The relationship between a parent and an adult child often includes a degree of unresolved emotion. This may not be completely visible when the relationship involves only occasional casual visits. However, conflicts often re-emerge when an adult child steps in to assist a parent recently requiring more assistance due to age or illness. Unfortunately, by the time a family realizes it's time to intervene, the situation is often in crisis mode, and there is little time to adequately resolve past issues.

Family caregivers should ask themselves the following questions as the need for care and assistance begins to grow:

• What level of care am I able to provide my parents?
• At what point will I need to involve a professional, like a care manager or lawyer?
• How has my family resolved issues in the past involving difficult and complex concerns?
• How did my parents manage the care of their aging parents?
• What is my relationship with my siblings or other care providers and how are our roles similar or different?
• Do I have the feeling my parents are making the right decisions about their future? Do my siblings agree with me?

PARENT RELATIONS:

Frequently, adult children don't feel their parents are making the right decisions. We ask ourselves "why can't our parents just cooperate with us?" Ongoing conflicts with siblings can dramatically increase the frustration level. I'll talk about sibling relationships a bit later in this section.

First, it's important to reflect on what role your parents have played in developing the plan for their future. Remember that few of us will "buy-into" something we've had no part in creating. Involve your parents and other family caregivers in all conversations about their future. Even older adults with memory loss should be included in these discussions despite the fact that much of the information will be forgotten. The fact that you involved them in decisions will be remembered on some level.

Even for families who have involved their parents in this process, it might be impossible to agree upon a basic course of action. In this case, you must think about the following:

Are your parents at risk to themselves or others?

Separate your thoughts about "quality of life" from your thoughts about risk and danger. You might conclude that you're not comfortable with their present living situation, but your parents pose no significant risk to themselves or others. In this case, you're in the same boat as most other caregivers!

The best course of action might be to accept that your parents are still ultimately in charge of their lives. Tell them your concerns, if you feel strongly. However, a better approach is to provide information and options. See if your parents will tour different facilities and investigate other housing options without the pressure of imminent transition. Make clear the final decision will be theirs.

If you think that your parents are at risk and you have gained legal authority to proceed (see legal aids in decision-making) then continue on your course. It may be helpful at this point to elicit the assistance of a physician, case manager, or lawyer who can offer an independent assessment of the situation and discuss the options with your parent. Sometimes an outside, non-family member can have more influence then those in the immediate family.

If you believe that a risk exists, but you have no legal authority to proceed and your parents refuse to cooperate, then seek the advice of an attorney well versed in elder law and competency issues. You can also contact the County Health and Human Services Department and talk with someone in the Vulnerable Adult Division.

SIBLING RELATIONS:

The last time you and your sibling made a tough decision together might have been on a family vacation when you fought about who had more room in the backseat. Now, you're family is in crisis mode, and you're trying to figure out how to work effectively with your siblings, like a team.

Like most teams, one of you will probably emerge as the natural leader. He might live closest to your parents, or have professional training well suited to the task (nurse, social worker, lawyer), or he might have always played this role, even as a youngster. As long as you have confidence in his ability to play the leading role, and he seems willing to carry out the plans of the group at large, try to accept him in this role. In this capacity, he'll be the one who gets the midnight phone calls, leaves work midday to accompany your parents and has to communicate status to the other siblings.

On the other hand, since you're reading this book, chances are you're probably the natural leader of the family and you will have to accept the leading role. It will be important for you to think about the roles that other siblings can play. Some siblings may be able to contribute financially, but not hands-on due to distance, family commitments or other barriers. Some siblings may be available to give you a break, even if it's just once in a while. Regardless of your particular role, make sure you have a clear understanding of what you'll be expected to contribute and a predetermined course of action.