Caring for an Aging Parent When the Relationship Is Complicated
When Aging Brings an Old Family History
Back to the Surface
Relationships with aging parents can be complicated for many reasons. A previously healthy relationship may become strained when a parent refuses help or resists changes intended to keep them safe.
In other families, the difficulty may be rooted in a long-standing history of conflict, estrangement, poor boundaries, or even, emotional or physical abuse.
Most conversations about caring for an aging parent begin with an assumption: the adult child and parent have a loving, supportive relationship and that the primary challenge is figuring out how to help.
For many families, it is much more complicated.
Sometimes, there is a history of difficult family relationships, emotional immaturity, chronic conflict, poor boundaries, estrangement, or emotionally or physically harmful behavior. Adult children may have spent years establishing boundaries or creating distance, only to find themselves facing a new question as their parent gets older:
‘What should I do when my aging parent needs help, but being closely involved in their care is difficult or emotionally harmful to me?’
There isn't one answer that works for every family. However, needing care does not erase a family's history. Ensuring that a parent has appropriate support does not necessarily mean that an adult child must personally provide every aspect of that support.
Aging Does Not Erase
a Complicated Family History
An older adult can have legitimate needs for help with medical appointments, transportation, household tasks, care coordination, or navigating the healthcare system while an adult child simultaneously has legitimate reasons for limiting direct involvement.
Both can be true.
Aging care needs can also change family dynamics that an adult child previously thought they successfully managed. A hospitalization, a fall, a new diagnosis, loss of driving privileges, or increasing difficulty managing everyday responsibilities, may suddenly place the parent and adult child into much more frequent contact.
For an adult child with a complicated family history, changing care needs can bring back longstanding patterns and emotions.
Common emotions or dynamics may include:
Guilt or a strong sense of obligation
Anxiety before or after interactions with the aging parent
Difficulty maintaining previously established boundaries
Repeated demands for immediate assistance
Criticism when the adult child is unavailable
Attempts to involve siblings or other relatives in disagreements
Pressure to take on responsibilities the adult child does not desire to, or have the ability to manage
Conflict between concern for the parent's welfare and concern for one's own well-being
These situations do not always involve abuse or estrangement. Family relationships exist on a spectrum. Some are simply difficult or emotionally exhausting, while others involve histories that make close contact genuinely unsafe or harmful.
The appropriate level of involvement will therefore look different for every family.
Caregiving
Does Not Mean Doing Everything Yourself
Adult children often think they must either become the parent's full-time caregiver, or find placement into a higher level of care.
In many instances, there are more options than an all-or-nothing approach .
There is an alternative third option. An adult child may decide to enlist outside help, while ensuring they are still kept apprised of their parent’s health status.
That might mean arranging professional help for medical appointments, transportation, household support, care coordination, or other needs while maintaining limits on the adult child's own involvement.
For example, an adult child might:
Receive updates without attending every medical appointment
Arrange transportation rather than becoming the default driver
Hire assistance for errands or household tasks
Use a geriatric care manager to coordinate providers and services
Establish one point of contact for all scheduling and appointments, while still having access to electronic health records for the most recent information
Help develop an emergency plan without becoming available for every non-emergency request
Coordinate appropriate services while maintaining limited contact with the parent
Delegating part of the caregiving workload does not mean care and concern for your parent stops. Sometimes professional support allows an adult child to remain involved in a way that is more sustainable.
When Boundaries Become
Part of the Care Plan
Consider a common situation:
An adult child has repeatedly asked a parent to provide several days' notice when transportation to an appointment is needed. The parent schedules an appointment and calls the day before expecting the adult child to rearrange work or other responsibilities.
When the adult child relays their unavailability due to late notice, the conversation turns into criticism, guilt, or even, accusations that the child does not care. There may be an effort to triangulate other families members into taking sides.
The initial problem may appear to be transportation. However, the underlying problem is that the family does not have a care plan that can function independently of the conflict.
A more sustainable plan might be to establish the boundary that the adult child will assist when adequate notice is provided, and that a professional transportation, concierge, or care-management option will be used when the adult child is unavailable.
A boundary does not require the other person to agree that it is reasonable. It identifies what an individual is and is not willing or able to do.
Professional services can sometimes make those boundaries easier to maintain because there is an alternative plan when the adult child cannot personally respond.
Guilt, Duty and the Thought:
‘But They're Still My Parent’
A parent's increasing needs can create complicated emotions even after years of distance.
Adult children may experience grief, anger, guilt, resentment, sadness, compassion, all at the same time.
They may also find themselves grieving something different from the parent's physical decline: the realization that aging did not transform the relationship into the relationship they once hoped to have.
Alternatively, there may be powerful cultural and societal expectations surrounding caregiving. Statements such as ‘But that's your mother,’ ‘He's still your father,’ or ‘Family takes care of family’ can make an already difficult decision feel even heavier.
Concern for an aging parent's welfare and boundaries around your own involvement are not necessarily mutually exclusive.
The question may become less about whether you care and more about what kind of involvement is sustainable and appropriate for you.
Financial issues can add another layer to difficult family relationships.
In some families, an anticipated inheritance, financial assistance, property, housing, or other resources become intertwined with expectations about caregiving.
An adult child may worry that establishing boundaries could have significant financial consequences, not only for themselves, but potentially for their own children.
It is important to note that this does not automatically mean the older adult is intentionally using money to control the relationship. However, it can be helpful to recognize when financial expectations are influencing caregiving decisions.
When Money or an
Expected Inheritance Complicates
the Relationship
Depending on the circumstances, an adult child may benefit from considering the following questions:
What assistance does my parent actually need?
What assistance am I personally willing and able to provide?
What services can reasonably be provided by someone else?
How much are financial expectations affecting the choices I am making?
A therapist, financial professional, elder-law attorney, or other appropriate professional may be helpful when the answers to those questions become particularly complicated.
What About Filial Responsibility Laws?
Some adult children are surprised to learn that certain states have laws concerning an adult child's potential responsibility for an indigent parent's support.
What is Filial Law, also known as filial responsibility law, or filial support law, is a legal statute that requires adult children to provide financial and physical support for their impoverished or indigent parents.
These laws vary considerably from state to state. Who may be responsible, under what circumstances, available defenses or exceptions, and how these laws are applied or enforced, are legal questions that depend on the individual situation and jurisdiction.
An estranged adult child, therefore, should not assume that they are legally responsible for providing a parent's care, or, that estrangement automatically eliminates every potential obligation.
If filial responsibility is a concern, an elder-law attorney licensed in the relevant state can provide guidance about the law and the individual's circumstances.
This information is educational and is not legal advice.
Creating a Sustainable Plan for a Strained Parent-Child Relationship
There is no single correct amount of involvement when it comes to caregiving for a parent.
For some families, healthy boundaries may allow the adult child to remain actively involved.
For others, limited contact may be appropriate and necessary for a number of reasons.
Lastly, in situations involving a serious history of abuse, remaining personally involved may not be an emotionally or physically safe option.
A sustainable plan can begin by pondering three questions:
What must be addressed?
Consider immediate health, safety, housing, transportation, and daily-living needs.
2. What tasks am I willing and able to do?
Consider your own work obligations, immediate family responsibilities, financial availability, emotional well-being, and relationship history.
3. What can someone else do?
Can someone else provide transportation, medical appointment support, care coordination, errands, portal management, household assistance, or communication with providers?
Considering these questions can make a an overwhelming situation, feel considerably more feasible when coming up with a long-term care plan.
Geriatric Care Management Can Reduce the Family's Emotional & Physical Load
A geriatric care manager or senior concierge service can provide a neutral layer of practical support between an older adult's needs and an adult child's personal involvement.
Depending on the older adult's circumstances and the services available, professional support may include:
Assessing current needs and identifying areas of concern
Attending medical appointments and providing summaries
Coordinating with healthcare providers and community resources
Assisting with transportation and appointment accompaniment
Assisting with errands and everyday tasks
Identifying additional services as needs change
Providing extended family with follow-up information without requiring their oversight of every interaction
Professional care management cannot resolve longstanding challenging family dynamics. It can however, reduce the number of situations in which those dynamics become the mechanism through which necessary care must occur.
For some families, that distinction can make caregiving more sustainable for everyone involved.
For more information on what care management or senior concierge services can do for your family, visit our Care Management or Senior Concierge pages.
You Can Care
Without Becoming
the Entire Care Plan
There is a delineation between wanting an aging parent to age safely and independently at home, and assuming that you must personally meet every need.
Sometimes the healthiest and most sustainable form of involvement is creating a system in which appropriate care exists without requiring one family member to carry the entire emotional and physical load.
If you are trying to determine what support may be beneficial to you and your parent, or which responsibilities could appropriately be handled by someone outside the family, a professional care-management consultation may be a good place to start.