Family Therapy For Aging Parents

With Aging Parents, Longstanding Familial Resentments Can Reemerge

Aging parents is a common life moment that causes adults to reach out for family therapy, particularly as parents struggle with illness and approach the end of life. With aging parents, adult children are conscripted to function as caregivers, healthcare proxies, advocates, and financial and other sort of decision makers. These are all roles historically played by the parent. At times, parents are reluctant to give up control or have different opinions from their adult children about how these matters should be handled. When siblings share these decisions and responsibilities, differences of opinions can result in conflicts. Old resentments, perhaps long latent, can reemerge.

In our NYC family therapy practice, we find the longstanding underlying issue or issues that lie beneath the conflict over decision-making related to an aging parent. At times, we address the underlying issue in session, but at other times, there is a conscious (and collective) decision not to address it. The decision, in this case, would be to agree that the issue is present and that members of the family are hurt, while working to agree to not let that interfere. Sometimes the necessary ingredients, time, space or collective will aren’t there in order to resolve it. We help folks put the issue aside, finding ways of being together as a family and tolerating that old hurts may not be addressed. This can help members of a family see the ways these underlying issues interfere and give them skills to let that go.

What If Not Everyone Can Be In The Room For Family Therapy?

It should be noted that while it’s best to have all the participants in the family in the room for family therapy, this is often not possible due to geography, health or a willingness to invest in the process. In such instances, we still consider the treatment family therapy and seek to work with whoever is able to show up in ways that are inclusive and respectful, even to those who aren’t present. Because of similar reasons, this work is often done, in whole or in part, over the phone.

Caregiving (And Caring For The Caregiver)

Aging parents often need work–whether it’s visits, handling their affairs, or actually taking on some or all of the physical labor of caring for someone who needs intense assistance. In our NYC family therapy practice, we often see conflicts arise both about the nature of the care, but also who is doing more or less of the labor and what is fair in light of other obligations (for example, professional demands or caring for young children). As with many issues related to aging parents, this is an area in which resentments can present themselves.

As family therapists, we often find that attention needs to be given to caring for the caregiver. It should be noted that the United States has historically done a poor job providing resources for the elderly relative in comparison to most of the developed world. Further, unlike many countries, children are more prone here to move away from home, which weakens extended families’ capacity to easily navigate issues related to aging parents. As a result, caregivers inevitably take on too much and their own needs can be diminished.

Grieving And Preparing For Loss

Failing health and aging, of course, often precede death, adding an underlying set of emotional challenges to the labor and decision-making associated with caring for older parents. The process of grief in these instances begins even before the loss itself. We understand grief as something that families do together, whether well or poorly. Often this grief isn’t the presenting issue (meaning it’s not what the family has identified as most in need of attention in family therapy), but it does influence other matters regarding caregiving and making end-of-life decisions for an aging parent.

In particular, there is a special sort of grief and incumbent challenges associated with witnessing the deterioration of a parent’s cognitive faculties, whether from Alzheimer's, dementia or another illness that results in cognitive impairment. Families often benefit from guidance in family therapy in navigating these feelings together.

Challenges Related To Medical Decisions

Among the decisions adults are conscripted to make about their parents are medical decisions. Even when parents are cognitively fit to participate in their own medical decisions, adult children can be increasingly deployed to make high stakes decisions. When parents aren’t fit, the stakes become much higher. While documents such as a living will or do-not-resuscitate order can help, adult siblings rarely avoid confronting high stakes decisions about their parent(s)’s health.

The Financial Impact Of Caregiving

Money influences and complicates the decisions and challenges families must confront in support of aging parents. End-of-life care is often expensive and can exceed what insurance and savings might cover.

All matters of money can come with endless differences of opinion. Whether medical interventions that are costly, but may extend life, widely varying options for caregiver or nursing home facilities, or caring for a parent in their home or the home of an adult sibling, these decisions all come with profound financial implications. Adult siblings bring both current financial hardships and complications, as well as old resentments: Who has more money to devote to caring for an aging parent? What sorts of preferences, real or perceived, existed in childhood around money?

Issues Of Inheritance

Related to the financial impact of caring for aging parents, matters related to inheritance can begin to creep in with families. Adult siblings may perhaps have different ideas about what funds should be spent on end-of-life care versus set aside for inheritance. There can be differences related to family assets or businesses, a family home, or conflicts over a parent’s wishes related to charitable giving or grandkids. A will is often not sufficient to avoid these conflicts.

The Family Therapist Is The Family’s Caregiver, Focusing On What’s Best For The Unit

In family therapy for aging parents, the therapist’s job is to stay focused on the family unit. This isn’t to say that the family therapist doesn’t care about and give attention to individuals, but when families are grappling with aging parents and the incumbent challenges associated with caring for them, there is tremendous strain not just on the individuals, but on their relationship as well. So the therapist is there to focus on the unit or the team. What decisions does the family need to make? What is best for the family as a whole? In a sense, the therapist can function as the family’s caregiver.