When Families Disagree

When an aging loved one begins to need help at home, conflict often follows. Family members all want the best for Mom or Dad, but they may disagree over what that looks like.

Emotions are already running high. One sibling may live nearby and have a good sense of the day-to-day reality, while another lives hundreds of miles away. One may prioritize safety, while another worries about preserving independence. Getting everyone on the same page isn’t always easy.

“This is something we see in families often, and it’s nothing to be embarrassed about,” said Tammy Hooker, Regional Operations Director — Austin. “People love their parents and want to do the right thing. They just may have very different ideas about what the right thing is.”

Family members may disagree over whether a parent should remain at home or move to a senior living community, whether to continue aggressive treatment or emphasize comfort. Conflicts can arise over medical interventions, or even everyday questions about food, bathing and activities. Siblings may also disagree about how much risk is acceptable — or who is carrying too much or too little of the caregiving load.

Research confirms that such disagreements are common. In one Canadian survey, hospice and palliative-care professionals estimated that nearly 80% of families experienced some degree of conflict while a family member was near the end of life. Dementia can make decisions especially difficult because family members may increasingly need to speak for someone who can no longer clearly express his or her wishes. That can leave plenty of room for different interpretations of what Mom or Dad would want.

Tips for navigating conflict

What can families do?

Listen — and give each other some grace. Remember that everyone is under stress.

“Try to begin with the assumption that everyone wants what’s best for the person they love,” said Gary Hooker, Cambridge Caregivers’ Regional Development Director — Austin. “You may disagree strongly about how to get there, but recognizing that shared goal can change the conversation.”

Listen for what lies beneath the disagreement. “Dad should stay home” may really mean, “I promised Dad I would never put him in a nursing home.” “Dad can’t stay home” may mean, “I’m terrified he’s going to fall when no one is there.”

Bring in a neutral third party. A physician, geriatric care manager, social worker, chaplain or palliative-care professional can provide perspective and help families focus on facts rather than emotions.

Cambridge Caregivers can help, too.

“We’re not therapists, and we’re not there to settle old family disagreements,” Tammy said. “But we do have experience with these situations. Sometimes it helps to have someone who isn’t part of the family step in, listen and offer a professional perspective based on what we’re seeing with the client.”

The presence of family conflict is something that experienced caregivers learn to navigate. At a recent company Town Hall, Cambridge Caregivers shared how they can best help: listening carefully, communicating clearly and calmly, drawing on professional experience and, above all, keeping the client’s interests at the center of the conversation.

If possible, talk before a crisis hits. If a parent has been diagnosed with brain change but can still make decisions about care, now is the time to ask: Who do you want making decisions if you cannot? What matters most to you if your health declines? Research supports those conversations. One study found that fewer advance-care-planning discussions were associated with greater family conflict.

Keeping priorities in focus

Keep the loved one who needs care at the center of the conversation. Instead of asking, “What do I think Mom should do?” ask, “What would Mom want?” If she can still participate meaningfully, include her. If she cannot, look to previous conversations, advance directives and the values that have guided her life.

And remember that siblings may be seeing different realities. Someone who visits twice a year may see a very different parent from the sibling managing medications, meals and doctor appointments every day. Both perspectives deserve to be heard.

Finally, accept that there may not be a perfect answer. With progressive dementia or serious illness, families are often choosing among options that each involve trade-offs. That’s when experienced support can make a difference.

“We’ve walked alongside a lot of families through difficult transitions,” Gary said. “You don’t have to have all the answers on your own. Sometimes having an experienced person there can help everyone take the temperature down and bring the focus back where it belongs — on the person you all care about.”