Navigating Family Dynamics in Caregiving

Thanks to advances in medicine, people are living longer. While this is a positive thing, extended caregiving can add tension and some stress within the family. How will you care for your parents at home? Who will look after them? How will expenses be paid? Watching your parents' strength and independence decline is difficult for anyone to witness. After combining the emotions, stress, and predispositions of a whole family, it is understandable that tensions may arise.

An article published by Family Caregiver Alliance has not only put together a helpful guide on how to navigate this situation as a family but also suggests having the conversation of care as early as possible. While it is easy for family members to make assumptions, without having a clear conversation, this can do more harm than good. Establishing clear and attainable responsibilities within your family because of these assumptions will allow your family to be as prepared as possible as your loved one ages.

Similarly, depending on your family dynamic, there may be disagreements on the level or type of care your family believes that your loved one needs. For many people, accepting the fact that your loved one needs help can be difficult to digest. Family Caregiver Alliance suggests the following ways to handle this problem:

1. If there's no emergency, allow some time to get everyone on the same page. It's natural for [family] to take in the situation at different times and in different ways. This can happen regardless of whether they're far away or close.
2. Share information. Get a professional assessment of your loved ones condition by a doctor, social worker, or geriatric care manager and send the report to your family. Try using email, online care-sharing tools, and/or in-person family meetings to help keep everyone abreast of care issues and information.
3. Keep in mind that your loved one will often tell their family members different things about how they're doing. This is a good reason to keep communication lines open with each other and to try to pool your information about your loved ones health.

It is easy to become side-tracked and feel like you are not making your loved one "happy". This is too much of an emotional burden on you and your family to hold, and the primary focus should be getting the support that they need, whatever it may be. Family Caregiver Alliance has pinpointed these "clues" that might show that you and/or your family are acting out emotionally:

1. Your level of emotion is out of proportion to the specific thing being discussed right now. For example: getting into a heated argument about which of you should go to the doctor with Dad next week.
2. You or your family criticize the way you think another person is being. For example: selfish, bossy, uncaring, irresponsible, or worse.
3. You feel that none of your family understands what Mom needs the way you do and you are the only one who can do certain things.
4. You or your family generalize a discussion, saying, for example, "You always do this!"
5. You or your family criticize the way one another feels, for example, "You don't care anything about Mom."

If you feel these emotions at any time, it could be the moment to take a step back and re-evaluate your reaction to the situation. Was it rational? Was it helpful to your loved one and/or family? Is there a more effective way to tackle the situation at hand?

Lastly, below are some tips for winning more support from your family, put together by Caregivers Alliance:

1. Try to accept your family - and your loved one - as they are, not who you wish they were. Families are complicated and never perfect. There are no "shoulds" about how people feel. They are not bad people or bad children if they dont feel the same as you do. If you can accept this, you are likelier to get more support from them, or, at least, less conflict.
2. Do not over-simplify. Its easy to assume that you are completely right and your family are all wrong - or lazy, irresponsible, uncaring, etc. Each person has a different relationship with their loved one, and each persons outlook is bound to be different.
3. Ask yourself what you want from your family. Before you can ask for what you want, you need to figure this out and thats not always as simple as it seems. First of all, ask yourself whether you really, deep down, want help. Many caregivers say they do but actually discourage help. So think hard. Do you want them to do certain tasks regularly? Do you want them to give you time off once in a while? Or do you feel you have everything under control but youd like them to contribute money for services or respite?
4. Or - and this is a big one for many caregivers - do you really not want them to do anything but youd like more emotional support? Many caregivers feel lonely, isolated, and unappreciated. If youd like your family to check in on you more, ask them to call once a week. And tell them it would really help if they would say "thanks" or tell you youre doing a good job. They are more likely to do this if you dont criticize them for what they are not doing. Ask for help clearly and effectively. Asking is the first step. You might ask for help by saying: "Can you stay with Mom every Thursday? I have to get the shopping done for the week and it gives me some time to myself." Dont fall into the common trap of thinking, "I shouldnt have to ask." Your siblings may assume that you have everything covered so they dont recognize the added responsibilities and "burden." They are involved with their own lives and struggles and not so attuned to yours that they can read your mind. Also, if youre not exactly sure what you want from them, you may be giving them mixed messages. Ask directly and be specific. Many caregivers hint or complain or send magazine articles about the hardships of eldercare. But these strategies do not work well. Ask for whats realistic. People get more when they dont ask for the impossible. So consider the relationship your family member has and ask for what that person can really give. If your sister cant spend ten minutes with Mom without screaming at her, dont ask her to spend time; ask for something thats easier for her, like doing paperwork or bringing groceries.
5. Watch how you ask for help - and steer clear of the cycle of guilt and anger. Avoid making your family feel guilty. Yes, really. Guilt makes people uncomfortable and defensive. They might get angry, minimize or criticize what you are doing, or avoid you. That is likely to make you angry, and then you will try harder to make them feel guilty. They will attack back or withdraw even more. And round and round you go. Sometimes your family will criticize you because they are genuinely concerned about your parents. Try to listen to these concerns without judgment and consider whether it is useful feedback. At the same time, be bold by asking for appreciation for all that you are doing - and remember to say thanks back when someone is helpful. Be careful of your tone and language when you request something. Its not always easy to hear the way we sound to others. You might think you are asking for help in a nice way, but if youre angry, thats the tone your family will hear. And theyre likely to react in unhelpful ways.
6. Get help from a professional outside the family. Families have long, complicated histories, and during this very emotional passage, it is often hard to communicate with each other without overreacting, misinterpreting, or fighting old battles. Even the healthiest families can sometimes use the help of an objective professional. People like family therapists, social workers, geriatric care managers, physicians, or clergy can help establish what is real, and needs to help distribute responsibilities more equitably. In family meetings, they can help you stay focused on the topic at hand and help you avoid bringing up old arguments.
7. Steer clear of power struggles over your parents assignment of legal powers. Whether or not you have been given your parents legal powers over finances or health, you need to remember that it is your parent who has made these decisions. If you have your Moms or Dads power of attorney, be sure to keep detailed records and send your siblings statements about how you have spent Moms money. This may seem like a lot of extra work, but record keeping is required by law, and being open will reduce distrust or distortion - and lawsuits. If a sibling has been given legal power, try to accept your parents decision and dont take it as a personal attack on you. Do your best to work with the sibling who has the authority by presenting expenses and bills in black and white. If the sibling who has the purse strings doesnt cooperate, then bring in a professional to explain your parents needs and to mediate. If you are concerned about manipulation, a changed will, or undue influence, contact your local Adult Protective Services.
8. Dont let inheritance disputes tear your family apart. If you feel wronged by the way your loved one has divided their money and property, its natural to be upset, especially when you are grieving. You may feel that you deserve more because you have cared for your loved one. If thats what you feel, you need to discuss this with your loved one while they are alive and can make these decisions. If you suspect foul play by another family member, then this is the time to consult an attorney or Adult Protective Services.

Yet, research shows that our loved ones feel a need to leave their estates equally as a sign of their equal love for their entire family. When they divide things unequally, its often because they are worried that a particular member of the family will be in greater need. Whatever their reasons, remember that it was your loved one, not any one family member, who decided this. 

Remember, this is a complex and emotional situation for your family. Whatever emotions you may be feeling; those around you could be feeling the same way. Take time to care for yourself, while at the same time remaining patient and open-minded with your family. Now, more than ever, it is time to come together and support each other during this time of transition for your family.

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