How to Avoid Sibling Conflict Over Caregiving for a Parent

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If you’ve ever argued with your sisters over whether it’s time to move your mother to assisted living, or your brother thinks he knows better than you what’s best for your father with Alzheimer’s, or you have a sibling who doesn’t want to be involved at all with your parent’s needs, you’re not alone.

Sibling disagreements over a parent’s caregiving issues are common, says Dr. Susan Leonard, M.D., assistant clinical professor of medicine at UCLA Medical Center. “There’s a lot of sibling conflict over everything,” says Leonard, who specializes in geriatric medicine.

“It’s a lot like taking care of a child. There’s a whole spectrum of how people choose to deal with it,” Leonard says, explaining that it can become very challenging for adult children to come together  to figure out how to plan and care for a parent.

Factors such as how many siblings are in the picture, everyone’s financial status (adult children and parents), and whether or not everyone lives in the same town or is spread out across the country can impact how siblings deal with decision-making. Here are some strategies for minimizing sibling discord over caregiving for an older parent.

Should siblings divide and conquer?

While caregiving should be a team effort among siblings, selecting one person to be the “designated representative” in the family is one approach that can work, Leonard says. For some, that job naturally falls to the oldest or to the sibling who lives the closest (or in the same home) as the parent, she says, but it doesn’t have to be that way. Some siblings may choose a family member who’s a doctor or nurse since that person may be more at ease talking with a parent’s health care team.

If the parent still has the ability to make decisions for themselves — if they’re not cognitively impaired — siblings should give their parent the chance to select the designated representative, says Leonard. “The parent’s wishes should take precedence over what the children think should happen. When that individual is still able to make decisions, the children have to respect what that wish is and have a conversation about how to address conflicts and disagreements about it,” says Leonard. She notes that as a physician, her goal is to prioritize the wishes and choices of her patient.

If a parent is cognitively impaired to the point that their decision-making ability is poor, then the designated sibling’s job might include anything from assuming power of attorney to making choices about medications and nursing home care. Regular family meetings in person, on Skype or FaceTime, or on conference calls can help keep the lines of communication open between siblings. Siblings who aren’t the designated representative can use those family meeting times to weigh in on decisions, too. (Related: Putting Plans in Place for a Loved One with Dementia.)

Communication strategies for siblings

Staying up-to-date on a Facebook page or other social media site — sharing pictures and anecdotes about a parent’s health and life, or updates on their medical conditions — can keep siblings better connected and reduce conflicts.

“I think it helps to meet regularly. It depends on family dynamics, but in order to avoid crisis situations, it’s important to stay in touch. There should be communication — ongoing communication — rather than only when a crisis happens,” Leonard says.

If siblings are struggling to make decisions together, doctors and social workers at geriatric medical practices, nursing homes, and hospitals can help them work things out, too. “We have conversations if the family members are conflicted. We can guide them through it and provide assistance and input,” Leonard says. With the advent of telemedicine, siblings can make a lot of care arrangements and medical decisions virtually with each other and with their parent’s medical team, too, says Leonard.

Some siblings do seem to weather a parent’s end-of-life issues more successfully than others, Leonard says. Those families tend to have two qualities she says: communication and flexibility.

“It’s similar to a work environment. You have to communicate and get along — and have the ability to delegate tasks. For example, one sister may be the one who manages transportation to appointments, another one may handle financial things, and another one handles caregiver issues,” she says.

Amy Goyer, AARP’s Family and Caregiving expert and the author of the book Juggling Life, Work, and Caregiving, recommends siblings make the effort to communicate in a collaborative way even about the little things — choices about mom’s meals or daily routine, for example. “Sometimes those little things are the things that build up and can cause problems among sibling relationships,” says Goyer.

Avoiding emotional landmines of caregiving

When one sibling takes on most of the care and decision-making, it leads to caregiver stress and burnout. “It happens more when the family members can’t agree and someone takes over,” Leonard says.

“I have patients whose adult children every single time spend half of the time in the clinic arguing. I have others where the [adult] children get along well and collaborate and work well as a team. What’s really important is that in the family they have to feel comfortable with the dynamic. Otherwise the conflict creates a bigger domino effect,” Leonard says.

Sometimes, by talking together on a deeper level, siblings may come to a better understanding of each other’s feelings. Goyer says, “With caregiving, it’s often very emotional. Mom’s 85 and deep down we’re afraid she’s not going to live long. There can be fear and grief, particularly as part of the journey with a parent who has dementia.” (Related: How to Avoid Caregiver Burnout for Alzheimer’s and Dementia Caregivers.) Understanding where the other person is coming from and communicating with respect can ease tensions, she says.

It’s also common for some siblings to be in denial about a parent’s health and prognosis. For example, when a parent is in the early stages of Alzheimer’s, one sibling may not want to believe their parent is going to become sicker — especially if that parent was the family matriarch or patriarch — while another sibling may already be planning for nursing care for when the parent becomes sicker. Being realistic and creating a health care plan together for the future can make things less complex later for siblings, Leonard says.

“Be resourceful. Be in touch. Be educated. Be aware of what’s going on,” she adds. Being proactive, not passive, about a parent’s care can help siblings stay close and connected and make good decisions if a health crisis does occur, she says.

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