In most families the care of aging parents will fall on one person. There are exceptions of course but most of the time one person will become the primary caregiver. Sometimes this is a rather natural process that seems to automatically choose the person to shoulder this task. It may be that this person happens to live closer to the parents. Often it just seems to be the natural choice. Somehow this person has become the one who does this sort of thing for the family. I have tried to analyze this to see if there was some pattern like first born, middle child, or baby in the family but I can't find any pattern that fits. It just seems to happen.

Sometimes the task is assumed by the person themselves. They can't allow anyone else to do it or they want to give the care for their own personal reasons or because they are natural born caregivers.

At other times the family hangs it on one vulnerable person. I sometimes say, "Many are called, but you have been chosen." Too often the game is to hang the care on one person and then sit back and criticize everything that person does. I wish I could relate the pain I have heard as I speak around the country. I hear stories ranging from constant criticism and anger all the way to law suits after the care is over. 

This makes a family meeting ahead of need all the more important. If the meeting is done right, then the primary caregiver issue is handled in a mutually acceptable and understood manner and rules are laid down to help prevent some of the abuses now happening.

Most families could predict well in advance who will be the primary caregiver. Most people who will become such already know they will do so. It may well be that no one person should have to fit this role, but the actuality is in most families this is how it is going to be. If you are the one who will be chosen or picked then you are the one who needs to take the initiative and call for a meeting of the family ahead of need. You dare not wait for someone else to do so. In almost all cases, the parents will not do what we did in our family and call for a meeting. We did so out of my experiences dealing with families who did not do so. If not for that, I am sure it would not have dawned on me either. Most likely it can only happen if one person sees the need and the future and insist that the issues be faced together.

Almost every time I talk about family meetings someone in the audience says, "You don't understand, my brother would never come to such a thing." My response is to say, "Write him and say 'if you don't come to the meeting we are going to mail mother to you'. And then do it." This is not the time for timidity and fear. This is a time for demanding responses and ideas.

I tell primary caregivers to call the meeting to order and make every one else talk first. Don’t' tell them what you think and then ask for agreement. Ask them how they see the future care and how they think it should be handled. Make everyone there speak. Do not allow spectators. Spectators become critics. I think it would be wise to take notes or even tape the session so there can be no dispute about the agreements later. I know this sounds harsh and over the top, but believe me the decisions ahead have the potential of tearing the family apart so err on the side of caution. 

I hope it is understood that the parents should be present and heard at this and all meetings as long as they are cognizant enough to participate. I have watched audiences smile in agreement with me as I talk about family meetings and then have seen them freeze when they realize they are going to have to say these things in front of the parents. That can be intimidating to say the least. Far too often the children meet together, talk about the parents behind their backs, make decisions about what kind of care they will receive and then wonder why the parents reject their ideas. A lot of time the issue isn't where the parents are going to live or what kind of care they will receive, often the issue is who made the decision. Aging is a gradual loss of independence and each tiny loss is noticed and felt. We need to be "in the loop" whether or not that is intimidating to the children. To exclude is to ask for conflict. To exclude long enough is to ask for war.

Let the meetings begin. 

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