Managing Emotions of Caregiving

Simply reuniting for the holidays once a year is tense enough for most families. Caring for an elderly parent or relative, often through years of sickness and decline, can tear a family apart.

Siblings and other relations must deal with financial strains, complex medical decisions, infuriating bureaucracies, and old personality conflicts rekindled by new stresses. The resulting guilt, tension, exhaustion can trigger a combustible mix of family dynamics that until recently has been little talked about.

"It's only on television where people fly in from all corners of the country and rally around and make decisions in five minutes and there's peace," says Barbara Moscowitz, a social worker in the Geriatric Unit of Massachusetts General Hospital. "The last thing that's discussed is that care-giving unfolds in the context of relationships that are strained."

For Kathleen Dignan, sibling tensions have proved to be the most shocking and embarrassing part of sharing the care of her 92-year-old mother with her two sisters.  "You revert back to being little kids - the sibling rivalry, vying for your mother's attention," says Dignan, an oncology nurse in Virginia Beach, Va.

After Dignan's mother grew too frail to live alone in Boston, she moved to Dignan's house in 2001.  Dignan's older sister also moved in to share the care, but left in 2003 over tensions about the type and intensity of care needed by their mom.

"Let me tell you, I have just started speaking to my older sister again," says Dignan, who cared for her mother for another year before recently moving her to another sister's home in Delaware.

Elder care is often rewarding, but undoubtedly draining.  The average care-giving situation lasts more than four years, according to a 2004 report by the National Alliance for Caregiving.  Sixty percent of caregivers work, and most have had to leave early, come late or take extra time off from work a result of their responsibilities. And, 40 percent say they had no choice in taking on the care, perhaps because they live nearby or did it our of sense of duty.

If elder care responsibilities are dividing your family, try to get an independent assessment of the situation and hold a family meeting, perhaps moderated by a trusted friend, clergy or healthcare professional. Tensions typically escalate when families are faced with key decisions or a new crisis, says Boston - based elder - care expert Diane Piktalis of Ceridian. Remember to care for the caregivers, too; 60 percent of elder abuse is perpetuated by relatives, often because they are exhausted or depressed.

Two years ago, Kathleen Dugan and her sisters had a family meeting and, despite differences, they agreed that their top priority was caring for their mother in their homes. "Once we cleared the air and talked and got on the same plane, which took two- and - half years, we were all OK," says Dignan. "We went through a lot of decision - making to come to this."

Reprinted from The Boston Globe March 13, 2005 By Maggie Jackson