All in the Family: Sibling Rivalry and Caregiving

I’m an only child, so I’ve always known that when my fiercely independent mother needs care, the responsibility will fall squarely on my shoulders. I view this fact as both a blessing and a curse.

On one hand, I will have no one to argue with about important decisions. My mom is incredibly detailed and organized, so I know exactly what she wants at the end of her life, and I don’t need anyone else chiming in. On the other hand, I’ll have no one to cry with as we clean out her closet and reminisce about her love of white pants and clip-on earrings.

This isn’t to say I don’t have support. My husband and friends couldn’t be more available and empathetic. But they’re not her offspring. We don’t have a shared history. They don’t know where she keeps the Christmas village reindeer and that when she asks politely if you’d like to take your shoes off as you enter her house, it’s not a request.

What’chu talkin’ ’bout, Willis?

I’ve long romanticized the sibling dynamic, viewing early influences like The Brady Bunch and Diff’rent Strokes as more fact than fiction. Sure, Marcia lost a hot date when Peter hit her in the nose with a football, but what really mattered is that they loved each other enough to come to amends by the end of the episode and lived happily ever after with no resentment or ill will.

Because that’s what happens in every sibling relationship, right? Complete harmony and cooperation on key issues, like caregiving for instance. Wait—it’s not?

Come to find out, one sibling—and one alone—generally takes on the vast majority of the responsibility of caring for an older parent. And that inequity, combined with the stress of watching someone you love decline in health, can be devastating to the overall sibling dynamic.

Beth MacLeod, a licensed clinical social worker in San Francisco, says personality type, birth order, and one’s external relationships can affect sibling caregiving involvement. “For some people, taking on and giving has always been their role. Some can handle difficult emotions and others just can’t. There also may be a sibling with a spouse who’s jealous or ungenerous and who restricts the availability of the sibling.”

Geography is a major factor, too. The sibling who is physically closest to a parent usually ends up making most of the decisions, which can be an issue for siblings who live on the other side of the country and have conflicting views on the way care is provided. All of this is a recipe for conflict. Longstanding rivalries can reignite, and old wounds can reopen.

A better way

Inexperienced family caregivers provide 90% of the support and care received by older persons, and a survey from the National Family Caregivers Association found that 76% of those caregivers perceive that they don’t receive help from other family members. But it doesn’t have to be this way.

Yes, caregiving can cause resentment, but it can also strengthen bonds and provide a common, uniting purpose. “Few families are so cooperative that there is no discord, or so chaotic that older relatives get ignored or abused,” write Donna Cohen and Carl Eisdorfer in their book, Caring for Your Aging Parents. “Some families may appear to be too contentious and bitter to cooperate, but that same family may rally together during a life-threatening crisis.”

One way to increase the likelihood of rallying together? Set clear expectations from the get-go.

The family meeting

Experts recommend getting on the same page as quickly as possible after determining the need for caregiving by holding a family meeting, whether in person, by email, or over video or phone conferencing.

During the meeting, it’s important to set boundaries, agree on goals, assign responsibilities, and air feelings without attacking others. If you’re the primary caregiver, be as clear as possible about the ways you need help. If caregiving is causing you financial hardship, ask your siblings to contribute if they are able to.

If your sibling is the primary caregiver, offer support and ask how you can be of assistance. If tensions run high and you aren’t able to agree on key issues, MacLeod recommends involving a mediator or private geriatric care manager, who “can help dispel what may be a lack of information about both the illness and the long-term care system, and what options are available in the community.”

MacLeod also encourages meeting with the majority of parties even if everyone isn’t on board. “Don’t hold off having a meeting because one person won’t get involved; go ahead and do what you can as soon as you can. Then be specific in your requests—like ‘I need you to take Mom to her doctor at 3 p.m. Thursday because I have to work’—rather than a general statement such as, ‘I wish you’d help out more.'”

Tips for clear communication

In her book How to Care for Your Aging Parents, Virginia Morris offers some specific guidelines for communicating during family meetings:

• Agree to rules in advance, and don’t allow anybody to dominate the meeting.

• Agree on a time limit for each person’s input, and listen without interrupting.

• Avoid accusations and blaming.

• Keep the discussion focused on parent care rather than on sibling issues.

• Discuss the parent’s diagnosis and prognosis, what the major concerns are (both now and in the future), and what needs to be done.

• Make a detailed list of all tasks, such as paying bills, researching resources in the community, interviewing home health aides, touring senior day care or assisted living facilities, talking with financial and legal professionals, and organizing important documents.

• Appoint one sibling to serve as the family’s voice when talking with health care professionals. This person may or may not also be the primary caregiver.

• Divide the duties. Start by letting siblings volunteer. Even those who live far away can handle bills, make phone calls, or do some paperwork.

Ultimately, if your siblings fail to help, reach out to the larger community. It’s important for the primary caregiver to have a support network, and if that can’t be in the form of family, it can be in the form of friends, a community support group, or even an online forum.

Most importantly, don’t close the door on your siblings—metaphorically or literally. As MacLeod notes, “It’s important to hold the mind and the heart open to change. As much as possible, maintain an open invitation.”