By Deborah Harkins
If caregiving issues begin to roil, it’s not always easy for family members to stay in sync, especially when major decisions need to be made.
Worry, resentment, self-righteousness, anger. These and other emotions can shatter family accord when siblings are confronted with problems in caring for an elderly parent. When Mom can no longer live alone, who will take her in? If no one can, or will, what’s to be done? Under these stresses, sisters and brothers can be provoked into mean-spirited attacks: “It’ always about you, isn’t it?” or “You don’t really love Mom!” Emotional issues can bring out the best-and worst-in all of us. And when they occur, what’s a well-meaning family to do?
The “Win-Win” Waltz
When I took on this assignment, I doubted that such prickly dilemmas could be resolved through sweet reason. The three conflict-resolution experts I consulted, however, were confident that opposing viewpoints could be shepherded into consensus. “If you have the relatively simple skills of win-win conflict resolution, or shared decision making, you can keep the tug-of-war between family members from becoming antipathies that last a lifetime,” says Susan Heitler, Ph.D., a clinical psychologist and family therapist in Denver.
Unfortunately, most of us don’t naturally possess the skills required to do what Dr. Heitler calls ‘the win-win waltz.’ But the ability to speak respectfully, curb your impatience and suggest solutions, rather than demand them, can be learned. Her book, The Power of Two (New Harbinger Publications, Inc.), lays out the skills that can help couples and families perform the careful, courteous dance that keeps differences from becoming fights.
For starters, Dr. Heitler suggest that even before relatives hold a family meeting to address a problem, everyone should agree to certain (even written!) rules that one sibling has drawn up. First on this list: eliminate two potentially contentious words from all future discussion: but and don’t. “The word ‘but’ erases whatever came before,” points out Dr. Heitler. For example, “If Isabel lays out her heartfelt concerns and her brother Joshua starts his response with ‘but,’ he has just dismissed what Isabel has said. She’ll be hurt and angry, and the war will have begun.”
As for the word “don’t”, it darkens and depresses everybody, says Dr. Heitler. She urges graciousness: “Try ‘would like’ instead of ‘don’t like.’”
Stop Butting In
Next, agree to refrain from cutting in when someone else is speaking. Promise to take a break for a drink of water whenever the discussion gets unpleasantly hot. And-perhaps most important-listen to learn, not to point out what’s wrong. Even if someone puts out a terrible idea-something as ridiculous as “Let’s put Mom up in the Ritz for the rest of her life”-resist the temptation to criticize, says Dr. Heitler. Focus on the positive, on what makes sense. “Yes,” Joshua might respond, “Mom was so good to us, she deserves the best.” The others can then jump in with ideas about what can be done, like “We could figure out how much money is available, and what places we can afford that preserve Mom’s dignity.”
The “win-win waltz” can be broken down into a three-step process. First, each person lays out the course he thinks would be best for Mom. Next, everyone states what his concern are-his worries, fears, desires. Then everyone participates in generating a plan of action that all can agree to, starting with the one or two issues that seem most important to everyone. Dr. Heitler cautions against telling other family members what they should do. Instead, when you speak, tell them what you can do: “I can contribute X.” Then, using open-minded questions, you might add, “Joshua, what might you contribute?”
Reaching Out Early
Anthony P. Jurich, Ph.D., a marriage and family therapist and a professor at Kansas State University, argues that often siblings can defuse loaded issues by talking to their parents before a crisis occurs.
“Someone in the family should talk to Dad while he’s still lucid,” says Dr. Jurich. “Of course, all of my patients come back with ‘I can’t talk to my dad about what he wants us to do when he’s terminal! My God, I can’t talk to him about his death!’ My response is to go home and say, ‘Dad, you’ve lived 85 years making your own decisions. You’ve earned the right to make your own decisions at the end of your life. We just want to know what they are, so we don’t choose a course you wouldn’t want us to.’” Explains Dr. Jurich, “Once you frame it that way, most elderly people will say, ‘Thank you; here’s what I want.’”
Advanced Directives
After you’ve gotten his attention, you might persuade Dad to give one of his children power of attorney. It can be crafted so that it goes into effect only if he becomes mentally incompetent. It’s important, also to:
- Develop a living will, in which Dad lists the medical procedures that he does and does not want if he is too sick to make his own decisions.
- Have Dad fill in a healthcare proxy form, which names the person who will make medical decisions for him if he cannot speak for himself. Naming a healthcare agent is particularly crucial in New York and Florida, where doctors can override family members’ medical decisions when a proxy hasn’t been signed.
Dr. Jurich advises that the child given power of attorney be the one to convene a family conference. Try starting the first meeting by saying something like, “We are the people responsible for Dad’s care, and we have decided to make this decision together.” It sets a collaborative tone. “Everybody works as a team,” says Dr. Jurich. “And if Dad is capable of contributing his ideas, he should be there, too. Elderly people hate losing their power to make decisions.”
Surprisingly, Dr. Jurich suggests that siblings try to ask Dad about his wishes-even when he’s suffering from say, Alzheimer’s disease. In one case, for which Dr. Jurich was a consultant, the father’s dementia was so advanced that he could no longer recognize relatives. He needed an operation, but it was very risky, and he could have been left in a persistent vegetative state. Very slowly the patient’s doctor and his daughter told him about the operation, trying to make him understand.
Amazingly, he had a moment of lucidity and replied, “’If I’m in a vegetative state, don’t let me stay that way.’ When it’s important, ask the patient what he wants, even if he seems beyond the capacity to understand,’ counsels Dr. Jurich. “Human beings are unbelievably resilient.”
When Fair Isn’t Fair
To watch a loved one decline is to be suffused with sadness. That’s tough enough. But all too often, siblings must also pick their way through an emotional minefield because one or two of them won’t do their fair share.
For example, sister Carrie, in Boston, lives near her frail and mentally incapacitated mother, who has been failing for years. Meanwhile, sister Emily, who’s in Seattle, shoulders barely any burden: She makes an occasional cheerful phone call and flies in once a year for a brief visit. Carrie is flagging; she needs to hire an aide to lessen the burden. At the very least, she wants to be freed to go on vacation. But she can’t afford either without financial help. Emily seems well off, yet, doesn’t offer to contribute anything toward their mother’s care. What to do? Kristene Doyle, PhD, has a startling answer. She is a clinical psychologist on the staff of the Albert Ellis Institute, a not-for-profit educational organization in New York City that offers counseling in short-term cognitive-behavioral therapy.
Focus on What’s Best for Everyone
“It’s human nature for Carrie to focus on her own demands,” she says, “However, in doing so, she adds anger, anxiety and trouble communicating with her sister to her caregiving problem. The reality is that one sister is closer to the parent than the other. Does Carrie expect Emily to move to Boston? That’s not reality. Of course, it would be preferable if the sister moved closer, but must she move? There’s a difference between what would be better and what has to happen. The more she tries convince Emily that she’s right, the more trouble Carrie is making for herself.”
But Emily won’t even pay her fair share! The doctor is unmoved. “It’s tough,” she says bracingly, “but people have got to get over this ‘fair’ thing. It sounds harsh, yes, but it’s reality.”
- Accept what you cannot change: Dr. Doyle would work to get Carrie to accept the things she cannot change. “The first thing Carrie has to do is step back and calm herself,” she says. “I’d work with her to help her get her emotions under control, even if she’s frustrated and annoyed. If she stays calm she’s more likely to persuade Emily to help in some way than if she shows her rage.
- Engage in role-reversal: Carrie and the doctor might do role-playing-rehearse Carrie’s next call to her sister, with the therapist playing Emily. This gives Carrie a chance to practice what she wants to say so that later she’ll be more effective in communicating her wishes. “That won’t always work either,” admits Dr. Doyle, “but at least she’ll feel better, and she won’t say something in anger that will ruin their relationship forever.”
- Make a list: Carrie’s next step would be to make a list of her expectations. Are they realistic? Many may not be, and she needs to recognize that. “But even if her expectations are realistic, she’s more likely to be able to make her point if she can learn not to get overly upset,” Dr. Doyle says.
“Sometimes there just isn’t a solution that’s satisfactory to the victim-and Carrie is the victim here. In a case like this, the best a beleaguered caretaker can do is to accept the way things are,” she continues.
“Adults have a hard time with that, probably because they equate ‘acceptance’ with ‘liking it.’ You don’t have to ‘like it’ to ‘accept it.’”
Tactics for Persuasion
Dr. Heitler, too, acknowledges that sometimes there is no way to persuade obdurate relatives into doing their fair share. “When there have been long-standing antagonisms among family members, adopting “win-win” tactics may not be feasible,” she admits. “For most families though, these skills can bring a solution everyone feels good about-in fact, family members can end up with a better decision than anybody had initially proposed.”
When clients continue to lament the unfairness of it all, Dr. Jurich has this galvanizing response. “They’ll complain, ‘I’ve done all the work for years, and I’ve contributed the most money, and I feel like a sucker!’” he says. “And I say to them”—the doctor adopts a tone of amazement—“This is your mom!’” It may take a few minutes for the idea to seep in, but in the end, “it’s not fair” usually gives way to: Message received!
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