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When Mom suffered a hip fracture, Maria took on her care. It was harder than Maria had anticipated to juggle Mom's care, her job responsibilities, her marriage and her two school-aged children. She began to resent her brother Robert, who had moved away from town after college. "He breezes into town," reported Maria. "He takes Mom out to dinner, spends an evening with her and heads out. Meanwhile, I do all the heavy lifting—literally, since I'm the only one trained to help Mom out of her chair or to the bathroom." To top it off, her brother sometimes criticizes Maria's care. "Robert complained that Mom mostly wears sweatpants these days instead of dressing up like she used to. He doesn't even realize how hard it is for me to help her dress!"
When the needs of aging parents change, one adult child often ends up doing the lion's share of the caregiving. Maybe this child lives nearby while others don't. Maybe she gets along better with Mom or Dad. Maybe he is in a better position to ask for flextime at work. Gender assumptions might be a factor—Princeton University researcher Angelina Grigoryeva recently confirmed that in the U.S., daughters still provide more than twice the amount of care to aging parents.
Whether primary caregivers gradually take on more and more tasks as their loved one's needs change, or assume the role in response to a sudden health crisis, chances are good they will need more help as time passes. Caregiving is hard work, impacting the caregiver's health, emotional well-being and career. Caregivers are at risk of stress and depression—the "caregiver burnout" that experts warn us about. If you are the primary caregiver for an elderly parent, consider this strategy for getting more help from brothers and sisters:
Hold a family meeting. The first step is to get everyone on the same page—and if possible, in the same room. The meeting might be formal or informal, depending on your family's style. If it is not possible for everyone involved to be together, out-of-towners can Skype or conference in. It might help to prepare an agenda ahead of time and share it with your siblings and loved one.
Prepare a list of caregiving tasks. Let your siblings know what you have been doing for your parent and what needs to be done. Then, involve everyone in devising a new list that divides the tasks. It may be impractical for family who live at a distance to be in charge of hands-on jobs, such as grocery shopping, home maintenance, personal grooming and transportation to doctor appointments. But they can provide support and backup. Some families establish a year-long schedule during which senior parents travel to stay with adult children who live out of town Or, if that's not practical, out-of-town siblings can visit to provide time off for the primary caregiver. Put the agreement in writing and distribute to everyone.
Don't make assumptions about your siblings' motivations. If you approach the meeting full of resentment, this will probably set the tone for the gathering, which could quickly descend into defensiveness. Instead, keep in mind that your brothers and sisters may not be aware of all that you do. As they are not as familiar as you are with your parent's care needs, they may feel awkward and unqualified to help. They may already be feeling guilty, which can stand in the way of practical progress. They will most likely be grateful to you for providing them with concrete information and a "to-do" list.
Include your loved one in the discussion. Whenever possible, the parent for whose care you are planning should attend and participate in the meeting. None of us likes to think that others are plotting behind our backs! No matter what your parent's physical or mental status, acknowledge and respect their presence. And never talk about your parent in the third person as though he or she were not in the room.
Avoid the pitfalls of sibling dynamics. Almost every family has their "issues"—old patterns of behavior, competing loyalties, hurts, insecurities, jealousies. During family meetings, there is a primary agenda—"How do we care for Dad?" And then, often just beneath the surface, a secondary agenda of old family business: "Mom always loved you best." "The folks helped you buy your house." "We gave them grandchildren…." The best way to minimize this rehashing of old business is to acknowledge that there are, or may be, such issues and agree to put them aside.
Call in an expert. During the care planning process, many families enlist the services of a geriatric care manager, an elder law attorney, or a therapist specializing in geriatric issues. These professionals not only help families negotiate disagreements; they also help the family locate senior support resources. There is normally a charge for these services, but the expert help usually saves money and reduces conflict in the long run. As a bonus, during meetings, most family members are more likely to be tactful and cooperative with an outside person in the room. And knowing that the meeting is costing money often motivates families to remain focused on the business at hand.
Go to a support group or seek individual counseling. If in spite of all these steps your relationship with your siblings remains contentious and you are feeling emotional distress and confusion, it may be wise to work on your challenges with an individual or group that can offer emotional support and practical solutions.
Talking About Financial Fairness
Don't shy away from the money talk. Few people realize how much money family caregivers spend on their loved one's care—an annual average of more than $5,000 out-of-pocket, according to estimates. This figure doesn't even take into account the impact on a caregiver's paycheck when they must cut back on work hours or quit their job to take a less-demanding position. If you are the primary caregiver, present this information to your siblings. They may not realize how much caring for your parent costs you. Work together or with an expert to divide costs more equitably. An increased financial contribution is one way siblings who live at a distance can do their fair share.
Some families agree that the sibling who is providing hands-on care will be reimbursed by other siblings; in some cases, families assign a per-hour value to the caregiver sibling's time and reimburse for that. (Talk to an attorney about tax implications.) In many families, siblings who are not able to serve as primary caregiver help pay for professional in-home care to supplement the care provided by their sibling. Professional in-home caregivers come to the home while the primary caregiver is at work. They provide personal care and hygiene, housekeeping and laundry services, meal planning and preparation, socialization, and care and supervision for special situations such as when an elderly parent has Alzheimer's disease. They provide much-needed respite care that allows the primary caregiver to take a break to spend time with children or take a vacation. In-home care also offers the advantage of normalizing the relationship between parents and adult children. When a professional takes over grooming and hands-on care, this frees the family to spend time together doing the things they enjoy and provides an extra measure of dignity for the elder who needs help with personal care.
Caring for elderly parents is an important chapter in the story of most families. Studies show that the way siblings handle their parents' needs at this time sets the stage for their future relationships—and sets an example for the next generation.
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