‘Each family is different’ – an obvious statement in my opinion, but one worth saying. In my work, offering support to families facing various types of dementia, I have seen a theme emerge among families faced with making care decisions for an older adult. The attitudes, feelings and relationships established years ago are recreated in these new moments as the family attempts to act as a unit once again.
Grow up already!
Each family system has a unique yet similar pattern of operation. While living in the same household, many conflicts, boundary issues, relationship patterns are established and maintained. Once the family begins to age, we see those patterns shift perhaps because children move out, often to a different city to raise their own family. Some children may be happy to leave the home to get away from enmeshed relationships with parents, competitions with siblings, and a childhood history that is not easily forgotten. But leaving physically does not resolve those conflicts. The family history remains.
Coming Back Together
If the family is coming together, physically or otherwise, to assist with an ill or aging parent, how are the past relationships, conflicts, competitions and dynamics going to be activated once again? These problems are hibernating but easily awaken when the family is brought together. Even during the holidays families often see these dynamics reemerged. Dr. Ellen Weber Libby gave a great example of a holiday conflict in which and family is caught fighting with each other.
Making Care Decisions
In my role as a Social Worker, I have noticed the most difficulty families face is while making serious care decisions for the person living with dementia. At those moments I wonder why the family can or cannot rally together to make decisions, what is in their way? Consider this case example:
Bob, 82, has had a diagnosis of Lewy Body Disease for 4 years. He is in need of 24 hour care due to his increasing care needs and concerning hallucinations. Bob’s wife, Marie, has been caring for her husband, but now there are more physical needs and she is looking for extra support. Since the diagnosis, Carol, Bob’s youngest has been assisting her parents by helping provide relief for her mom and care for her father. She attends most of his doctor’s appointments and helps with her parents’ finances. Carol and Marie decided that it is time to look into nursing homes for Bob. Frank, Bob’s oldest, has been concerned about how Carol is managing the finances, and believes that his father should be cared for at home only. He thinks his mother is basing her decision to move his father on her emotions and is not thinking of what Bob would prefer. As Bob’s Power of Attorney for finances, Frank, decides he is not going to allocate money for a nursing home, instead he thinks paying for a few hours of at home care a week will suffice. In this case, the questions may be, what is motivating Frank to make this decision? What does/did his relationship with his mother and his father look like?
Will the Past Be Their Future
Typically there is one person who is “in charge.” This individual may have been designated by the person with dementia or it could be the spouse/partner, the adult child who lives nearby, the child who had a close relationship with the parent, the only child, an adult child monitoring from afar, or the only child who stepped up. Typically that individual, while often left with the decision making power, has to look at the other family members for support, resources, encouragement and in many cases validation. This might be where family triangles, enmeshed relationships and conflicts re-appear.
For example, if in the past the family members would give each other a “silent treatment” when in conflict, we might see this again. The family breaks down and stops all communication. It could be a stalemate with no-one acting. This behavior will inevitably affect the care of the older adult.
Why do we fight?
Caregiver Stress blog reviews a few reasons why there are family feuds when caring for an aging parent. A common problem facing families is estate planning decisions as Chicago Bridge author Eric Parker describes in his article.
Old family dynamics resurface when a family is brought together to care for an elderly parent. It is important to examine these dynamics and help insure that the goals of care for the older adult client are met.
Please share your thoughts and ideas on this subject!