When siblings become caregivers

A few years back, Sheila’s mom, Marlene, crashed her car in Sheila’s driveway. Sheila and her three brothers made the difficult decision to take away their mom’s car.

“She didn’t like that situation, but I told her, this is for everyone’s safety,” says Sheila. Sheila then noticed that her mom was struggling to do basic things like keep track of time, make decisions about what to buy at the grocery store and to shower properly. Not long afterwards, Marlene was diagnosed with dementia, and Sheila, who is now 60, was spending seven days a week at her mother’s house, cooking and cleaning and helping to bathe her.

All of Marlene’s children live within an hour of her Michigan home, yet Sheila, who lives the closest and is the only daughter, ended up in charge of most of the work. When Sheila, who requested that her last name not be used, told her brothers that their mom wasn’t showering, for example, her younger brother said that he and his wife had noticed she smelled the last time they visited — but “they didn’t ask if I needed any help, or assist mom,” Sheila says. “They just went about their lives.”

Collaboration between siblings is vital when caring for an aging parent — and that can present a challenge for even the most solid of sibling relationships. It’s a challenge that more and more people are facing: In the United States, the number of caregivers of family or others aged 50 and over increased by 7.6 million from 2015 to 2020 to reach a staggering 41.8 million, according to a report by the nonprofit National Alliance for Caregiving and the AARP. This means that today, around 17 percent of Americans are caring for an aging individual.

The Covid-19 pandemic has only exacerbated the situation; elderly people, especially those with preexisting medical conditions, are more vulnerable than their younger peers to Covid-related complications. This has piled on stress for caregivers like Sheila, who spent the entirety of lockdown in 2020 taking care of her quarantined mother while the rest of Sheila’s life was put on hold.

Even when there isn’t a pandemic, siblings may face numerous stumbling blocks when looking after an aging parent, from unequal division of caregiving tasks, to different perceptions of the parent’s needs, to denial over the parent’s condition. Old wounds and rivalries may reemerge, leading to arguments and resentments that affect care decisions.

“In some profound ways, your brothers and sisters, they’re equal. You’re on the same line of the family tree,” says University of Calgary researcher Bonnie Lashewicz, who focuses on how families navigate responsibilities and identities while supporting relatives who have a mental health disorder, chronic illness or other disability. But at the same time, “adult sibling ties are complex — and when parents need care, sibling ties can be fraught with divided alliances, histories and priorities.”

How these sibling relationships are navigated while caring for a parent can greatly affect how the quality of caregiving plays out down the road. While each case is different, experts have some general advice that can make the process easier — such as breaking down caregiving tasks early, listening to each other’s concerns and reviewing the financial implications of care.

Sibling animosity and accord

Siblings are known to play a pivotal role in adolescent development, providing an important source of companionship, affection and intimacy. But they can also be a huge source of hostility. The frequency of sibling conflicts typically peaks during early adolescence, says University of Missouri developmental psychologist Nicole Campione-Barr, coauthor of an overview of adolescent development in the Annual Review of Psychology.

In the teenage years, these disagreements tend to revolve around issues of equality or fairness — like who has to take out the trash — or feelings of invasions of personal space — like your sister going into your room without your permission. But fluctuations between affection and animosity don’t necessarily mean the relationship is a poor one; the siblings who can negotiate this tricky love-hate bond are the ones likely to have supportive and beneficial relationships later in life.

Each sibling also has their own distinct relationship with their parent, and these family dynamics are often bubbling beneath the surface when it comes time to care for an aging mother or father, says Matt Lundquist, a psychotherapist and founder of Tribeca Therapy, a psychotherapy center in New York City.

“There are old hurts and bad feelings, resentment, rivalries, expressions of hierarchy, senses of long-ago injustices, conflict between siblings,” Lundquist says. “There are often more historical issues afoot that are unknowingly, perhaps, or not fully knowingly, interfering with what seems like an already complicated decision.”

Dave (not his real name), a writer in San Francisco who also cared for his aging mother, recognizes that childhood resentments have played a significant role in how he and his sister approached caregiving tasks. “My sister always felt that I was the favored child and called me the ‘mom whisperer,’” says Dave, who asked to remain anonymous in order to preserve what remains of his family relationships. “She was treated not as well. Not cruelly, or maybe she’s experienced this as cruelty. She tended to be somewhat overlooked.”

In most cases, according to Lundquist, it’s best for siblings to try to put these feelings aside and focus only on what’s best for the parent. This can begin with breaking down each siblings’ strengths and assigning caregiving tasks accordingly. One sibling may be better at managing schedules and should therefore be in charge of the parent’s medical appointments, while another sibling may be great with numbers and should handle the parent’s bills. This may also involve appointing a primary caregiver who will deal with most of the work and be the first to step in if there is a crisis.

Often, the sibling who lives closest to the parent becomes the primary caregiver by default. But long-distance caregivers can still do plenty by providing emotional support, arranging professional services like nursing aides, handling online duties like finances, and planning visits that provide important respites to the primary caregiver.

If siblings are on different pages about caregiving tasks, it’s crucial to listen to and respect each other’s, and the parent’s, concerns. “Understanding the other person’s values or goals is critical to navigating the differences in those goals,” says Allison Heid, a Pennsylvania-based gerontologist who works as an independent research consultant and studies how to provide ethical care to older adults. “What are the values and preferences of both parties in this care relationship?”

Facing up to finances and death

Along with complicated emotions, many of these decisions often come with significant financial implications, forcing siblings to choose who will pay or whether they should use their parent’s assets to help cover the costs.

Ideally, the parent will already have written a will or assigned someone as their financial guardian. If this is the case, that sibling should keep their own funds separate from their parent’s funds and be completely transparent in all of their financial dealings, because secrecy can raise tension and suspicions down the road when the time comes to divide any assets. If there is no will, siblings should gather a list of their parent’s finances, tax returns and assets, including property, and make an appointment with a lawyer who can review the information and advise on next steps.

Preemptively talking about parents’ deaths can also help families prepare. This is difficult terrain, as some siblings may be struggling to accept the reality of their parent’s condition and refuse to be involved in caregiving tasks in order to protect themselves from facing their own loss, writes licensed clinical professional counselor Gary Gilles, who practices in Illinois, at the website MentalHelp.net.

“We don’t like thinking about mortality,” says Lundquist. “Individuals who are themselves getting older can think about the consequences, as they become more frail, on their adult children and grandchildren, or great-grandchildren.” The goal here isn’t to make talking about death easy, Lundquist says, but to become more comfortable talking about uncomfortable things.

If a sibling is really struggling with this process, it may be best for them to talk to their own therapist, friends or partner, as opposed to their siblings, in order to keep emotional disputes to a minimum, Lundquist adds. Or, if the siblings are willing, they can go to family therapy together. In cases like these, Lundquist starts by asking what the siblings’ goals are. Are they aiming to try to resolve old resentments and conflicts? Or do they want to deal only with the caregiving tasks at hand?

Sheila has seen many of these issues arise with her siblings while caring for their mother, who is now 84. Before their mom started needing help around two years ago, they never discussed the logistics, or the financial and emotional pain, that comes with caring for an aging parent.

But Sheila’s older brother has been willing to have some of these tough conversations more recently, and in November 2021, just before Thanksgiving, the siblings made the difficult decision to move their mother out of the family home and into a nearby assisted living facility.

To pay for her care, they’ll have to sell some of their mom’s assets. This includes the family home and the land surrounding it. Sheila’s youngest brother isn’t happy about the decisions, but Sheila is trying to look at things pragmatically. 

“We’re going to have to sell the house and all the belongings for her care,” she says. “And that’s OK, because it has to be done.”