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How Caregiving Stepfamilies Can Get Along Better

Blended families need to learn to sideline divisive issues

Couple in hospital waiting room. Caregiving for step families (Shalom Ormsby/Getty Images)

Shalom Ormsby/Getty Images

Part of a caregiving stepfamily? Try these steps to foster greater cooperation

Consider this journey from crisis to indignation: The 75-year-old woman was distraught about her husband's recent stroke — then outraged by the ensuing actions of his three grown children.

When she married their father 15 years ago, the kids had been outwardly supportive. (By then, a full decade had passed since he divorced their mother.) But now the three were challenging their stepmother's authority as medical power of attorney for the disabled man, going behind her back to talk directly to their father's doctors.

There was worse to come: Her stepchildren questioned her love for her husband. When the woman told physicians she didn't want all-out efforts to save her husband in the event of another devastating stroke, one of the children angrily accused her of "giving up on Dad."

With about 45 percent of first marriages ending in divorce and 60 percent of divorced men getting remarried (the figure is lower for women), stepfamilies are common in the United States. More than 4 in 10 of us have at least one step-relative. There's no shortage of painful anecdotes about how disagreements over parenting, money or living arrangements can make step-relationships shaky at best.

When step-relatives are called upon to become members of a caregiving team for an aging parent or disabled spouse, those relationships can weaken and buckle under the stress. Whoever came up with the saying "Blood is thicker than water" must have had stepfamily caregivers in mind!

This was borne out by a study published in the September 2013 Journal of Marriage and Family. University of Michigan researcher Carey Wexler Sherman interviewed 61 late-life second wives, all of them caring for husbands with Alzheimer's. When it came to nitty-gritty caregiving tasks, Sherman found, the wives received little help from their adult stepchildren. At the same time, however, the children freely offered unsolicited advice — and unwanted criticism — about the wives' efforts. They also vied with their stepmothers for the power to make medical and financial decisions for their fathers. Hurt by their stepchildren's behavior, the wives were more likely to feel burdened — and to become depressed.

What explains this meager support? Sherman concluded that "a lack of shared family history and norms likely affect the way stepfamily members cope with the demands of taking care of a loved one with dementia."

In my view, caregiving can inflame long-held grudges within a stepfamily. Rather than commiserate nonjudgmentally over a loved one's medical condition, many step-relatives try to cope with the crisis by venting their anger at one another.

Is there a smoother path? My experience says yes. If you're part of a caregiving stepfamily, try these steps to foster greater cooperation.

Respect family connections

Soon after a loved one is diagnosed, the spouse should organize a family meeting that includes the adult children from the first marriage. This acknowledges:

a) the loving bond that each relative has with the ailing family member;

b) the right of each person — regardless of when or how they came into the family — to obtain information and offer input; and

c) the fact that you have joined forces to restore the health and well-being of someone you all love.

When a stepparent withholds information or doesn't solicit the opinions of the adult children, he or she risks making adversaries of potential allies. The children may try to inject themselves in the medical decision-making, opposing the stepparent's views merely to demonstrate their importance in the aging parent's life.

Be clear but inclusive on legal topics

In situations where an ill family member can no longer make decisions for himself, a legal basis may exist for a spouse or adult child to take charge of his care. (A medical power of attorney document provides one such basis.) Though other relatives may not like the arrangement, they must accede to it. The person who has power of attorney, however, should continue to seek input from all family members. This level of openness makes eventual cooperation more likely, even when disagreements arise.

Mutual concern means mutual responsibility

Recruiting family members to take on caregiving chores is a challenge in any family. But spousal caregivers who may not have had strong previous relationships with their stepchildren may have to be more direct: You may have to make specific and repeated requests of a stepchild to secure his help in caring for an aging parent. Broach these requests as opportunities for the child to assist his or her parent, not necessarily the stepparent.

Yes, it can be tough for spouses and stepchildren to pull together, not drift apart, during the caregiving years. Yet the result, a newfound respect for one another, rewards the effort — and may continue to do so long after the aging parent's recovery or death.

Barry J. Jacobs, Psy.D is an AARP caregiving expert.