If you have siblings, you know one thing you can easily agree on is that you are all different. Sibling dynamics differ from family to family, and the bigger the family, the more challenging it can be to express yourself while navigating varying personalities and perspectives. When parents need help from their adult children to navigate issues that come with aging, including hiring senior care, sibling dynamics may inevitably shift.
Often, as parents age, one sibling takes the reins on family caregiving, which may mean other siblings are out of the loop. “If it’s not currently your responsibility as a sibling, you may have no idea [about] all the logistical, physical and emotional responsibility that the primary caregiver is holding,” says Marie Clouqueur, therapist and geriatric case manager at McLean Hospital in Massachusetts, who adds that for that reason, it’s crucial that all siblings gain understanding of which of the senior’s needs are currently being met — and which can potentially be offloaded onto a professional caregiver.
Although it might be challenging, it’s a must for the whole family, ideally alongside their older loved one, to have a discussion to determine when it’s time to hire senior care and what that might look like.
It’s important to discuss hiring additional help with siblings and possibly other family members because doing so “marks a significant shift in a family dynamic,” says Clouqueur. Because hiring senior care is likely a new experience for everyone, it’s important for everyone to focus “on the fact that you’re at a care transition, and more help may be needed,” she notes.
Most importantly, including your older loved one in the conversation is crucial if and whenever possible, says Clouqueur. “The guiding principle for care for any human being is that we uphold their dignity, and we promote their quality of life while at it,” says Clouqueur. She offers a motto popularized by the disabled community to guide thinking about aging parents: ”Nothing about us — without us.”
She adds, “We can observe that older adults, especially those who have notable declines in their physical or cognitive abilities, often have their decisions made for them which then violates these basic principles of care.”
Regardless of what your individual conversation might look like or who it might involve, the experts we spoke with agree that navigating this delicate topic requires empathy, compassion and prioritizing the best decision for your aging loved one. Read on for their insight, tips and advice.
How to prepare to discuss senior care as a family
Before diving right into discussions with siblings, it’s best to prepare yourself by gathering information about available senior care resources and options. A great place to start: Search the Department of Aging and Elder Services for the state you live in, says Dr. June McKoy, a geriatrician and medical professor at Northwestern in Illinois.
You can also use The Area Agencies on Aging’s elder care locator which allows you to search state-specific free and subsidized services available and eligibility requirements. Some state agencies provide for someone to come in to prepare meals, administer medications or provide light homemaker assistance. Other programs may include access to a set amount of hours of geriatric care management or funds for assisted living expenses. For example, McKoy says seniors in Illinois are eligible for up to four hours per day of in-home care by a geriatric care manager. It does bear noting that some of these services may have income limit requirements which will differ from state to state, she points out.
After reviewing available options, you might want to organize the information into a list or spreadsheet. You can also reach out to a health care professional, such as your senior’s primary physician or an aging life care manager, to get insights on the most viable options that suit your family’s needs and circumstances.
Once you finalize your list of agencies and resources, reach out to your siblings to set aside a dedicated time and space for the discussion. Armed with information, it might be easy to discuss options and come to an agreement on the best options, notes McKoy who adds that it may also be wise to steel yourself for potential pushback from siblings or other family members.
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How to initiate the discussion
It’s important to think about how you want to approach that initial conversation with your family, says Clouqueur. “From the outset, we want to avoid finger pointing and saying things like, ‘You’re not doing enough,’” she explains. “It’s just not helpful and doesn’t get people to rally around the cause.” What’s more, this kind of language could imply that the discussion for hiring care is based on someone’s deficiency instead of the fact that your aging loved one’s needs for care have evolved, she says.
Instead, she encourages siblings and family members to “begin by expressing the goal of changing the current situation.”
You’ll also want to find time for an open, honest conversation as soon as you realize that your senior loved one’s care needs are changing, says McKoy. You could kick off the chat with a phone call, Zoom, email or even a text that says something like, “We need to discuss bringing care into the home for Mom and Dad.”
“From the outset, we want to avoid finger pointing and saying things like, ‘You’re not doing enough.’ It’s just not helpful and doesn’t get people to rally around the cause.”
— Marie Clouqueur, therapist and geriatric case manager at McLean Hospital in Massachusetts
Why it’s important to discuss the financial aspect of hiring senior care
Another important aspect for siblings to consider when deciding on hiring care is the cost of senior care. Hiring care for your aging loved one can also be a significant financial consideration for families, so siblings will not only have to make joint decisions about what kind of care is needed but also consider what they can afford.No matter what type of care works best for a senior, siblings will need to decide what type of care is the best fit financially — and then figure out a game plan for covering the cost.
For example, Iliana Artime from Florida says even though her dad was financially independent, and a subsidized facility would have actually cost her less than hiring almost 24-hour in-home care, she chose to respect her dad’s wishes to age in place. Artime’s brother didn’t agree that hiring in-home care was the best financial decision, but he let her take the lead and supported her in her role as primary caregiver.
“He supported me in everything that had to do with hiring care, but he was concerned about what would happen to me when we ran out of money,” says Artime. “I was prepared to move into my dad’s house if it came to that. But it didn’t.”
You’ll also want to discuss the need to be flexible given that things can change depending on each sibling’s constantly evolving financial situation.
Adrian Izquierdo, also from Florida, says neither of his parents had prepared for dependent care expenses so he and his brother decided to use the money in his parents’ joint savings account to support his mother’s care after their father passed away. Izquierdo is single and doesn’t have children, but does have concerns about what he will do when the money runs out. He says his brother, who is a husband and father, was initially able to contribute to covering their mother’s care but is no longer able due to his own family obligations.
“Managing the finances is the most stressful part for me,” says Izquierdo.
It can be challenging for a number of families that don’t have funds to assist a senior family member. Gerald Harris from Maryland says he remembers that when his mother had dementia that his other two siblings were unable to contribute financially, so he had to fill in the gaps. “I remember someone telling me one of toughest things you will deal with [when it comes to] Alzheimer’s is [that] not all siblings will be able to help the same,” he says. “It’s not realistic splitting financial obligations, especially if other siblings have kids.”
This conundrum is a common one, given that many adults navigating care for an aging loved one may be sandwich caregivers who are also financially supporting a child, says McKoy.
“I remember someone telling me one of toughest things you will deal with [when it comes to] Alzheimer’s is [that] not all siblings will be able to help the same. It’s not realistic splitting financial obligations, especially if other siblings have kids.”
— Gerald Harris, a family caregiver from Maryland
How to make a senior care hiring decision as a family
When it comes to expressing the need for collective responsibility between siblings, Clouqueur says it is fine to acknowledge all roles may not be the same or equal. She recommends siblings try a popular business framework used in project management called the responsibility assignment matrix, or RACI (Responsible, Accountable, Consent, Informed), to approach decision-making and communication. It will also help you to clarify which sibling will take on which role(s), which can be helpful, says Clouqueur.
Here’s one example of how to apply it.
Responsible: The sibling who is responsible for researching the options for hiring additional care and sets up the meeting with siblings.
Accountable: The sibling(s) who is may assist interviewing options for care or paying for organizing and/or paying a portion of care needed.
Consent: The sibling(s) who has or shares health proxy who needs to give consent.
Informed: The sibling who may be out of town but still needs to be informed and kept in the loop.
Clouqueur says one way to encourage open dialogue among siblings is to examine care options and decisions with a mentality of experimentation. “You can say, ‘Let’s try this, and see if it works’ while [acknowledging] that things can change if they don’t work,” she notes.
Regardless, you’ll want to create a detailed care plan and map out how you’ll all monitor the situation and regularly assess your older loved one’s evolving needs, says McKoy. Find ways to keep communication among siblings going, especially as the situation changes, she advises. When you check in, you’ll do well to ensure everyone can be present and included in the conversation, and discuss the challenges that are arising.
The bottom line: Hiring senior care should be a family affair
Although it might not always be easy, being on the same page with family members about care needs is a must. Despite potential differences, siblings need to find common ground to support their parents and one another.
The experts we spoke to agree the key to having the best, ongoing conversations about the care needs of our loved ones means remembering to lead with compassion, be flexible and stay focused on the shared goal. As Clouqueur concludes, “It’s about having compassion for yourself, your siblings and for the process.”
