Home • Community Resources • Register • Search

State Agencies

Helpful Articles

Legal Forms

Elder Caregiving - bringing the family together

By Rae Horwitz
This article originally appeared in Elder Caregiving: An Exploration, a special edition of New Jersey Jewish News.

It's a common situation in the case of an elderly parent who lives alone. Mom is ready for discharge from the hospital. She lives alone and has fallen in her apartment. This is her third admission this year. The diagnosis is unclear, but she is frail and ill. Little home-care help is available through Medicare.

Sally, the eldest daughter who lives closest to Mom, has taken on the role of primary caregiver. Andrew, her brother, can't make the discharge planning meeting because of business commitments. Jean, who lives furthest away, arrives with lots of advice about how Mom should be cared for. Jean then returns home to a different state and communicates by phone with the family. Sally feels abandoned but continues on her third round of caregiving. On the surface, she accepts her role as her duty and doesn't complain. On the inside she is tired, frustrated and resentful. It's hard to provide loving, not dutiful care when you feel alone in he process. Many family members complain that when an illness is sudden and critical there is an outpouring of help, but when the illness is chronic, well?wishers soon tire, leaving the primary caregiver with the full responsibility for care.

For most individuals, the family is the primary source of social support. The study of family dynamics teaches us that all families have a set of unwritten and unspoken rules. These rules re represent the attitudes and values that have been handed down through the generations, and they define how the family members interact with each other and with outsiders. These values have an impact on how family problems, including the aging process, are addressed and resolved and how seeking help outside of the family is viewed.

The roles that siblings take in these situations often reflect roles and dynamics they established in childhood. Although not always the oldest, one sibling may be designated leader. This leader was often depended upon by Mom or Dad or both, in other instances, to be "the responsible one." Another child may be the joker of the family, providing comedic relief with a humorous approach to any family situation. Some children become the provokers of conflict who stir up arguments while other siblings assume the role of "peacemaker" to counteract the family conflicts. Other siblings are the family "negotiators" who like to see things running smoothly. All vie for attention from their parents through their individual roles and in fact often remain in these roles throughout their lives.

How does this relate to caregiving? When there is a crisis and families come together for decision making, invariably the adult children take on childhood roles and recreate old dynamics of competition and resentment. Mom or Dad is not there to settle these disputes so they must find new ways to resolve the situations.

When we cannot restore our loved ones to their previous levels of day-to-day functioning, all sorts of feelings emerge in the caregiver. Feelings of frustrating quickly turn to anger that life has been disrupted. Sometimes the child who becomes the primary caregiver resents having to nurture a parent who was not a particularly nurturing or loving individual. Just as parents view each of their children differently, each child sees his or her parent in a different light. For children who have always struggled to please their parents, it is time to recognize that the parent's need may be insatiable.

The best way for the primary caregiver to get help is to ask for help. Although this sounds simple, it is not always easy. Often the caregiver has been in the role as family leader since childhood and is perceived by others and him/herself as completely competent and comfortable in this role. It is expected that the caregiver will continue in this role. It's a big step for this person to acknowledge a need for help and to say "I need your help" to family members. These four words can go a long way toward describing feelings and needs. If caregivers can delegate responsibility to family members, by all means they should. Maybe the family member who lives furthest away can be encouraged to assist in paying for home care since actual visits will be infrequent.

With some siblings it may be best to communicate by e-mail, particularly if the sibling is the "conflict provoker." Just be sure you're feeling calm before logging on. This might be a good opportunity for the family peacemaker to arrange a family meeting to discuss what's happening and what is needed to address a parent's situation. If the family needs help organizing themselves, then a geriatric case manager who has experience with individual and family therapy, knowledge of aging issues and awareness of local resources for the parent and family members, can be contacted.

Becoming familiar with local community resources, such as the Jewish Family Service and the County Division on Aging, can be beneficial.

The sudden or gradual dependency of an aging parent or spouse disturbs the equilibrium of the whole family. The parent may have irrational expectations of the caregiver, and the caregiver may grow frustrated and resentful with the parent. The crisis of illness, however, affords an opportunity to improve family relationships. The highest quality of care is available only when family harmony can be achieved.

Rae Horwitz is a licensed clinical social worker, who is coordinator of Private Case Management and the Hospice Affiliate Program of the Jewish Family Service of Central New Jersey.

Back to the top