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Caring for Our Aging Parents

An elder mediator and author helps siblings negotiate care for Mom and Dad

When we were younger, cocktail party conversation used to quickly turn to talk about the kids or work. But today, at least for boomers and the older crowd, casual chatter is quickly being replaced with heart-to-hearts about the challenges of caring for aging parents or in-laws. You might have only just met this person or barely know them, but there you are, exchanging confidences, or hinting, about thorny family dynamics!

See also: Excerpt from Mom Always Liked You Best.

Elder mediators are in popular demand by their baby boomer children

Elder mediators help siblings resolve Mom or Dad care issues. — Photo by: David Madison/Getty Images

You probably leave for your therapist or closest confidante the super-juicy stuff: frustration with your bossy sister or doesn't-lift-a-finger brother, or the mudslinging and recriminations over your parents' safety, capabilities and wishes, or topics involving inheritance or the division of cherished family possessions.

But these days, you also might turn to an elder mediator. In elder mediation, a trained professional, who might also be a therapist or an attorney, helps adult siblings and, if they're alive and up to it, their parents resolve contentious issues relating to Mom or Dad. Everyone gets to express an opinion (no extra charge for tissues). The mediator's job is to redirect the accusations and keep the family focused on coming up with solutions.

Rikk Larsen, along with partners Arline Kardasis, Crystal Thorpe and John Dugan, founded Elder Decisions, a Boston-based company that provides mediation and trains professionals in this burgeoning, and quite new, field of conflict-resolution coaching. Mediator Larsen and his colleagues have poured their collected knowledge of how to navigate the tricky world of taking care of aging parents into a self-published book, Mom Always Liked You Best: A Guide for Resolving Family Feuds, Inheritance Battles & Eldercare Crises.

Larsen spoke to the AARP Bulletin about sibling disputes, elder mediation and this complicated time of life.

Q. Why is elder mediation taking off?

A. Interest is exploding now because baby boomers tend to be sophisticated consumers and are comfortable with the concept of therapy and other forms of professional help. Elder mediation is not therapy, although it is therapeutic.

Q. What's it like for parents to know their children are sparring over their care, property or decisions they've made?

A. It's very painful because they think they're making good choices and they may resent their children trying to take over. They're particularly troubled that their kids are unable to get along and "be there" for one another. They can't bear to hear their kids bickering about anything. So Mom, who has been the rock of the family, now tells each child what they want to hear and agrees with everyone.

Next: What if family members are spread around the country? >>

Q. Should parents always be present for at least part of the mediation discussions with their adult kids?

A. Whenever possible, they should be there or at least have a representative standing in for them. Certainly there are times when it's inappropriate for them to attend because it will upset them too much or they're very cognitively impaired, or they can't physically make it, or they just don't want to be there, but having them in the room can change the tone of the meeting.

Q. How so?

A. I had a family with eight siblings, and although I'm certain their mother couldn't follow the conversation, they wanted her there. I think they behaved much better than they might have otherwise.

Q. What's the ideal attitude for going into such a process?

A. It's a willingness to hear others and the ability to be clear about what you want and why, without needing to get everything you want. You have to be curious about what's important to others, respect each person's viewpoint, have an open mind and a sense of optimism that as a group you can come up with a solution.

Q. Why is it so important for families to know what they're doing?

A. A mismanaged process can lead to a permanent rift.

Q. What are the most common reasons for family dissension?

A. There are a lot of issues! It's usually when siblings think things are unfair, such as one sibling shouldering the bulk of a parent's care needs versus the others who second-guess or criticize that care. Or one member using the vacation home a lot more than the rest and not considering another's interest to sell it when others live far away and/or need the money.

Q. Isn't it natural to have resentment when one sibling does more than the others?

A. Be careful not to confuse being equitable with being fair. There's no way to measure a contribution of love or effort if one sibling does more because she lives nearby. It's just the way it is. What she might need is acknowledgment and thanks from the others. It doesn't mean she gets to make all the decisions, though.

Q. How about the fallout when family members are spread around the country?

A. You have to work around it. You can still stay informed and help however you can, whether it's speaking with the doctors, handling the bills, offering financial support, researching resources or providing a break so your sibling can get away.

Next: Is elder mediation expensive? >>

Q. What are other reasons for disharmony and tension?

A. Parents are living longer. Dad may not be the capable patriarch he used to be or Mom no longer the communication hub. That means the old way of communicating and doing things must change, and that creates a leadership vacuum and thus more opportunities for disagreements. Also, the oldest isn't necessarily the smartest or the best leader, and maybe their parents have given them all the power. And don't forget entrenched family relationships. If you get people together, they sit where they did 30 years ago at the table and unconsciously act like they did then, too.

Q. How do you keep the ancient history from thwarting sound, joint decision-making?

A. You get it out there. Let people vent and acknowledge those old wounds. I might ask, "What do you need to hear from your brother in order to move on?"

Q. Why is it so tough to resolve these issues?

A. Siblings tend to feel strongly that their position is the right one and then talk over one another and don't really listen. Often sibling X reacts to an issue, like Dad burning pots and pans and not paying his bills, by insisting on an extreme outcome, like he has to go to a nursing home when there are other less drastic options available. Dad and sibling Y want him to stay in his own home as long as he's safe.

Q. What do you do?

A. Together, I'll work with them on thinking about ways to meet their common interests, which are to keep him safe and support his happiness and well-being. As a group, we'll do some collaborative problem solving. Depending on the situation — rather than the nursing home route — it could be hiring a bill-paying service and a part-time caregiver, signing up for Meals on Wheels or getting Dad driving help.

Q. Is professional help necessary to resolve elder issues?

A. Certainly there are families who successfully manage major life transitions by themselves, but I have no doubt that if you bring in a professional, the process can be less painful and the outcome better. The truth is that no family goes gently into that good night. By that I mean there are always issues, whether addressed or not. The way people communicate is critical, and unfortunately during times of elder transitions, that communication is tested. The typical family communication system is rarely up to the challenge, so just the act of getting together in a formal, safe session with a third-party neutral who isn't going to be making decisions is tremendously powerful and often leads to great problem solving.

Q. But everyone needs to have the same information for that to happen, right?

A. The first task is to get the facts on the table. We often ask families to bring in outside experts like a financial planner, a geriatric care manager or the family attorney to explain complicated legal and financial matters so that everyone has the necessary information and understands it.

Q. Is there a way to reduce or eliminate the ill will?

A. It's ideal to have families discuss issues before parents die, but we all know that doesn't always happen. One scenario I've seen repeatedly is the decision to give one child less money in the will because that child has a lot more financial resources than the other siblings. But that sibling might feel mistreated and view it as a symbol of not being loved because the rationale behind that decision was never discussed. Again, it's a communications problem.

Q. Does everyone have to agree in order to have a good outcome?

A. What's wonderful about mediation is that it allows everyone to be heard, and even if they can't completely agree, at least they've been treated well in the process and have a clearer understanding about why certain decisions were made.

Q. Is it expensive?

A. On average it's around $2,000 to $7,000. It depends on the number of people in the family and the complexity of the issues. If there were three or four individuals, it would cost around $2,000, and if you bring in financial experts it would cost more, but it would still be a lot less than going through litigation. Mediators don't usually take retainers or charge by the hour, and it typically takes two sessions.

Sally Abrahms, who writes on aging and boomers, has published in Time, Newsweek, the New York Times, Parade, and USA Today. She lives in Boston.

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