Eighty-year-old Millie had always expected, when she got older, that her daughter, Becky, would be there for her. But Becky now lives 45 minutes away, works full time and has teenagers to chauffeur. Though Millie's two sons and daughters-in-law live close by and pitch in often, she prefers her daughter's company.
Becky, for her part, visits frequently but always sees the disappointment and disapproval in her mother's cold stare. She feels both guilty and peeved.
"Why can't Mom just accept that our current caregiving plan is the one that's most practical?" Becky asks her brothers in frustration.
They haven't an answer other than to say she's always been Mom's favorite. Hearing that makes Becky feel all the more guilty, as if she's supposed to quit her job, uproot her family and move into their mother's cramped home.
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These siblings exemplify an unfortunate truth about caring for an aging parent: It is rarely an equitable enterprise. In the vast number of families, one of the siblings (generally a daughter) bears the brunt of the sacrifices. Who that child is may have little to do with practicalities. Among other factors, parental preferences affect caregiving choices and the relationships among daughters and sons.
These are some of the research findings over the past decade of Karl Pillemer of Cornell University, J. Jill Suitor of Purdue University and other social scientists who've studied aging mothers and caregiving. They have found that geographic proximity does shape whom mothers prefer to be their caregivers, but so do factors such as similarity of gender and emotional closeness. Mothers' choices have a powerful impact, dictating how most families divvy up the work. When those preferences are not honored because the chosen children are not willing, available or able, then the mothers may become disgruntled and the families as a whole may struggle.
How can conflict be minimized when a parent's wishes can't be met? There are no surefire solutions, but here are some ideas.
Foster open communication about what's expected
One definition of family is the group of people from whom we expect love, loyalty and labor. But when the specifics of those expectations — who does what for whom as well as how and when it's done — are assumed but never spoken, then misunderstandings and resentments can arise. In the caregiving situation, that can mean a daughter feels put upon because her mother is never satisfied with the extent of her efforts. Or the sons become miffed when their sisters balk at taking charge.
Long before older parents actually need care, it is vital that all family members discuss the ways they envision how caregiving will someday unfold. Who are the parents hoping will step up and help them when the time comes? What roles does each adult child imagine for herself and the others? These conversations may reveal mismatches between the claims loved ones make on one another and the degrees of willingness to meet those expectations.
Avoid avoidance and always empathize
Adult children sometimes feel that a parent's expectations of them are unreasonable or unrealistic. They therefore have a tendency to withdraw from caregiving as a means of avoiding feeling guilty that they are not conforming to the parent's wishes. That can lead to an ever more negative cycle: The parent feels neglected and becomes annoyed at that child. The child feels more guilt and avoids the parent even more. The parent feels abandoned and is furious. The child feels beleaguered and distances himself further.
A more productive response is for the adult child to empathize with the parent's wishes but to admit her limitations in meeting those expectations: "I know that you would like me to take care of you the way you took such good care of your own mother. But because I work full time, I don't have the ability to devote as much time to you as you expect." The parent may not be happy about the situation but may be touched by the child's sincere regrets and accept without further judgment what the child can give.
Focus on ends, not means
An adult child's ultimate responsibility to an aging parent is not necessarily to care for her in the exact manner she prefers. It is to ensure that she is well cared for in a way that's sustainable for as long as that parent is likely to need care. That may mean that a sibling other than the parent's favorite is the primary caregiver or that the siblings switch roles among themselves over time as their own life circumstances change.
Expectation is not dictum — not even when that expectation is held by a cherished, powerful or finicky parent. The caregiving plan has to be tailored to all family members' needs. The goal is for everyone to best manage this life passage and to thrive.
Barry J. Jacobs, a clinical psychologist and family therapist, is a member of the AARP Caregiving Advisory Panel.