Taking A Team Approach

By Amy Dickinson

Five years ago, Chuck Thompson and his wife Chris moved from the Philadelphia suburbs, where they had raised their three children, back into Chuck's parents' home in Levittown, Pa., to assume full-time care of Charles Sr., 76, and Ruth, 73. Charles' worsening dementia and Ruth's health problems meant that if the parents were to stay in the family home, someone would have to live with them. Chuck, 56, says that as the oldest of the Thompson offspring and with his kids grown, he most naturally got the job. Now he cooks the meals, maintains the house and manages his ailing parents' complicated medical care--all while running a home-based marketing business. Even though he describes his daily life as careening from crisis to crisis, Chuck says he copes with his complicated caregiving duties only with a lot of help from his "team"--his brother and sisters.

Chuck is lucky enough to be one of six children, and all but one take an active hand in caring for their parents. Brother Scott, a lawyer, has power of attorney and handles legal issues. Sisters Jodie and Diane live nearby and help with doctor's visits and by sitting with their parents at home when Chuck and Chris go out. Just now sister Nina is taking a week off from her job as a social worker in Auburn, Maine, to spell Chuck for a few days, something she does four times a year. The other siblings take turns parent sitting so that Chuck and Chris can get in their weekly golf game and attend meetings of Children of Aging Parents, their caregivers' support group. Says Chuck: "In support group, we see battles and heartbreak in families where siblings don't help out. I got so lucky with my brother and sisters, because I truly couldn't do this without them."

Gem Brown is less fortunate. Although she is one of five children, Gem, 36, bears most of the responsibility for her ailing father Hencliffe, 73, a retired mail-room worker. Gem, who works full time for a medical home-care company, has moved her dad into her two-bedroom condo in Mount Laurel, N.J., so that she can look after him. She has enrolled her father at the Tender, an adult day-care program that he attends while she's at the office, and she schedules morning doctor's visits so she can get to work on time. Gem's brother Marshall, 44, and his wife Nancy help out by playing host to Dad in the afternoon when day care is over and fixing dinner for the family before Gem arrives to take him home. But Gem thinks her other three siblings, all of whom live in the area, should pitch in more. "If they would participate more in his daily care, it would make things so much easier for all of us," she says. "I just wish they would roll up their sleeves and help."

Caring for ailing parents is a burden that a growing number of families now face as the elderly population increases. Nearly 1 in 4 American households is involved in caregiving to older relatives, according to the Department of Health and Human Services. And an estimated 90% of caregiving takes place at home. Deciding which sibling makes sure that Mom takes her daily medicines or that Dad regularly gets out for some fresh air can add strain to an already stressful situation.

Beth Witrogen McLeod, author of And Thou Shalt Honor: The Caregiver's Companion (published in September by Rodale Books, in conjunction with a pbs documentary of the same name), says a parent's illness can cause a rift between siblings, as old wounds surface and brothers and sisters begin to squabble over care, money worries and commitment to the parent. "Sometimes the most painful part of a parent's illness for a family is what it does to the sibling relationship," she says. One sibling usually ends up "in charge" while others may balk at duties or back away altogether.

Geraldine Kijowski, 62, of Millville, N.J., is in charge and doesn't like it one bit. For the past 10 years, the retired secretary has had sole responsibility for her bedridden mother, including home care, emergency hospital stays, hospice visits and now daily trips to a nursing home. Geraldine says her only sister hasn't visited for years and doesn't participate in any aspect of their mother's care. The roller coaster of emergencies and emotions that she has experienced over the years has been almost more than Geraldine can bear alone. "Now that I'm losing my mother, I've also lost my relationship with my sister. The burden has been completely on me, and it has broken my heart," she says.

There are ways to avoid or at least reduce the heartache. Getting professional assistance is one. The goal for a hired elder-care manager is to help assign everyone a suitable job. "I figure out what people's different strengths are so they can find a way to contribute," says Steve Barlam, a Los Angeles geriatric-care manager. "I just don't buy it that someone is too busy to deal with part of the care. That message is better coming from me than from a big sister."

Here are some tips on how to care for an ailing loved one as a family:

FIND A MEDIATOR A neutral third party such as a social worker usually initiates a meeting or a conference call to discuss what each family member can contribute. One family member can handle research and paperwork, another the doctor's visits and a third the shopping and driving. Then the social worker can periodically follow up to see how things are progressing and tweak the system when needed. A mediator can help families find outside help for housework, errand running and home-based medical care. The National Eldercare Locator will assist families that are looking for local resources and answer questions regarding elder care. You can call 800-677-1116 Monday through Friday, or visit www.eldercare.gov The National Alliance for Caregiving offers tips and resources for families at www.caregiving.org

USE TECHNOLOGY E-mail and conference calling are great ways for siblings to keep in regular contact for updates about a loved one's condition and changing needs. Siblings who might have problems communicating face-to-face owing to distance or personality conflicts can share information such as nursing-home reports or updates on doctor's visits. Some geriatric-care managers maintain separate Web pages for their clients, sending out regular email with updates, so that everyone is literally on the same page.

BE CREATIVE Some families share duties by assigning a "sibling of the month." That sibling takes the lead for managing care, doctor's visits and medical emergencies during those weeks. Siblings might even rotate living in the parent's home on a week-to-week or month-to-month basis to provide live-in care.

TAKE CARE OF YOURSELF Community resources such as church groups, senior services, neighbors and friends can give you a respite from caregiving. Support groups can provide encouragement. It's important to maintain your interests as much as possible, whether you enjoy a weekly golf game, a movie night or a book club.

BE FORGIVING Even if a sibling refuses to participate in the care of a parent, you should keep in touch with him or her and find some way to accept the situation. "Not everyone can handle this or will handle it, and you can't force them," observes author McLeod. "That may mean accepting your sibling's limitations and moving forward to do the best you can do. It's healthy to forgive someone, and it's also what the loved one you're caring for would want you to do."