Elder care can reignite old family feuds, say social workers

Blood is not always thicker than water. Resentment, anger and jealousy that have festered since childhood often create new problems as families cope with long-term care arrangements for aging parents and relatives.

“Instead of working together, families can get stuck placing blame,” said Ada Burko, director of older adult services for Jewish Family and Children’s Services of the East Bay. As negative emotions surface, reignited old disagreements and feuds often threaten vital emotional and physical care for the elders. “The biggest challenge is to get families to contact us before the crisis occurs.”

Burko and Donna Schempp, program director at the S.F.-based Family Caregiver Alliance, planned to discuss some of these issues in a workshop titled “When Everyone Talks and Nobody Listens: Working With Your Siblings.” Held Thursday, April 15 at the Contra Costa Jewish Community Center in Walnut Creek, the event was part of a series that highlighted concrete alternatives to internecine family squabbles. Other such workshops are slated in the future.

Burko, a licensed clinical social worker, estimates that family tensions boil over among at least 95 percent of the families facing long-term care issues. Once these feuds erupt, they often escalate and imperil often-tenuous family dynamics. Those who call for help “usually make a move when they feel something is happening, before a family lets things go too far.”

Letting things go too far can be extremely dangerous, especially for caregivers, said Schempp, a licensed clinical social worker. “The incidence of depression is much higher among caregivers. And the mortality rates for caregivers even after the cared-for person dies is much higher.”

Recognizing that the caregiver, as well as the patient, requires care, a few years ago Congress passed the National Family Caregiver Act that allocated federal money for caregiver support. But there is much work to be done, according to Schempp.

Many social service professionals, she added, have to reorient their thinking and actions to provide the best care for families. “I’ve been caring for my mother and every time we go to the doctor, the doctor doesn’t ask me how I’m doing. The caregiver needs extra amounts of support to avoid burnout, which sometimes leads to elder abuse.”

Burko shared a story about the kind of unresolved family conflicts she deals with.

A few years ago, an older couple relocated to the Bay Area from the East Coast. They had lived near a favored son who was unsuccessful but wholly supported by his family. Their daughter, who resides in the East Bay, is a successful businesswoman who had never received much monetary support from the parents.

The father was subsequently diagnosed with early stage of dementia, so the daughter became the family’s main support system. Once the parents needed more acute care, family tensions spiraled. It turned out that the daughter had always felt slighted because her family didn’t accept her life-partner, a woman.

“The conflict was between the siblings and the daughter and her parents,” Burko said. But it spread to the daughter and her partner. The partner wanted to know, “How much time should you spend with them when they don’t accept me?”

How best to defuse family discord and promote harmony?

For one, families need to be aware of options for elder care and community resources. Schempp recommended “families begin the process of understanding various social service agencies and options within the community before the crises occur. One of the biggest issues is that families don’t know how to access resources.”

She cited her own mother as an example. When her mother was released from the hospital two years ago following treatment for a broken arm, no one there asked about her home situation. Schempp’s mother was caring for a husband with dementia. Because of Schempp’s background, she contacted Meals on Wheels and hired an attendant for her parents.

“Families need to know how to have conversations about various what-ifs long before it’s necessary,” Schempp said. The crucial ingredient is having a family meeting — the FCA Web site, www.caregiver.org, outlines how to hold one — so “everyone has the same information.” She noted that since many Alzheimer’s patients have intense moments of lucidity, one family member might not realize the extent of the person’s illness and disability.

“The worst thing a family can do,” cautioned Burko, “is solely to handle the physical burden of care, doing the harsh and unpleasant duties, because it distances them from the soul of the person. Caregivers must create time to be close to the person, to sit, to touch, to feel, and see the person as a real, whole human being.”

A number of Jewish community organizations offer elder services. Among them: Jewish Family and Children’s Services of the East Bay, (510) 704-7480 or (925) 927-2000 or www.jfcs-eastbay.org and S.F.-based JFCS, (415) 449-3777.

Steven Friedman

Steven Friedman is a freelance writer.