Caregiving When You're an Only Child

For adult children, caregiving for their parents as they age and decline is an inevitable rite of passage. But only children who have to be caregivers face a different burden compared to those who were raised in a family with one or more siblings willing to share the duties and stressors. Only children often have to do it all.

Based on interviews with several experts, all suggest that only children can benefit from preparing early for the eventuality of their parents needing caregiving assistance, anticipating the financial repercussions, and meeting with an attorney about power of attorney and overseeing their parents' wills.

Caregiving is so prevalent that the New York Times reported that one in five adults (or as the article states, according to AARP, more than 50 million) is providing unpaid health or support to a loved one, such as an aging parent or a spouse with an illness or disability.

Since every situation of caregiving for a parent is different, Brenda Avadian, founder of The Caregiver's Voice, a website aimed at caregivers with family members who have dementia, says, "Looking at it comparatively from a child who has siblings compared to a single child, sometimes it's easier and sometimes it's not." 

An only child, she notes, "can step up, make the decision and get the work done." With siblings, sometimes there is strength in numbers and sharing activities. But often "not all siblings agree, and the primary caregiver, who is often female, steps up to take care of mom while other siblings bicker against the primary caregiver," Avadian notes.

Those conflicts undermine the efforts of the caregiver and exacerbate the situation. Then again, Avadian said she has observed a family of ten siblings who cooperate and all take turns caring for their parent.

According to Avadian, if the only child sees signs that the parent is faltering, such as forgetting appointments, neglecting to take their medicine or being unable to balance their checkbook, it's likely time to intercede. She advises asking the parent open-ended questions, which aren't judgmental, to determine if they're forgetting things, or facing daily difficulties.

The parent should be listened to and consulted, depending on their mental state. Include the parent in care decisions whenever possible. Avadian advises that the best place to start is by learning as much about the parent's failing health or emerging dementia as possible, about the disease's progression, and behaviors associated with it. That way, the adult child can know what to expect and better prepare for the parent's future options.

Take your parent to their primary care physician, do your homework, prepare two or three pertinent questions, and in consultation with the physician, assess the situation.

At that point, it's a good idea to meet with your parent's attorney to discuss their will, see if you can obtain power of attorney, determine if your parent has a health care directive and then ultimately become executor of their will or estate if necessary.

At what point does the only child consider placing the parent in independent living or assisted living when they can't take care of themselves in their apartment or house? "When you find a parent is a risk to himself or herself, then it may be time to consider other options," Avadian says, adding that behaviors like leaving a heater on or consistently having expired food in the refrigerator may be signs.

If the parent lives a significant distance away, Avadian advises considering inviting the parent to stay with you. See if that eases their burden; perhaps living together, or in proximity, can be a possibility for a while.

When you're an only child taking care of your parents, "you're always walking that line between respecting your parents' autonomy and assuring their safety," explains Aaron Blight, who wrote "When Caregiving Calls: Guidance as You Care for a Parent, Spouse or Aging Relative" and is founder of Caregiving Kinetics, a consulting service for family caregivers based in Berryville, Virginia.  Further, only children have to monitor both parents since one may be worse off than the other. "It's quite a balancing act," he says.

Because the only child has no siblings to lean on, "it can be very isolating and lonely. You feel everything about your parents' well-being rests on your shoulders. You have no siblings to relieve one another," Blight notes. For that reason, the only child could benefit from self-care, either through counseling, support groups (in-person or online), or possibly have a spouse offer assistance. Hiring a professional caregiver could also be an option.

"You have this Herculean task, and you have your own life and responsibilities, and now the needs of your parents can encroach on your existing life. Somehow you have to manage that with the needs of your parents," Blight says.

The only children who handle caretaking of parents well demonstrate "resilience, the ability to adapt to adverse conditions and make adjustments to meet the demands," Blight explains. The ability to learn is another key skill since "there's no handbook that comes with being a caregiver for your parent. Each situation is unique."

In order to determine if the parent needs to be placed in an assisted living facility, Blight describes several factors including: what kind of caregiving support does the parent need; what services does the facility provide; if the parents' needs exceed what the adult child can provide, and the parents' wishes, since many prefer to remain at home and receive care.

One of the key issues to grapple with for only children caregiving for their parents is whether the parents have sufficient financial resources to pay for the support, explains Carol Levine of New York City, who is a senior fellow at The United Hospital Fund and The Hastings Center and a 2016 Next Avenue Influencer in Aging.

"Some parents have a lot of money and are willing to spend it on care. And some parents say, 'no, this is my money, why do I need to spend on it a stranger whom I don't trust?'" Levine says. But having enough money can ease pressure in many ways, and Levine suggests planning early for future financial caregiving costs.

Much of what transpires between an only child and an aging parent depends on their existing relationship. "If it's been close, open and transparent, even with ups and downs, it's more likely that the relationship will change but continue to be close," Levine notes. If the relationship has been fractious, "it's hard to build a relationship when both people are stressed, needy and not sure what's going to happen."

But the only child can also reap a number of surprising and unexpected rewards. "Spending time with one's parent, talking about their history, finding out how your parents met, and [other questions you] never thought to ask them" can be very satisfying, Levine says.

Caring for a parent "takes patience, persistence and a sense of responsibility that most people haven't planned for, but can be learned and accomplished. But it's not a one-person job; you need help and support where you can get it. It's essential to have someone to talk things out with after a bad day," Levine adds.

Avadian agrees. "Caregiving is exhausting. It's often 24-hours, seven days a week, and it's a thankless job." But there are positives, she says — the only child gets to give back to parents, which is very satisfying, masters the art of patience and ultimately learns a lot about himself or herself.