My brothers and sisters and I have come together over the years to deal with family health crises: my mother’s two serious bouts of illness and hospitalization, my father’s bypass surgery, my brother’s wife’s year-long battle with terminal cancer. We were younger then and, for the most part, whoever was around and able stepped up to the plate.  But now that we are living many miles apart and entrenched in our own lives, with worries ranging from potty training to college tuition to rebuilding diminished retirement funds, how will we manage the care of our parents now that they’re old?

I was not surprised to read recently that the greatest source of interpersonal stress is siblings. The bond between brothers and sisters is persistent, deeply rooted, and the longest ongoing relationship of them all. The dynamic between siblings is fraught with rivalry from the very beginning. But somehow, amid the intense competition for parental love and attention, the seed of family solidarity is sown, nurtured by shared experiences and common gripes. Whether your relationship is one of love or hate or love/hate, that solidarity becomes an imperative as power transfers from one generation to the next and adult children make the moral trek towards parenting their own parents.

Thankfully, my mother and father are, at this moment, well and active and socially engaged. Yet I watched each of them deal with their own parents’ decline. My mother’s mother was happy and vibrant well into her 90s but died in a care facility a few months shy of her 102nd birthday. Mom wanted Grandmother to come to live with us, but her seven siblings wouldn’t agree to that. And they never really developed an equitable plan, although my grandmother received plenty of attention from her eight children, 25 grandchildren and many, many friends. My father’s father succumbed to emphysema in a nursing home and his mother, flummoxed by a series of strokes, moved in with Dad’s sister and her family. They cared for her for thirteen years.

My four siblings and I are close, but we are not alike—in fact, in some ways we couldn’t be more different. Beyond our respective talents, we assumed specific roles in the family, shaped largely by the ways our parents interacted with us in response to birth order, gender, and temperament. As the oldest, I was supposed to be responsible, a role model for the others. My youngest sister, the baby, struggled for years to be viewed as the capable adult that she is. All five of us are now middle-aged, and our parents are solidly in their 80s.  It’s time for us to begin a painful conversation.

Before I called my sisters, I felt compelled by history and common sense to pay attention to journalists with expertise in care giving issues, like Gail Sheehy and Francine Russo. Both say, Don’t wait for a crisis. Be prepared. Plan ahead.

Russo says that baby boomers are confronting a combination of conditions that have never existed before. Thanks to modern medicine, our parents are living much longer than they were a generation ago, but often with chronic illnesses or dementia requiring daily attention. Women, once available to assume family caregiving duties, now have professional commitments and responsibilities. American families tend to be far-flung these days, complicating efforts to share the duty of eldercare among siblings.

Parents requiring ongoing care can force siblings into a family reunion lasting years—conjuring up old wounds, resurrecting competition, and replaying the roles assigned in childhood as they negotiate the terms of who will take care of Mom and Dad. Daughters living closest to home tend to shoulder an unfair portion of the burden and resent siblings who haven’t a clue about what they’re going through. More often than not, parental favoritism plays a major role in an adult child’s inclination to participate at all. Who loves Mom the most? Whom did Mom love most?

We may be surprised that visceral hostilities, long dormant, take over rational decision-making when health issues for our parents become serious.

We may not even be able to agree on the need for care—one of us sees forgetfulness where the other sees Alzheimer’s. And the battles begin.

This is what we kept in mind as my sisters and I began to talk. We speak regularly with one another, and we’ll bring our brothers into the conversation at some point. As a family, this is what we know: our youngest sister was given healthcare power of attorney by our parents and we all agree she is best suited for this role; our mother adamantly opposes living anywhere but the home she has shared with my father for more than forty years; our father invested in long-term care insurance many years ago, not wishing to be a burden to his children.

What’s difficult is creating discussion from the unknown. We don’t know what will be asked of us. We have no idea what the future looks like. And there is no guarantee of what we all wish for: a sudden painless death after a long and happy life.

At the very least, as brothers and sisters we can be civil, show respect for one another and commit to finding consensus about what is best for the ailing parent. It’s clear that I, living two thousand miles away, don’t have the same perspective as the brother who lives in my parents’ home, or the sister who’s balancing a career and very young children. But we can agree to be aware of old resentments creeping into the conversation. And we all know that it’s important to get the best information we can from health care professionals.

I’m anticipating a few disagreements with my siblings as we navigate the future. Each of us has strong opinions. I tend to be practical and forthright, for example, while my youngest brother is sentimental. My sisters and I talked about possible hot-button topics—financial questions and inequities of time and effort. That’s as far as they wanted to go at this point, with serious health concerns seemingly so far away. We’ll take small steps towards a real plan, following the experts directives, harboring high hopes that we never have to use it.

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  • Amanda Mecke July 9, 2010 at 5:20 pm

    You are absolutely right to start talking now with your siblings.

    The most important thing I learned as the eldest adult child — and the one living closest to my parents — was to talk as often as I could to all my siblings. We were scattered over the country. When I was too tired to repeat myself three times, I emailed or asked one to talk to the others. It is never to early to discuss with your siblings what your parents may not yet be able to talk about with you themselves and to explore various scenarios. Besides if you talk before the emergency, you can agree to disagree while you each learn more than you want to know about health care (or lack thereof) in America. You don’t want to argue when that makes it harder to come to a final decision, but it is only fair for everyone to have his or her say. It is also only fair that the person who is “on the ground” has to be able to make everyday decisions without having to get prior approval.

    Furthemore, when my father had a series major strokes, and my mother’s heart failure was getting worse, we hired a Case Manager to monitor her increasing medications as well as to help us understand the doctors’ reports on both my Mom’s and my Dad’s conditions. Her advice went a long way to helping all of us, both when we visited Mom and Dad and when we were trying to help from a long distance.

    We found an extremely empathetic woman who had been an RN, and even though insurance didn’t pay for her, she earned every bit of her hourly rate. She made the single greatest difference in our being able to make sure my father’s final three months were the best hospice care he could have had. Furthermore, she helped us negotiate with the hospital to maximize the early rehabilitation he very much wanted to attempt; she drove my mother to visit him, and gave her (and all of us) accurate but realistic advice about my father’s final illness.

    When we convinced my mother to leave the Cape and move close to me, we had a complete record of her medical care to give her new doctors, and we had learned from my father’s illness much of what we needed to know for her benefit about Medicare, Estate planning, Assisted Living vs. “In home” care; Rehabilitation vs. Skilled Nursing, Housekeeping help vs. Medication monitoring, etc. etc. etc.

    Since my mother’s move into Assisted Living and then Skilled Nursing I have not hesitated to ask Nurses and Social Workers the same questions I learned to ask during my father’s illness. They could help me much more because I had a better idea of what we could — and could not — control about my mother’s health and emotional well being.

    In the ten years since, I have never talked to someone else going through elder care without recommending they explore the option of getting help — even just as a consult — from a Case Manager.

    I found ours through my company’s EAP (Employee Assistance Program)who told me how to find lists of qualified people. Even if you’ve never thought going to EAP for help, it is worth making that call to see what support they can provide for elder care.

  • Bunnee July 9, 2010 at 7:19 am

    My sister and I have had major problems with these issues. Her philosophy was “whatever makes her happy” when it came to our mother. My more pragmatic approach was to insist Mother could not live alone any longer so we had to find another solution. My sister insisted she would be available as much as needed without factoring in her frequent multi-week vacations. I prevailed, with our mother moving into a retirement residence which was conveniently located, provided her with her own apartment, meals, housekeeping and activities. My sister then decided the house should not be sold “in case she doesn’t like the new place and wants to go back.” Fortunately, my mother expressed no interest in returning to a house in need of major renovation, a house which had become a burden in many ways. Honestly, I await the sale of the house at this point so I avoid further interaction with my sister – at least until the next major event.