Role Reversal: Caregiving for Aging Parents

When an aging parent needs caregiving, the children often need to take responsibility. But what happens when only one of many siblings steps up to the plate?

Reviewed by Louise Chang, MD on November 25, 2008

Hannah Kalil is 83 years old, and lives by herself in upstate New York. She has aides who help with her caregiving throughout the day. But the responsibility of managing her finances, health care -- both mental and physical -- and long-term living situation falls to one person: her daughter -- and my mother -- Eleanor.

It's almost a full-time job. Making sure my grandmother is happy and not feeling lonely means daily visits. Her never-ending stream of medical issues means weekly -- if not more frequent -- trips to the doctors. Paying her rent and her aides while keeping an eye on the bottom line means constant vigilance if she is going to have any financial security in the long term. Finally, my mother must deal with the endless stack of paperwork for Medicaid and health insurance.

To make matters worse, my mother shoulders these responsibilities on her own -- despite the fact that her two brothers and sister all live nearby.

This situation is not uncommon: When an aging parent needs care, it's often one child out of several siblings who steps up to the plate to offer help. And with more Americans living longer -- to 75 years and beyond -- this scenario will only become more familiar.

WebMD talked to experts for their insights into the aging of America. What it means for adult children, like my mother, who are put in a position to care for their aging parents. How the one child who shoulders the responsibility of parent-care can enlist the help of others, without starting a family war.

The dynamic of age in America has shifted dramatically over the last 60 to 80 years, experts agree, and its impact on the family is clear.

"There is definitely a changing age structure within families today," says Neal Cutler, PhD. He is the executive director of the Center on Aging for the Motion Picture and Television Fund in Woodlawn Hills, Calif. "Its cause is simply greater longevity."

With more Americans living well beyond their 70s, more adult children are now left in a position where they have to be caregivers for their aging parents.

"There's a greater likelihood today that, as a 55-year-old, you will have surviving parents, than there was say in the 1920s when both parents passed away before you reached the age of 50," says Cutler, who is also dean of the American Institute of Financial Gerontology. "This means that middle-agers, who are planning for their own older years, also have to think about their parents."

To complicate matters, one adult child of an aging parent often bears the responsibility of the parent's care alone. What factors play a part in determining who takes on the care of Mom or Dad?

"There is a gender bias in terms of who cares for an aging parent," says Lisa Hollis-Sawyer, PhD, coordinator of the Gerontology Program at Northeastern Illinois University. "It's fairly universal that we think of women as a caregiver, so their role in helping an elderly parent is not uncommon."

Another factor in determining who will take on the role of caregiver to a parent is age.

"It's also likely it's going to be the oldest," Cutler tells WebMD. "While gender does play a big part, now -- with women in the workforce -- it's not necessarily the case anymore, and age and order of birth can come into play."

But there's more to who is going to care for a parent than gender and age. Instead, siblings should consider who is the best fit.

It's selective matching, explains Hollis-Sawyer, meaning that personalities, geography -- simply who lives the closest -- and finances all play a role in determining who might be able to provide the best care.

If you are nominated -- willingly or not -- to be the caregiver for an aging parent, dealing with the situation can be a challenge. It can be especially difficult if your brothers and sisters aren't willing to recognize their sibling responsibility.

What's the key to enlisting the help of your family to ensure the best care for your parent? Read on for tips from the experts that will help you wade through not only the family issues that caring for a parent presents, but the practical ones as well:

Open the lines of communication. As a family, with all of your siblings and surviving parents, talk about how you will care for Mom or Dad before the situation turns into a crisis, suggests Cutler.

"Anticipate that these are decisions and choices that are best made before a crisis happens," says Cutler. "Sit down with everyone together, and talk about what you want to do, whether it's a financial issue or geographical issue. The key is conversation rather than crisis management."

Then, when it is time for a parent to reach out to their children for help later in life, it's clear who is responsible for what, from a financial and support perspective, without creating a family conflict.

Pick an age. Have this conversation when your parent is still of a "functional" age, whether it's your mother's late 60s or early 70s -- meaning she still has her mental and physical health on her side.

"A good guideline is to talk about long-term care with a parent when issues like a health care proxy or living will come into play," says Hollis-Sawyer. "If these are topics a person needs to think about, then how their long-term care will be handled should also be on the table."

Support comes in many shapes. If one person is elected to be the primary caregiver for a parent, the siblings should think about how they can provide indirect support, whether it's by pitching in with paperwork, finance management, or in-person help.

"A family needs to think about how to help support the sibling in charge of a parent, either with help or compensation of some sort, to help defray the cost that they are incurring," says Steven Stern, PhD, a professor of economics at the University of Virginia, who specializes in aging and disability.

Understand the finances. "Talk to a financial planner about finances if you are caring for an aging parent on your own," says Cutler. "You may be able to take a parent as a dependent on your tax return, if you are paying for more than half of their well-being, such as rent, nursing home care, or food."

The financial aspects of caring for an aging parent need to be taken into consideration for the sake of your parent, but also for your own sake.

"Increasingly, the baby boomers will stay in the workforce longer, primarily because they can't retire on time because of the need to care financially or otherwise for a parent, maybe even a grandparent, and the cost of raising children," Hollis-Sawyer tells WebMD.

When help isn't forthcoming. If the productive discussion before a crisis strikes doesn't happen, and one child is left in charge with no support from his or her siblings, the key is still communication.

"This situation happens a lot," says Hollis-Sawyer. "When it does, the caregiver has to look at their options, and ask themselves questions like, 'Would I benefit by attempting to communicate my needs to others?'"

Reaching out to your siblings or other family members for support is a better option than trying to take on the situation entirely on your own.

"If you do reach out, and you don't get the help you need internally from your family, then it's time to look elsewhere," says Hollis-Sawyer. "Turn to your community for support, like county-wide respite-care programs, or caregiver support programs, or estate-planning consultations to understand the financial issues at hand."

It's not all about you. Pay attention to your parent and his or her needs, and remember that there are two people in this situation -- not just one.

"It's so important to realize that there is a lot of stress to being the care recipient," says Hollis-Sawyer. "There are just as many mental hurdles that need to be overcome for the aging parent -- like accepting care and depending upon someone else almost entirely later in life maybe when you'd like to be financially secure -- as there are for the adult child in charge of their care."

While the responsibilities of caring for an aging parent might overshadow the benefits at times, it's important to remember the rewards of the situation as well.

"There are definitely benefits of a positive caregiving relationship for an elderly parent and an adult child," says Hollis-Sawyer. "The bonding experience can create an intimacy that may not have been encountered when the adult child was going through their own mid-adult phase. Maybe hopefully, they are becoming closer to the parent."

Many people, she says, find that caring for an aging parent is a growth experience, which creates an opportunity for both people to learn more about themselves.

For the parent, having a child around to spend time with, and provide care, may make a difference in quality of life.

"When kids provide help for the parent, it has a significant effect on the parent," says Stern. "They have a stronger emotional connection to their child than they would to a stranger who is an aide or a nurse in a living facility. While it may not necessarily make them healthier, I believe it does make them happier."

Show Sources


Hannah Kalil, Sherrill, N.Y.

Eleanor Hatfield, Sherrill, N.Y.

Neal Cutler, PhD, executive director, Center on Aging for the Motion Picture and Television Fund, Woodlawn Hills, Calif.

Lisa Hollis-Sawyer, PhD, coordinator, Gerontology Program, Northeastern Illinois University, Chicago.

Steven Stern, PhD, professor of economics, University of Virginia, Charlottesville, Va.

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