Does Your Family Need a Referee for Caregiving Disputes?

When siblings clash over caregving, you may need outside help

As it became clear that their aging mother would be unable to live on her own much longer, the sisters began quarreling over how to help her. One sister, who lived in a small apartment in the same city as their mother, wanted her to move to a nearby assisted living facility. Their mother had friends there and could continue to worship at her lifelong church. The other sister, who lived in a spacious home halfway across the country, wanted their mother to move in with her, rather than “live among strangers” and “spend all her money.” Refusing to choose between her daughters, their mother became anxious and depressed. Still, neither sibling was willing to budge, each insisting that she only wanted what was best for their mom.

Coping with a parent's physical or mental decline is a challenge for any family. To meet critical caregiving needs, adult children may have to substantially rearrange their lives. When everyone works together, a family can support its elders and continue to function well, but sometimes new or long-standing tensions get in the way. If a parent is unwilling or unable to accept a transition out of their home, or to surrender their car keys, if that's necessary; if siblings quarrel over caregiving responsibilities and costs; or if the combination of needs and resentments just seems overwhelming, it may be impossible for a family to find a solution on their own.

“That’s when we often get the call,” says Crystal Thorpe, the co-founder of Elder Decisions, a mediation service in Norwood, Mass., and co-author of Mom Always Liked You Best: A Guide for Resolving Family Feuds, Inheritance Battles & Eldercare Crises. Professional mediators with a specialty in eldercare issues can intervene in family conflicts from convincing an elder with failing eyesight to stop driving to figuring out the best way to care for a parent with dementia. The most common sources of conflict, Thorpe says, are living arrangements – whether mom needs to move into an assisted living facility, for example – and inheritance.
Mediators don’t impose or even advocate particular solutions, Thorpe says. “We are neutral. Our job is make sure everyone’s views are heard and to make it easier for people in conflict to talk to one another.” Before scheduling a group discussion, the mediator prepares by speaking separately to each person directly affected by a dispute, including the elder or his or her representative. “I note each one’s perspective and try to identify all the issues and interests, not just the ones that have been openly stated,” Thorpe says. For example, a mother who lives with an adult child may insist that she simply doesn’t want to move out when the underlying concern is that she doesn’t want to evict her child. “Families need to bring that to the table, too," Thorpe says.

At the group meeting, which can last several hours, the mediator distributes and follows a detailed agenda tailored to the family's concerns, and works to keep the conversation focused on the relevant topics, weighing priorities and brainstorming solutions while deflecting extraneous conflicts — no arguments about past behaviors — and insuring that each person’s interests are dealt with. It's preferable that everyone be there in person, of course, but mediators can handle having distant family members taking part by phone. Within a week of the session, the mediator distributes a “memorandum of understanding” stipulating areas of agreement. The memo could include a concrete plan of action, including who is responsible for which piece, or just a clearer statement of the issues involved. 

Whether mediation resolves a family’s conflicts largely depends on the group’s commitment, Thorpe says. If everyone agrees to participate, that’s a good sign that a family will find sufficient common ground for a solution, or at least to keep talking on their own. “One person who absolutely must join the effort is the elder who needs help, if he or she is mentally competent," Thorpe says, "or someone who speaks for that elder, either as a personal advocate or as the person with power-of-attorney." Legal guardianship must be obtained in court, although a mediator could help a family decide who will be named guardian. When an elder is not mentally competent, nothing can be resolved unless the person with the legal authority to make independent decisions agrees. In the absence of that agreement, family members might end up in court.
If your family has reached an impasse and you want to try mediation, keep these points in mind:
Seek an expert mediator. Most mediators have backgrounds in law, social work or psychology, along with about 40 hours of specific mediation-skills training. However, in most states there is no licensing or certification for mediators. Some courts have training requirements for mediators in lawsuits but in general anyone can hang a shingle. Your best protection against poor service is a well-established mediation practice or program with experience in eldercare issues. Seek recommendations from your own lawyer, your parent's doctor, or friends. You can also find a guide to local eldercare mediators here.
Prepare to pay. Professional mediation can be expensive. Thorpe charges $250 an hour for her individual interviews and $350 an hour for group meetings. Other mediators may charge as little as $100 an hour, and the services of volunteer mediators working with local community groups may be available for free, for a small donation, or on a sliding scale. The National Association for Community Mediation lists 20,000 local mediators in 400 locations nationwide. (See if the group covers your area here.) The association's executive director, Justin Corbett, reports that 78 percent of its sites offer elder mediation.
Try doing it yourself. With some emotional distance and discipline, you might be able to negotiate your family conflicts yourself. For an hourly fee, some mediation practices, including Thorpe’s, will provide individuals with customized coaching and tips to use mediation techniques like validation, re-framing issues, and non-defensive listening to address your family's specific issues.

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