist or mediator to establish guidelines for their caregiving. For example, one strategy is to give each sibling a specific set of tasks, for example, one sibling makes medical decisions, one is in charge of dealing with the assisted living facility, and a third manages the finances.

But, regardless of how well the siblings plan for the parent’s care, feelings are bound to come up and conflicts are certain to arise. For that reason, it is best to arrange occasional check-up meetings with the therapist/mediator to see how the plan is working, discuss areas of conflict, and allow family members to air their feelings in a safe environment.

There is often a tendency for the kids to try and hide these conflicts from their parents. But that is really a useless effort since the impact of the conflict is sure to splash onto Mom and Dad. In working in Geriatric Psychotherapy, I believe ithat it is often valuable to bring the parent into the therapy sessions so that the family system that is supporting these conflicts can be addressed.