When complicated sibling dynamics get in the way of caring for an aging parent
By Eleanor Tanno, M.D.
Caring for an aging parent is one of the most stressful times in life. In my primary care practice, I often commiserate with patients that it can be like caring for a toddler again. However, this dependent person becomes less, rather than more, independent with time. Unlike a toddler who grows up in a predictable number of years, this stage of life has an undefined timeline and can linger. And, this parent may be twice as heavy as their caregiver. This makes doing even simple tasks extremely challenging.
What can complicate caring for a sick parent even more is caring for one when there is a stressful sibling dynamic. Having a sibling who is less involved than you are can cause resentment when you are spending all your free time doing the extremely difficult task of caregiving.
Things often worsen if your parent becomes critically ill and you need to make medical decisions for them. Many times, at this point, a distant sibling will show up and expect to have an equal voice in the care. This can be maddening to the sibling who has been there, day in and day out, caring for their parent. How dare this sibling show up at the eleventh hour with their entitled opinions and uninformed suggestions!
Or, perhaps, you know your sibling will not be there at the end, even when time is short with your parent. Perhaps you are estranged, or your sibling has a mental illness that impedes them from being available.
How can you plan for these situations?
You can talk to your parent in advance. You can discuss their end of life wishes. You can ask them to create a legal medical Power of Attorney (POA) that specifically names whom they want (or don’t want!) to be present and making these decisions for them. If your parent is not married, decisions will fall equally to all adult children unless there is an advance directive that specifies otherwise.
It is also important that you encourage your parent to talk to all people who may expect to be involved in the end. Even if your parent names you and not a sibling as their medical decision maker, you should still encourage them to discuss their wishes with everyone. That way, there are no surprises at the end of life that could further damage your relationship with your sibling.
I’ve heard more than one patient over the years tell me that their sibling has accused them of “giving up” too early on their parent at the end of life. No one wants the added burden of this kind of accusation. This is a huge amount of guilt in what is likely an already very challenging situation. This guilt can be prevented if all children are involved in the conversation with their parent about end-of-life wishes. That way, everyone has a clear idea of their parent’s goals and whether the medical care is consistent with those goals.
To summarize, if you have a complicated relationship with your sibling, I highly recommend encouraging your parent to discuss their end of life wishes with both of you, and, legally name their POA(s) in writing. Having these things done in advance can minimize straining an already compromised relationship between siblings.