Laura had heard the cliché about the primary caregiver of an aging parent who is ignored by neglectful siblings. She just sometimes wished it were true for her. In the excitable and opinionated family of seven in which she grew up, everyone needed to have their say on everything. Little wonder, then, that her siblings now constantly questioned whatever decisions she made for their 88-year-old Italian American mother. Whether it was scheduling medical appointments or home health aides, no caregiving choice appeared too insignificant for them to debate with her and each other. She didn’t begrudge them the right to speak their minds; this was their mother, too. But she grew defensive and weary with the frequent arguments.
This is the downside of caregiving teams. Lone caregivers without family support may be at high risk for burnout. The more relatives who are involved in caregiving, though, the greater the likelihood of conflicts and power struggles. These family members may roughly jostle with one another for control over decision-making, thereby damaging their relationships for years to come. But it is the care recipient who suffers the most, feeling distressed and guilty that tasks relating to her health have resulted in skirmishes among her loved ones.
Adult siblings may be most prone to this kind of infighting. They often have early histories of rivalries and mutual clashes. To be dutiful advocates for a beloved parent, they may feel compelled to beat their chests and trumpet their views. That was the case in Laura’s family. She and her siblings were deeply invested in their mother’s care but competed to control it. In fighting for the best means to help her, they sometimes hurt one another.
How can squabbling siblings learn to pull together in one direction and improve their collective performance as a caregiving team? Here are some ideas.
First, work toward a common vision. Psychologist Eduardo Salas, noted for his research on teamwork, has identified seven key team components, none more important than a shared mental model of what should be done. For caregiving siblings, that means having a clear sense of an aging parent’s remaining strengths and growing weaknesses in order to define the challenges at hand. That’s the only way to know what types of assistance really would be helpful. Next, siblings should create a useful caregiving plan. When they disagree about a parent’s capabilities, they too often become polarized and reach a stalemate (“He can drive!” versus “He can’t drive!”; “She has dementia!” versus “She’s fine!”).
The best way to devise a common vision is to give every sibling access to the same information in the hopes that this will lead them to the same conclusions. Every son and daughter should have the chance to spend a weekend or two with a parent to see firsthand, over a prolonged period, how Mom or Dad is functioning. Each child should receive and read the evaluations of the medical providers, physical and occupational therapists, and other professionals. Not everyone will interpret this information in the same way, but siblings’ views are likely to become more similar over time.
See competition as a form of cooperation. There is no teamwork without the belief that working cooperatively with one another will bring better results. Even competition can be a form of cooperation in which team members push one another to come up with better ideas. Caregiving siblings, likewise, have the choice to view their debates as either painful head-butting or productive brainstorming to improve their plan.
Because Laura considered competition only as hostile, she and her siblings became caught up in a vicious cycle. The more often her brothers and sisters made uninvited suggestions to her, the more likely she was to stop listening to them. But the less she listened, the more they raised the volume on their arguments and pressed her to hear them. She would have been better off proactively soliciting their advice — perhaps through a group text or email or family meeting — and treating their ideas as contributions, not attacks on her judgment or control. By showing appreciation for their ideas, Laura wouldn’t lose power; rather, she’d win over supporters. She could then relax, and so could they.
With ideas come responsibilities. A common rule used by high-functioning teams is that the member who offers ideas for doing things differently is required to create a coordinated action plan. This works well for caregiving siblings. No brothers from across the country or sisters around the corner can phone in complaints without committing to doing more themselves.
For Laura and her assertive siblings, this would mean several changes. Her siblings would take greater responsibility for managing the aides or scheduling the appointments. She, in turn, would delegate more tasks. Control of the day-to-day caregiving would no longer be a prize to be tussled over but instead be a shared commitment. Their relationships would be strengthened through the experience of caring for Mom or Dad very well — together.
Barry J. Jacobs, a clinical psychologist, family therapist and healthcare consultant, is the co-author of Love and Meaning After 50: The 10 Challenges to Great Relationships — and How to Overcome Them and AARP Meditations for Caregivers (Da Capo, 2016). Follow him on Twitter and Facebook.