When Family Caregiving Is a Conflict Zone

We often see multigenerational family pictures with everyone harmonious — one big happy clan. Does that describe your family? If so, congratulations! But if your "family portrait" is more like the one below, you're not alone!

Senior man on the couch during a disagreement with his adult children

Ben is angry with his son and daughter-in-law. The doctor told him to stop driving, but then those two went and took his car keys!

The American Geriatrics Society recently published a study examining common sources of friction between older adults who are ill or have disabilities and the family members who provide care support for them.

The study, which appeared in the Journal of the American Geriatrics Society, was based on interviews with a group of seniors and their caregivers about how each perceived the caregiving situation. Not surprisingly, the study found that control was a big source of conflict.

For example, reported the team, "Some care recipients felt that their caregivers were too involved. In visits with healthcare providers, the individuals felt that with their caregivers present, their own voices were not getting heard.” On the other hand, caregivers believed they could get more accurate information from the doctor if they stepped in. Some also felt that their loved one would intentionally withhold information from the doctor.

The senior/caregiver pairs also experienced conflict about following the doctor's recommendations. And to top it off, caregivers reported feeling underappreciated!

Power struggles about healthcare are just the beginning, as many caregivers will tell you. Here are other areas where conflict can erupt:

Financial issues. Mom doesn't always remember to pay bills on time. Perhaps she fell for a sweepstakes scam, yet took great measures to keep it a secret. Wouldn't it be better to have someone take over her money matters, family wonder? Mom, on the other hand, wants to retain control and resents the kids butting into her business.

Home safety. Ken's dad has advancing vision loss. After Dad fell several times, Ken spent several weekends installing handrails on the stairs — despite Dad's protests that he didn't need them and that Ken was treating him as if he were "feeble."

Where to live. The folks want to stay in their long-time home — complete with two flights of stairs — even as they are dealing with mobility problems. There's a nice assisted living community nearby, but they won't hear of it. So their son and daughter-in-law are tasked with keeping up the house, doing laundry and mowing the lawn.

Driving. Grandpa has had several car accidents, but he refuses to give up the car keys. His adult children brought over some bus schedules, but those ended up in the trash before the kids even left for home.

What can families do to reduce these conflicts?

Work together to create an accurate picture of the situation. Family members who are providing care support need a thorough understanding of their loved one's conditions and needs. Likewise, the caregivers need to be open with their loved one and other family members about how providing care affects them — how much time and money do they spend? How does it affect their health? Their careers?

Get everyone on the same page. Other family members and friends who don't have the full picture can sometimes inadvertently be part of the problem. Cassie is the primary caregiver for her mom, who has diabetes and has been ordered by the doctor to lose weight. Here comes Cassie's sister April, bearing a box of Mom's favorite rich, calorie-laden desserts. "Oh Cassie, it won't hurt Mom to have a few cream puffs,” says April. "You're just being mean!" Of course, Mom smiles in agreement. Finally Cassie brings out Mom's health instructions from the doctor for April to review. Fortunately, that helps — no more cream puffs in future visits!

Try to see things from the other person's point of view. A caregiving spouse is exasperated that her husband, who suffered a stroke, is refusing to use his walker. She might be more understanding if she got that he is grieving the loss of independence, and sees his assistive device as an outward sign of that loss. On the other hand, what if her husband understood that his wife fears he will fall, thereby setting back his recovery? Empathy could move this pair beyond the "He is so stubborn!" and "She just wants to control me!" stage.

Communication is key. Empathy often flows from information. Sometimes just knowing the reason behind a person's behavior helps us accept it. "Mom, put on your sweater," says Elsa as she helps her mother into the car. "No, I'm warm enough," responds Mom. Elsa is tempted to snap, "Just put on the sweater!" But instead she explains, "I think it will get cold with the AC on, and it won't be safe for me to help you put on your sweater when I'm driving on the expressway." Remember that your loved one is an adult who deserves an explanation.

If there's continued disagreement, call in a "referee." This might be as simple as talking together with your loved one's doctor. "Is it really safe for Dad to drive?" "What will happen if Mom forgets to take her medications?" Or enlist a friend whom you both trust. A qualified counselor can help. Elder care attorneys assist with legal and financial decisions. Geriatric care managers (also called aging life care professionals) are skilled at helping families reach an agreement and access support services. Especially if your loved one is living with Alzheimer's or other memory loss, these conversations should happen sooner rather than later.

If your loved one lives at home, bring in professionals. Maybe you've slowly but surely ended up doing more and more for your loved one. They say, "I don't want a stranger in the house" or "I don’t want to pay for a caregiver — why should I? My kids live in the area!" It's a real irony: There might be a big argument about whether to bring in professional home care, yet adding a caregiver to the mix often is the very thing that calms the waters! Freed from cleaning their loved one's home, helping them bathe, and taking off from work to provide transportation to medical appointments, family caregivers often find they have a lot more patience. And when it comes to sensitive personal care, a professional relationship is much less fraught with emotion. After all, the professional in-home caregiver and your loved one won't be dealing with "old history."

For information on topics related to home care and healthcare, visit our Home Care and Healthcare Advocacy group on LinkedIn.  

Right at Home, Inc. is a national organization dedicated to improving the quality of life for those we serve. We fulfill that mission through a dedicated network of locally owned providers of in home care services.