I have been corresponding with a friend primarily about her grief journey which is being compounded and interfered with by a mother who is showing strong signs of dementia. I only mention her case because the situation is typical of the kind of things I have heard over and over again. There seems to be a pattern built into families as their parents age and the pattern almost always ends in chaos or worse.

This friend lives in the same town as her mother. She has a brother who lives a couple of states away and has never been very much help or support in family matters. She sees him as irresponsible with problems of his own and his wife is currently dealing with her own parents. 

The first step in this pattern seems to always be some reason why one person must face the total load of care. Somehow families will usually figure out a way to hang this burden on one person and then sit back and criticize every decision and move that person makes while giving the care. There are two sides to this step. One side is the siblings not showing any interest or competence in giving care, and the other side is the one being left with the care agreeing with that evaluation. The siblings are dismissed by the caregiver with, “Oh they never have been any help and they would not know how to help even if they wanted to.” With that, everyone is off the hook except the one hooked.

The next step in the pattern is denial. The siblings who live away cannot believe the parent is as bad as the one living with the mother claims. The parent becomes part of the denial as well. They don’t think they are as bad as the doctors say and can’t remember what they have been told. When the out of town siblings come for a visit, their excitement gives them a shot of adrenalin and they seem well and happy. The siblings go home thinking the condition has been exaggerated and the parents are fine. The excitement dies away and the parent returns to their true condition. The poor caregiver is left with no one to believe their story.

In my friend’s case, I can see the next step developing on a daily, step by step basis, she must give more and more time trying to convince her mother that she should not drive her car, that she must be sure to take her medications, and to be sure the stove is not left burning. The doctor is saying that her mom should not live alone and my friend is left with facing the next step all alone while knowing her brother will not agree with her decisions. You can imagine the rest of this story before it even happens.

The question is how do we break these kinds of patterns? I do think there are ways to avoid the pattern. The most effective way is for the family to have a meeting well ahead of need to discuss what kind of care the parent wants and lay plans for providing the care when and if it is needed. Most long term care just evolves without pre-thought or planning. When it happens by evolution, it usually ends up in one person’s overworked lap. 

In my friend’s case, it is too late for such planning but not to late for some smart moves. I recommended that she asked her brother to take his mother for at least a two week visit to give her time to catch her breath and deal with her grief. The visit should make the brother aware of the mother’s true condition and get him involved in deciding on the plan for her care. He may not decide to give the care himself, but he will at least understand what is involved in the care. 

When the visit is over, then the two of them should sit down and think through all of the possible solutions to meet this need. The brother is no longer a spectator, and spectators tend to become critics. This is a family affair and it can only be really solved by the family as a whole. 

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