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Caregiving and Family Conflict Management

There are a number of reasons that conflicts occur when multiple family members are involved in caregiving.  Hopefully, there is a common goal of meeting a senior’s physical, emotional, and spiritual needs in a dignified manner and within a safe environment.  How to meet this goal is where the situation can quickly deteriorate.  Each family member will approach a caregiving situation with a unique viewpoint, based on personal beliefs and experience, past and present roles within the family, and current life situation.  Even families who have always had strong relationships can experience tension when faced with the responsibilities of caregiving.

One type of conflict that I’ve heard a number of adult children voice is the unwillingness of their siblings to “step up to the plate” and do their part in assisting with caregiving tasks.  Although nobody can be forced to participate as a caregiver, there are ways to approach the situation which are more likely to have a positive result. Begin by making sure that all family members have an accurate understanding about the care needs of the individual.  Seniors may paint a different picture of how they are doing depending on which family member they speak to.   Try to reference objective information from third parties (such as a physician, close friend, or neighbor) so that there is more “evidence” to support the need for care than just the senior’s self report or primary caregiver’s “opinion.”  Allow all family members an opportunity to suggest solutions to care needs and carefully consider each suggestion.  Perhaps a suggestion may not be the way the primary caregiver would handle that particular need, but if the suggestion is a safe alternative and the one who made the suggestion is willing to participate in that area, isn’t it worth a try?  Greater cooperation will occur when others feel that they have been involved in the planning process.  When a caregiver answers, “I already tried that” or “It won’t work,” the message being sent is that help isn’t really wanted.

It is also important to consider each member’s relationship with the one who needs care, as well as with each other.  If one child has historically been more distant to a parent than the others, asking that child to spend one-on-one time with the parent or perform intimate personal tasks is probably not the best idea.  Perhaps less hands on, but no less important tasks, such assisting with finances or grocery shopping would be a way for this type of individual to stay involved. A potential trap for families is for adult siblings to revert back to childhood roles and expectations of each other.  These old roles most likely will not work for caregiving, but acknowledging them may help family members understand each other’s behavior.  This insight  is the first step  leading to changes which can preserve relationships and promote teamwork for meeting the current needs of the elder.  The process of watching a senior family member reach the end of life is certainly not easy, and the emotions and reactions of individual family members naturally will vary. If a primary caregiver tries to make others feel guilty about their emotions or level of involvement, discomfort and defensiveness will follow, not cooperation.

Two methods that caregivers often use to try to solicit help from other family members are by making a general request, or by trying to give subtle hints that help would be appreciated.  The best approach is to make detailed requests for assistance.  Instead of asking if someone can stay with the elder “once in a while,” ask a family member to set aside a specific day and time, or perhaps a regular bi-weekly visit.  Expectations are clearer for both parties when this approach is used, which will decrease frustration and misunderstandings.   It can also be helpful to tailor each request around a caregiving task that takes advantage of various family members’ strengths and abilities.  A family member with young children may have difficulty running errands, but can provide a welcome social visit to boost the elder’s spirits and allow a little respite time for the primary caregiver.

One final tip for enlisting the aid of others who may be reluctant to participate in caregiving is to start small.  Find a task which will allow for a successful outcome without an extraordinary investment of time or energy.  And remember to say thank you.  Just as the primary caregiver’s routine probably started by doing one or two occasional tasks for the elder, then built up over time, it may be easier for a new caregiver to start by just getting their toes wet, instead of having to take a deep plunge.

Karen Kaslow, RN