“You don’t have any money left to buy extra things,” I told my mother flatly.
“Yes, I do!” she countered.
We had this disagreement three dozen times during the years in which I was her caregiver. It wasn’t resolved until her dementia progressed to the point that she lost the capacity to spend money on her own. Yes, it made my mother feel good to buy lunch for her home health aide or purchase new slacks at Talbots. But, as I kept annoyingly repeating, her savings were nearly gone, and her Social Security check barely paid her bills. Didn’t she care that I was already digging into my pocket to cover some of her costs while also worrying about paying for my own family’s needs? She didn’t care, it seemed. “I’ve got to live!” she insisted during every argument.
Family members of all kinds have fought over money matters since time immemorial, but it may be worse for cash-strapped caregiving families. The costs of caregiving activities, including hiring aides, buying supplies, and covering medical and pharmacy copays, negatively affect family caregivers’ pocketbooks and morale. According to the “Caregiving in the U.S. 2020” report by AARP and the National Alliance for Caregiving, “about one in five caregivers report experiencing high financial strain as a result of providing care.” This is especially true for those involved in high-intensity caregiving for over 21 hours a week, who often deplete their savings and go into debt.
Caregiving-related money conflicts are only partially about dollars and cents, however. Some, such as the ones I had with my mother, hinge on differences in priorities: Should the family’s finite resources be directed to the care recipient or spread among all family members? Some are about fairness: Should the cost of, say, a front door ramp for a parent’s house be borne equally by all the adult siblings or solely by the primary caregiver who lives with that parent? Some may be perceived as about love: Should a declining parent give all her assets to the adult child committed to caregiving or divvy them up to all her children?
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Caregivers, care recipients and other family members may take up different positions on these questions and then argue angrily. The result can be bitterness that tears families apart during the caregiving years and afterward. How can caregiving families avoid such conflicts and schisms? Here are some ideas:
Reduce the heat
Because caregiving decisions about money are laden with charged family issues, such as those of fairness and love, they quickly become emotionally inflamed. That often leads family members to get their backs up and become righteously indignant. How dare you withhold your contribution to paying the costs of caregiving, one might accuse another. How dare you try to force me to pay without understanding my situation, the other might respond. Their heated standoff will be irresolvable unless they can set some ground rules first about how they are going to maintain a respectful tone as they hash out their differences — without raised voices, finger-pointing or intentionally hurtful barbs.
It’s not enough to not get angry. In the best of all possible worlds in which everyone is on their best behavior, family members would extend to each other understanding and compassion — even if they hold conflicting viewpoints. When disagreeing (not disagreeable) family members feel heard, understood and, yes, cared for by one another, the bonds among them are strengthened. Their empathy toward one another will be mutually reinforcing and may yet serve as the foundation for later agreement on the same money issues.
Use group decision-making for big questions
One strategy to help caregiving families avoid constant financial conflict is to handle little and big questions differently. For the little decisions that need to be made every day — for instance, which doctor to see or pharmacy to use — all other family members should defer to the primary caregiver’s judgment without second-guessing. For the more consequential decisions that arise — for example, about selling the family home to help pay for a parent’s nursing home care — all family members, including those who aren’t on the front lines every day, should feel their opinions are sought out and respected. It is usually those family members who feel like their voices are not heard who protest the most loudly and trigger the fiercest debates.
Consider professional help
If caregiving family members still can’t find a way to stop arguing about money, then they should consider meeting with a pastoral counselor, family therapist or elder mediator. They are trained to manage emotions, clarify points and frame acceptable compromises. They help prevent further damage to already wounded family relationships.
Barry J. Jacobs, a clinical psychologist, family therapist and health care consultant, is the coauthor of Love and Meaning After 50: The 10 Challenges to Great Relationships — and How to Overcome Them and AARP Meditations for Caregivers. Follow him on Twitter and Facebook.