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As Parents Age
A Psychological and Practical Guide
by Joseph A. Ilardo, PhD, LCSW

From Chapter 3: The Impact on the Family (continued)

What factors determine whether a family successfully adapts to the stress of an aging parent? Even more specifically, what variables affect the quality of the family's solution? There are many variables, but four are most important: (1) the informal rules that govern behavior within the family, (2) the role and importance of the aging person, (3) the extent to which problems can be directly addressed within the family, and (4) past experiences within the family and the quality of relationships over the years. Because the family is a human system, it is possible for us to know what these variables are and to appreciate their potential influence. Knowledge of these variables can prevent families from being victimized and stymied by them. With the help of books like this one and the intervention of skilled mental health professionals, families can arrive at better solutions, solutions that might otherwise not have been possible.

Families of aging parents face many practical difficulties, among them deciding about financial responsibilities, choosing medical treatments, and deciding how to respect a parent's wishes about end-of-life matters. These tasks are frequently compounded by systemic reactions. For example, if one member becomes detached, her contributions are lost to the family and her attitude may undermine its efforts. Rather than seeing her lack of involvement as a moral failure or proof of her indifference, the family needs to view it as an indication that the entire family is failing to respond adequately to the crisis.
In my experience, families face these system-related problems most frequently:
One or more family members may become overinvolved. As they do so, others will become detached.
A struggle may emerge between siblings about how best to deal with the problems of an aging parent. For example, some children may advocate institutionalization while others may see that as a course of last resort.
An aging parent who is capable of helping herself may not take responsibility for doing so.
To illustrate how to use the problem-solving methods I am recommending, I will take the first systemic problem, overinvolvement and uneven distribution of responsibility. You will see how this problem, which is often intimately bound up with the other two, can be addressed. The method illustrated here can be applied to any problem faced by your family.
The first step in solving this or any other problem is to determine whether a problem exists. Here are some questions that can help you to step outside your immediate situation and look at the big picture.
1.Am I, or is someone else in the family, taking on too much responsibility? One woman reported that whenever a crisis arose in the care of her elderly father, her siblings invariably turned to her, despite the fact that they were no less able than she to provide help. Understandably, she felt resentful. She buried that resentment for a time, but that took its toll: she was short-tempered with her children and her spouse. She knew she had to do something. Rather than swallowing her anger, she brought the matter to the attention of her siblings.
2. Am I, or is another family member, doing things for my elderly parent that are not essential? Sometimes, in an adult child's desire to help an aging parent, he or she does more than is necessary. For example, one son was determined to accompany his elderly but robust mother to every doctor's appointment she had. While this, in itself, might be considered a bit extreme (after all, not every appointment is crucial), he also felt constrained to pick up his mother at home and drive her to and from the doctor's office. This added to his burden. It was only when he stepped back and reevaluated his behavior that he realized his mother was perfectly able—financially and otherwise—to arrange a ride for herself. When he began backing off, his mother happily hired a taxi or asked a willing neighbor to drive her.
3. Am I, or is another member of the family, doing more for our care-recipients than they are willing to do for themselves? One client told me that her parents—both ill and in need of help—bickered constantly and failed to help each other, when they could have behaved more rationally and been more mutually supportive. The most conscientious caregiver in the world cannot rescue people who will not make an effort to help themselves. When she tries to do so, she does them and herself a disservice. They become increasingly dependent and noncooperative, and she becomes resentful. Everybody loses.
4. Am I suffering, or are my spouse and children suffering, while others in the family are barely affected by the demands of caregiving? One client, an educational administrator with a busy professional life and a family of her own, lived two hours from her elderly mother. Once or twice a week she drove from her home in Connecticut to provide care; the trips became more frequent as her mother's health deteriorated. Meanwhile, her brother and sister-in-law, who lived only twenty minutes away from the elderly woman, saw her once a year, if that. Pressed for his help, my client's sibling's response was, "Take Mom to Connecticut, and let me know when she dies." (In this case, efforts to discuss the desirability of sharing responsibility seemed pointless. Consequently, it became necessary for my client to convince her mother to accept help from neighbors and professionals. Reluctantly, the elderly woman agreed.)
5. Am I entering into a silent conspiracy with my parent to "elbow out" other family members who could help? One man was very wedded to his long-time role of the good son. In caring for his elderly father, he consistently took on the primary burden of caregiving. Simultaneously, he made certain his two siblings (one male, one female) were not encouraged to share the burdens of caregiving. Only in therapy was it possible for him to recognize that his overinvolvement served his psychological needs at the expense of the psychological well-being of his siblings and the welfare of his father.
It may seem odd that I speak of the undesirable behavior of family members as symptoms of the fact that the entire family is failing to respond appropriately to the problem. It is often convenient for a family to think of such undesirable behavior in other terms: The overinvolved daughter is often seen as "a goody two-shoes." The uninvolved son is seen as "uncaring, cold, and selfish." The adolescent who acts out his or her distress is labeled a "deviant" or a "brat."
Such harsh and judgmental labels do little to facilitate problem solving. Specifically, they prevent the family from looking at the family problems at the root of such behavior. "Goody two-shoes" may feel she has no choice but to do what others are not inclined to do. The "uncaring, cold, and unselfish" son may feel deeply hurt that he is being pushed away once again, while the "good" sibling is allowed to maintain closeness and provide care. The "deviant brat" may be bringing the wrath of the family on himself deliberately (though unconsciously) in order to maintain the existing hierarchy and rules governing the dysfunctional family system.
Looking at families from the perspective of family systems requires that all individual behavior be seen in the broad context of the entire family's way of functioning. When this perspective is maintained, and when undesirable behavior is seen as symptomatic of a family problem (rather than as a personal quirk or a moral failure), it is possible to look at the issues that give rise to the behavior. This is far and away the most constructive approach to take.
Sometimes the help of a professional therapist is required to recognize symptoms for what they are and to examine what needs to change. Competent help can expedite the corrective steps that must be taken so that nonproductive patterns of caring for aging parents do not become deeply rooted. A well-trained therapist will take into account the many factors contributing to the family's collective difficulty.
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