Who Cares More for Mom?

By Francine Russo

Kathleen Wittstock's two younger sisters always considered her their parents' favorite--and the only one who could stand up to their formidable mother. So they probably weren't surprised when Wittstock, 65, a retired teacher in Medina, Ohio, persuaded her ailing parents to move nearby so she could look after them. Sometimes Wittstock secretly wished her sisters, who lived in Texas and Kentucky, would help more, but she also confessed that the task was easier without them--less drama for her to deal with.

After their father died in 1994, Kathleen wanted to apply for legal guardianship to put their increasingly resistant mother in an Alzheimer's unit, but she wanted her sisters to agree. "I felt it would be easier for all of us," she explains, "if we came to that conclusion together." And that's when the wounds of childhood really divided them. The youngest sister--described as the peacemaker--could not bear the rage her mother was sure to feel. "My sister had a fantasy," Wittstock says, "that Mom would get better and that she could take Mom to lunch and buy her pretty things."

It took four years and 15 police reports before the youngest sister gave in and agreed that Kathleen should become their mother's guardian. Wittstock assumed guardianship in 2004. By that time, their mother was living alone and unkempt in her condo with no food in the house and the gas turned off. Now Mom is safely ensconced in an assisted-living home, and Wittstock is proud of what she accomplished with her sisters. "Our relationships are not always great," she says, "but we work at it."

If you're a 50-year-old with 80-year-old parents, you may think that the sibling rivalries and parental hurts of your childhood are history. Fat chance. Simmering resentment between siblings has a nasty way of re-erupting as boomers confront the reality of caring for aging parents. "We have an unexpressed wish that our parents will someday acknowledge the injustices done us," notes University of Pittsburgh elder-law professor Larry Frolik. "Someday Mom will understand that I'm as smart as my rich older brother or will finally admit, 'Honey, your husband's really a swell guy.'"

Of the dilemmas adult children must confront at that point, caregiving--who does it, where it is done, how it is shared (or not)--is one of the most charged. The practical tasks occur in the midst of one of our most difficult emotional passages as adults. Our parents' frailty forces us to confront our own mortality. And in that emotionally volatile atmosphere, the psychic baggage from childhood complicates the important work of caregiving.

Those issues are complex, and families differ in countless ways. Yet elder-care specialists see common patterns emerge among siblings as the death of a parent looms. One such dynamic is a renewed competition for their parents' love and favor. "You become needy children again, not getting enough of the goods," says Victoria Hilkevitch Bedford, a professor of psychology at the University of Indianapolis.

How intense can that competition become? Deborah--not her real name--a Minneapolis, Minn., health-care aide who preferred not to be identified to protect family members' feelings, had always been favored over her elder sister, she says, as the daughter who behaved best. When her parents became ill, she sold her house and moved with her husband and their kids into Mom and Dad's home to care for them. As Mom's dementia worsened, she often refused to take her pills. When Deborah insisted, Mom whined, "Deborah's being mean to me." No one in the family took it seriously except Deborah's elder sister. After years of staying in the background, she then began calling Mom every night, encouraging her to complain about Deborah. And like King Lear bouncing among his daughters in search of better treatment, Deborah's mom grew warmer toward her less favored child. "I'd always been the 'good' daughter," Deborah says. "This was her chance to be the good daughter."

During their mother's last hospitalization, Deborah was tending to her acutely ill father, so her elder sister became the hospital's main family contact. When a nurse called her sister at 2 a.m. to say their mother was fading fast, Deborah's sister did nothing. Deborah had hoped to be with her mother at the end, perhaps to say a few last words. "My sister took that chance away from me," Deborah says, "and because of her, my mother died alone. I will never forgive her for that."

Deborah's bitter account is only her side of the story, because her sister could not be contacted. But it does illustrate that the way siblings negotiate such challenges can determine their future as a family. Those trials can bind brothers and sisters together or, as Deborah's story shows, send them spiraling into a vortex of animosity and despair.

In many families, when legitimate disputes break out over how to care for Mom or Dad, old issues of parental hurts and sibling rivalry are likely to be lurking under the surface. One of the hardest obstacles for siblings to overcome is the unequal burden of caregiving. With few exceptions, one sibling in a family gets to be--or gets stuck with being--the primary caregiver. Whether that means stopping by Dad's to run errands, nursing an Alzheimer's patient in the spare bedroom or responding to late-night calls from the nursing home, one adult child usually does the lion's share.

It's easy to predict which sibling will take on the job. Most frequently, says Cleveland University sociologist Sarah Matthews, the caregiver is the female child who lives closest and the one who is single or has the fewest career or family responsibilities. Sometimes a son will take on that role, but it is rarely a group effort. Less understood are the underlying psychological reasons that a particular adult child steps up to embrace--or gets stuck with--a parent's late-life needs. But, clearly, the history of family relationships--which child was more in synch with which parent, which siblings were close in age or temperament--influences how, where and by whom the needs of the parents are met.

Caregivers complain that their siblings don't help, don't appreciate their efforts and make matters worse by criticizing their efforts in the trenches. The faraway or less involved siblings claim that the caregiver plays the role of the martyr, taking on the burden of caregiving and spurning offers of help.

"Caregivers often send out mixed messages," observes Denise Brown, creator of Caregiving! newsletter and the online support group Caregiving.com "They say, 'I can do it all myself' and 'Why doesn't anyone help me?'"

Those mixed messages often mask a complex stew of emotional issues with long histories. "Acrimonious" is the way one professional woman in her early 60s describes her relationship with her "very successful" older brother, which is why she insists on anonymity and won't name her brother or allow him to be contacted. She lives in a Northeastern city with their 90-year-old mother, who has midstage Alzheimer's; he lives far away. When they were kids, brother and sister fought over control. Now in their 60s, they're struggling over, well, control. "To me, he was always a tyrant," she says, "but my mother couldn't see it. He's still the golden boy, even while I put her before myself."

Her brother, she says, wanted to take control of Mom's money through a power of attorney and then place her in a nursing home. To prevent that, his sister gave up full-time work for part time, closed up her own house and moved in with Mom, for whom she does everything. Her mother arranged for her to receive a stipend for helping--a rarity for family caregivers. The compensation is not much, but she's sure her brother thinks she's sponging off Mom. So she refuses to ask him for help.

Despite the favoritism issues in nearly every family, dissension is not inevitable, no matter which child becomes the caregiver. Good relations do not require equal contributions to caregiving, observes sociologist Matthews, but depend on siblings' doing what is reasonable, given their location and their other responsibilities.

It is even possible for sisters and brothers to overcome ancient grievances as they band together for their parents' sake. As a child, psychologist Bedford, for example, often fought with her twin, Barbara, and her elder sister Margie. In adulthood, the three women harbored grudges and rarely saw one another. But in 1985, after Margie had a serious accident, her siblings teamed up to tend to her through months of rehab. The three of them talked through their childhood conflicts. Margie was their father's favorite, Barbara was their mother's, and Victoria felt like a neglected middle child. The women acknowledged those realities but also showed one another that there was a flip side to being a favorite, including a larger burden of parental expectations to fulfill. Looking back on their childhood, Bedford says, "I realized that there was in some ways enough love to go around."

A few years ago, when their mother entered an assisted-living facility, the geographically scattered sisters made sure that one of them visited her at least once a month. Barbara, who lived farthest, could visit only twice yearly, but the others understood. When their mother died, the three sisters comforted one another--as they still do. "I don't need a support group," Bedford says. "My sisters are 100% there for me in my grief."