Navigating Health and Aging: Family dynamics can make caregiving even more difficult

For my followers who may wonder how I arrive at a subject on which to write, I offer an explanation. I have a long-running list of potential topics, all of which I encounter as a nurse and geriatric care manager in the course of navigating clients through the maze of our current health care system and extended care.

I often get emails or am stopped by readers who may request that I write on a particular topic. I do my best to accommodate requests. There are times that I deviate from my list and have an occasional rant about something that just gets my blood boiling or is particularly distressing.


Usually I have a pretty good sense about how readers may or may not react. I was somewhat surprised to get a lot of positive response to an article on depression. Sometimes I hit a nerve and — ouch — the comments roll in. This is a long lead into preparing you — and me — as I know I'm going to hear about this one.

Let me first say that I am not an expert on sociology or human behavior. However I get a good dose of both each time I enter a client's home and/or interact with their family. Family dynamics are always interesting and each one is different. While most of us at some time in our lives thought that everyone else had the perfect Norman Rockwell family, hopefully we have all come to the reality that just isn't so.

Every family has its own style. And each has its own dysfunction of some kind or another. So when we all stop fantasizing that everyone else's family is perfect then we can just all say "we've got what we've got" and get on with it.

How does this relate to care? The illness or decline of a loved one doesn't always bring out the best in family dynamics. It's rare for me to see a totally cohesive family that sees all the facts and problems in the same eyes. The experiences of one child or parent are rarely the experience of another. Sometimes family members are truly informed on the details of a loved ones condition and begin planning to make decisions for what may lay ahead. Most often there are many different opinions on the matter.

When the health — whether that be physical, emotional or cognitive — of a loved one declines to the point that there are concerns for their ability to care for themselves, this can become an issue and family dynamics can be tested. It is very common for different family members to have different perspectives. It is extremely common for one or more loved ones to be in denial of the situation. Others may see the decline while some may rationalize and make excuses for the behaviors or health issues.

That's where the family dynamics can become tricky. You think Dad needs help but your sibling feels that everything is fine. In cases where one sibling becomes the primary caregiver and the other siblings are telling the caregiver what they should be doing but not really pitching in, it becomes really frustrating. Anybody relate?

Here comes the dynamics. There's a term in care management "sister Sally in California." She's the one who may be giving everyone who is pulling their hair out here in the thick of things, advice from elsewhere. This can be incredibly frustrating and angering to the caregiver seeing the day-to-day reality of the situation. On the flip side, sometimes it's sister Sally who really notices that there is a problem because she hasn't seen the slow decline and now sees the drastic change in the loved one.

There is often a phenomenon of the "martyr," the sibling who refuses help and wants to control the whole situation until they become tired, frustrated and resentful. When that happens, they often point the finger at the others and blame them for not helping.

People have motivations that are driven by their own feelings and experiences. That's why it's so hard to be on the same page. Often times, if a child has guilt about a strained relationship with a parent, they may over compensate by holding on to "the old mom" so that they can make amends. I hear far too many stories from disgruntled family members about suspicions that family members are "only worried about the money." That is not for care providers to judge, but it does give insight into dynamics.

Caregiving is a demanding, full-time job. Caregiver burden can cause depression and serious health problems. Studies have shown that caregivers who have support from their family members fair far better than those going it alone or with family contention.

So what's the answer? Support through a caregiver support group is a good place to blow off steam. The most effective means to get everyone on the same page is to have a family meeting by phone with out-of-towners and in-person for those close by.

Having a third party to discuss the health issue and realistically address options for care and safety can allow everyone to share their thoughts and be heard.

The most important goal is making sure the loved one who is having issues is the focus. Working in the best interest of Mom or Dad should be above everything else. A mediator can keep the discussion on the right track. It is not uncommon for the stress to bring out the worst and before you know it someone is raising their voice and playing the blame game and bringing up old junk — like that time in the third grade when you (fill in the blank). I'm not kidding. It happens.

Remembering that the well-being of your loved one is what it's all about and can hopefully keep everything in focus.


Jill Rosner is a registered nurse, certified geriatric care manager and owner of Rosner Healthcare Navigation. She provides patient advocacy and care management services to clients with health and aging issues. Contact her at