Dealing With Siblings in Denial About Parental Care

As soon as the therapy room door closed behind me, before I could even sit down, my single, 45-year-old client, Jenna, let loose a river of tears. Between her sobs, she managed to say, “I can’t take it anymore. All I do is try to help everyone. They treat me like I’m a criminal. They’re driving me crazy!”

Jenna had temporarily moved into her mother, Donna’s, old Victorian house after her mother fell down the stairs while having a stroke. When Donna had come out of the hospital, with her new replacement hip and some mild cognitive deficits, Jenna was there to help get her back on her feet. Literally.

She’d taken all of her vacation time to spend the two weeks with her mother. Everything would have gone according to plan, except that it didn’t. Donna did not bounce back. She remained somewhat confused and forgetful and struggled with her balance, even when using her walker.

Of course, Jenna’s two older brothers saw things differently. When they visited from their homes, each about ½ hour away, Mom was on her best behavior. They found her to be recovering nicely and told Jenna to go back to work. They made it clear that they didn’t want her moving in with Donna permanently and “living off of her.” And she’d better not think that she was going to claim that the house would be hers after Donna’s eventual passing.

Jenna moved back to her apartment and went back to work, only to find, two days in, when she stopped by Donna’s house, that things were not going well. Donna had eaten almost nothing, was dehydrated, and had forgotten to take her morning pills two days in a row. She was dizzy and a bit delirious and extremely glad to see Jenna.

Sibling Patterns Run Deep

Sometimes, when a parent needs care, siblings revert to childish behaviors and interactions. They become bossy, jealous, and demanding, and compete to be the favorite. These siblings were beginning to experience tension around accepting that Donna had real deficits. The brothers felt that Jenna was exaggerating their mother’s difficulties because she was vying to leave her job and live with Donna. She had always been the baby, and the brothers resented the extra attention she had always received. They felt that Donna would recover best if she were responsible for doing as much for herself as possible. They didn’t want Jenna babying her.

In our conversations, it became clear to Jenna that this was becoming a more long-term caregiving situation. Our main goal was to help Jenna help Donna remain as independent and safe as possible. But it was also important to get the siblings on the same page about Donna’s status. And there would have to be conversations among them about how the caregiving would be organized and financed. And they’d have to nail down how committed to being involved in Donna’s care each of them would be. And, unless Donna was going to move out, it would require some effort to make Donna's home as safe as possible.

The Action Plan

We gave Jenna three main goals to begin to get the caregiving on track:

1. Donna needed a neurological evaluation. This could be with a specialist, a neurologist, a gerontologist, or her primary care doctor. Many of them will do a mental status exam, a gross measure of functioning. They will also ask about her activities of daily living (ADLs) to get an idea of how much help the patient requires. Jenna should be at the appointment and should share her experiences with the doctor. Getting a baseline of Donna’s current functioning would help the doctor to keep track of how Donna is doing over time. It would also help Jenna to convince her brothers that Mom isn’t just fine on her own. They would be more likely to believe what they read in a doctor’s visit summary than whatever Jenna has to say.
2. For the siblings to communicate most efficiently and effectively, Jenna should set up an email group or text chain in which she can post the latest medical results. She can also post about her observations, such as Donna forgetting to take her medications or stay hydrated. Ideally, this forum would be used by the brothers to share their opinions, concerns, and questions as well. The goal is to increase and improve the communication among the siblings and to keep it at the adult level as much as possible.
3. If the brothers get on board, then the next step is to get them more involved with Donna’s care. It seemed clear that Jenna would be doing most of the heavy lifting, but asking her brothers to step in to help in whatever ways they could would make them more likely to see how Donna is actually faring. They’d also get a view of what Jenna is handling as well. Jenna should make specific asks, such as, “Would you help Mom pay her bills this month?” “Could you mow her lawn?” “Would you take her out to lunch?” If they suggest something they’d like to do, then Jenna can help coordinate it. When siblings share at least some of the caregiving burden, they tend to become more cooperative. And when they look back on the caregiving years later, they usually feel good about having chipped in. And after all is said and done, the sibling relationships tend to be closer and stronger.

There were many more issues for Jenna to deal with, which will be covered in the next few blog posts. Hopefully, my suggestions for Jenna might come in handy for you, too, if you have sibling issues arising around caregiving.