How to Manage Sibling Relationships Strained by Family Caregiving

He recommends convening one big family meeting moderated by a wise and respected neutral party, ideally with the parent there, but without them if they are incapacitated or uncooperative. 

“You generally have one chance at this,” Blazer says. The mediator should allow family members to speak one at a time and then provide opportunities for others to respond. 

“What that does is permits each family member to actually have to hear the other person before they’re jumping in and interrupting or making a statement about what should happen,” he explains. At the end of the meeting, the mediator writes down and shares agreed upon decisions with all relevant family members.

Blazer saw this approach work in his own family when an elderly, indecisive aunt was allowing an unscrupulous nephew to live with her and he was “creating havoc.” 

The family came together and agreed that the best course of action was to move her into assisted living and sell the house. Although she didn’t initially want to go, she acquiesced. “We were able, in that circumstance, to get her into assisted living, which got the nephew out of the picture.” 

Work toward a common goal

Jennifer Weyenberg, a hospice chaplain at Providence St. Jude Medical Center in Fullerton, California, sometimes acts as a mediator for families in conflict.

She recalls walking into a hospital room to find two siblings screaming at each other. Because they had been raised to be “good Christian kids,” they stopped arguing when she, the pastor, entered the room. 

“I said, ‘Let’s sit.’ So they each sat on one end of the couch and I sat in the middle, and I said, ‘I’m going to ask you a question, and I’m going to look at one of you and the other one isn’t going to speak until I look at you. And it sounds like very first grade conversation skills, but, you know, you’re in a heated moment, right?’”

She asked the more agitated sibling what they were afraid of, because she says fear drives a lot of this kind of sibling conflict. “It turned out that the answer really was they were afraid that without mom, the relationship they had with the rest of the family would disappear and they would be left alone.”

She was able to guide these siblings through a short conversation about past grievances, allowing them to find enough resolution to focus on their parent’s care.

“They never actually said the words,’ I’m sorry,’" Weyenberg says, but “there was a lot of I’m sorry felt throughout the conversation.” 

Things don’t always end harmoniously, notes Weyenberg. In another instance, a parent was no longer alert or able to express their wishes and the siblings were unable to agree on a course of action. She advised the child who held power of attorney to make sure each family member had a copy of the will and recommended that they take turns visiting their parent. Then she said, “You know, it does mean that somebody may not be here when she goes, right?”

Weyenberg tries to help family members recognize that their goals are ultimately aligned to ensure that their parent receives the very best love and care and reminds them that end-of-life care, or comfort care, is not killing a person but making the dying process more comfortable for their loved one. 

She also encourages them to respect the parent’s preferences in terms of who gets to make decisions.

“Optimal care is really what people want and that may look different from family to family,” Gilligan says. 

Practice ‘cooperative caregiving’

One surprising preference that she and her colleagues found in a seven-year longitudinal study is that dying mothers often get more depressed if their preferred caregiver isn’t directly involved in their care, even if other children are providing care. 

“It’s hard for siblings to navigate that. It’s not comfortable, but there are definitely benefits, particularly to older parents, if those preferred caregivers can be involved,” she said. 

Gilligan has also studied differences in parental caregiving between Black and white families in the U.S. What the  Within-Family Differences Study found is that Black families are much more likely than white families to cooperate in parental caregiving. There is not only an expectation that they will provide care themselves rather than outsourcing it, but they place a high value on doing it themselves.

“So for example, we have found that in Black families, when there is conflict in care, particularly in care for older mothers, it’s much more consequential for [siblings’] psychological and mental health. It increases depressive symptoms,” she says.

The same pattern was not found to be true for white families. “White families tend to rely more on formal care such as paid help or residential facilities,” she says, noting that it is likely that Asian and Latinx families share similar values and expectations with Black families around caring for aging parents.

“For all families, regardless of race or ethnicity, parental care is something that most of us are going to experience,” Gilligan says. “And so I think that maybe racial and minority families anticipate that.”

All families can learn from their example of cooperative caregiving, she says.

Another thing Gilligan's team found is that mothers tended not to want to reconcile with estranged children amidst a health crisis that requires caretaking. 

“Mothers expressed that they were expecting that their other children would navigate that care without having an estranged adult child come back into that relationship,” she says.

Although there may be both guilt and grief in family estrangement, Blazer acknowledges that some relationships cannot be repaired, and because of that, he says the best approach is to keep contact minimal and superficial. 

As family members face the often heartbreaking and difficult challenge of caring for dying parents, Weyenberg advises them to recognize and honor the fact that each sibling is grieving and doing their best to love their parent. Even when there is estrangement, she says, “We can still give love to them, even if part of our giving love is by having no contact. … It’s really hard and it hurts because it brings up a whole other round of grief. But sometimes it’s what needs to be, at least for a while.”

*Name has been changed to protect privacy