IMAGE: Richard Aylward (L) with mother, Pat
Brian Kersey  /  AP file
Richard Aylward walks with mother, Pat, through the assisted living facility she lives, in Burr Ridge, Ill. The decisions that Richard and his two sisters made as they sorted out their mother's possessions before moving her into the facility resulted in tensions between the siblings.
updated 1/14/2007 2:32:57 AM ET 2007-01-14T07:32:57

The tension rose as Richard Aylward and his two sisters sorted their mother’s possessions into four piles: to keep, to donate, to throw out and to move with her into an assisted living facility.

He was annoyed that his sisters wanted to reminisce about every photo and book. He wanted to hurry up and finish the job.

“Because I was the one who had to do the moving, cleaning, selling, closing, etc., I knew I had to play the heavy,” he said.

Eventually, his oldest sister — fed up with her brother’s pressuring — walked out.

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Big sisters, little brothers, black sheep, Dad’s favorite — all the old roles, battles and rivalries resurface when a parent’s health is failing and decisions must be made.

With about 20 million Americans providing care for a parent or in-law, such family dramas — often with financial questions lurking unsaid — are playing out across the country, said Bonnie Lawrence, spokeswoman for the Family Caregiver Alliance.

Eighty percent of long-term care is provided by families, not institutions, Lawrence said. Even families that don’t provide care, though, are choosing a nursing home or making medical decisions about a dying parent.

But getting stuck in an old squabble can sabotage wise decisions, said researchers who study family dynamics.

To help, some states offer free consulting to families making decisions about elders, and a new school of professional mediation has sprung up to help baby boomers stop fighting with their siblings and refocus on what’s best for their parents.

Such services still are rare, though, leaving most families to cope on their own.

Family patterns re-emerge
Old family dynamics come back like a boomerang during anxiety-producing conversations about aging or ailing parents, said Brian Carpenter of Washington University in St. Louis. He has studied sibling issues.

“One person takes charge, the other is more submissive; one sibling is the joker, smoothing over disagreements with humor, while another sibling is the serious one, all efficiency and business,” Carpenter said.

Sometimes the roles help, because the family originally may have developed them to take advantage of individual strengths, he said.

“In other cases, however, when those roles have never been really helpful, they get in the way of making parent-care decisions, just as they probably got in the way of lots of family decisions throughout life,” Carpenter said.

Sisters tend to criticize their brothers for not doing enough, while brothers don’t take enough credit for what they do, said Sarah Matthews, a professor of sociology at Cleveland State University who has conducted research on siblings with aging parents.

Her interviews with 149 pairs of siblings found women and men have different expectations. Sisters saw their siblings as a team. They expected cooperation. They wanted communication about what each sibling was doing for the aging parent. Sisters also believed they knew more about what needed to be done.

Brothers, on the other hand, acted independently and expected to negotiate directly with their parent without keeping their sisters informed.

“That tended to annoy the sisters,” Matthews said, and the brothers didn’t understand their sisters’ irritation. When asked generally what they were doing for their parents, the men said, “Not much.” But then they gave specific examples that revealed they did a lot more than their sisters knew, Matthews said.

The eldest son holds sway in families from some cultural backgrounds, said Dr. Gail Gazelle of Palliative Care Associates in Brookline, Mass.

“No matter how bad the parent’s relationship has been with that son and how derelict he has been in his caregiving duties, he will be deferred to in decision-making in those families, much to the chagrin of the daughters who’ve been giving care for years,” Gazelle said.

She advises siblings to stay focused on what their parents would want, and to remember that their relationships with siblings will endure long after their parents’ deaths.

“That is what is going to live on, and that relationship is very important,” she said.

Defined roles, ‘happy ending’
After the tension died down, Aylward and his sisters successfully refocused on their mother’s needs and agreed on a plan to share responsibilities. Aylward handles the bills, insurance and legal issues. His younger sister takes their mother to hair appointments and shopping. His older sister, who has a nursing background, acts as an advocate for their mother’s medical needs.

“It’s really turned out better than we could have ever imagined. We have a happy ending,” Aylward said.

Although Aylward’s family worked out their differences on their own, some families need outside help to defuse old time bombs.

Some turn to professional mediators, a specialty that’s still in its infancy. A network of elder mediators formed last year to address training and policy issues, said Penny Hommel, co-director of the Center for Social Gerontology in Ann Arbor, Mich., who knows of several hundred mediators trained in issues of the elderly.

One company, Elder Decisions in Lexington, Mass., has offered such mediation for four years. This year, they worked with about 25 families involved in decisions about aging parents, charging $350 an hour.

Among the company’s clients were Sarah Burrows and her five siblings.

Two years ago, the siblings couldn’t agree on whether their octogenarian parents, both suffering from dementia, should continue living at home or move to an assisted-living facility. Some of the siblings also felt unappreciated, which clouded their decision-making.

Burrows sometimes thought she didn’t get enough credit for sorting out her parents’ chaotic finances or looking at 20 care facilities, she said. One of her sisters felt stranded with the household responsibilities, including the bathing and personal care of her parents.

The siblings met for mediation — one brother in Israel participated by speaker phone — and found common ground.

“We really wanted to keep my parents together,” Burrows said.

The family decided to hire caregivers so their parents could remain in their home. And the siblings listened more carefully, increasing their understanding, in Burrows’ case, of how she didn’t feel up to helping with her parents’ physical needs because she had just finished getting her own children out of diapers.

“The act of coming together was a kind of a bonding experience,” Burrows said. “We realized we really could work through a lot of decisions and challenges.”

They did it for their parents.

“Our parents raised us. They did the best they could,” she said. “We owe them.”

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