Family Fights About Aging Parents

The following has been transcribed from the Aging Boomers podcast on “Family Fights About Aging Parents

Frank: We have with us Carolyn Rosenblatt who is a Registered Nurse with 10 years of Nursing and 27 years of experience as a practicing Attorney. She has extensive hands on experience in elder care, aging parents, and working with caregivers. She has worked on hospitals and visited patients at home as a Public Health Nurse. Her law practice involve litigation and trials. She is familiar with insurance, financial, and elder law issues. She is an experienced mediator helping resolve family conflicts since 2006. She blogs for forbes.com weekly at Aging Parents. Her business is AgingParents.com located in San Rafael, CA, and her partner in business for the past 32 years personally, "Happy Anniversary!"

Carolyn: Thank you!

Frank: Dr. Mikol Davis is a Clinical Psychologist with over 38 years as a Mental Health Provider. He has worked with many families and is an expert in aging issues. He is the co-founder of AgingParents.com which serve caregivers, elders and their families with age-related issues. He is also an experienced mediator of many kinds of family disputes, and often works with Carolyn to resolve them. He does testing for dementia and helps families plan how to address dementia-related issues. Mikol and Carolyn, it's great having you on the show and thanks for taking the time on your anniversary to join us.

Carolyn: Well, thank you for having us, Frank!

Frank: Yeah, great!

Mikol: Thank you, yeah, we're glad to be here.

Frank: So, you know, this is a big issue and as you know that I'm in the business and many times are confronted with siblings that end up in arguments with each other, lots of family conflicts as it relates to decision-making regarding parents and their care, etc. It's always a difficult situation, so I commend you for the work that you've done. What would you say is the main cause of these family feud or fights regarding parents?

Mikol: Well, Frank, I think it comes down to two things. It's either the conflict is around money or the conflict is really about determining the extent of care, uh, for the aging loves ones. That seems to be the two primary areas that receive the greatest frequency of conflict.

Frank: So, what do you do, I mean, what's your procedure? Do you kind of get a conference call going with the family members and say, "Hey, wake up?," or what do you do when that is occurring and it's having such an effect on their parents?

Mikol: Well, the first is that to really understand the nature of the conflict. Often it involves interviewing different family members and finding out that generally what's driving the conflict is frequently something that has been going on for years and years. So, the conflict is generally not fresh. It's something that has been harbored as a part of the whole family structure, whether it's the oldest sibling adult child deciding that they're going to decide how things are going to go down, or it's the one that's got more influence over the parent. There are lots of, often it's the adult child that lives closest to the parents that feels that they're more involved and more knowledgeable about the extent of what their aging leveling needs. So, the first step is really understand the politics around the conflict and to be sensitive to the fact that generally what you're doing is your're waiting in a situation that has been going on for years and years in terms of the underlying feud between siblings or between conflicts between adult children and the parents.
So you know that you can be effective, the first thing is to really understand the nature of what we're dealing with which is often historically driven. Once you do that and we're able to do that fairly quickly, primarily I think because just the thousands of families that we've serve, we know just kind of how to cut to the chase and once we find out what the underlying conflict is. Then we start focusing on seeing if we can help the various members make some agreements about kind of the rules of the road going forward, and often one of those rules is that the focus is really on making decisions about mom or dad and it's really not about the past.
So, a good agreement is "Let's focus on the present right now," and not need to rehash history lesson of what you did when I was 13." As soon as we can begin to establish some resemblance of rules, that's an excellent start. From there, you know what we're really shooting for is to determine what realistically is going to be accomplished within the scope of our 'kind of' mediating or having a family meeting.
And that's what the third step is to kind of look at realistic expectations of either what the individual family members need, or as outsiders, providing some direction on things that we see that are eminent that need to be addressed. And generally, the kind of conflicts people are dealing with sometimes just the most immediate problems and often are very much unwilling to look at the scope of really what we're dealing with when, for example, in aging loved ones start to lose their sense of independence and decisions need to be made.

Frank: The issues we're talking about are mainly when the parent cognitively maybe having challenges. Because if that parent has it pretty much together, are you still sometimes getting families together or usually you're just dealing with that parent to make their own decision?

Carolyn: I think that decision-making independence is also a big issue. I think that most adult children want to honor their parents' independence and those parents definitely don't want to lose control of their lives and they see giving up any form of their independence as a step toward losing control which is quite terrifying from those people. So, there's conflict just over decision-making even if the parent is competent; maybe they are physically infirmed or getting that way. And the adult children want them to have help at home for instance. I'm sure you run into that, Frank.

Frank: Right

Carolyn: And they don't want it. They don't want it; they really need it, everybody else thinks they need it. They don't think they need it so there are arguments about that. And you know, we have that issue in our own lives right now with Nicole's mom who just turned 92

Frank: Wow

Carolyn: to live by herself, to still drive; she lives hundreds of miles away from us, very independent, very stubborn, and it's time for her to get some help at home. She's having trouble walking, her mind is sharper than yours and mine.

Frank: Yeah, it's not saying much about me, I mean, it don't take much to be sharper than me (laugh)

Carolyn: But it's really about (laugh). Well, you know a lot of people our age have signs of cognitive impairments pick up memory loss, not Alice.

Frank: Right, right

Carolyn: So, you know it's a bit of a struggle to try to get her to even accept using a wheelchair when we're gonna be walking for a long ways cause she just can't do it. And we're at the point now where she's trying out, she's on vacation too, in a different place. She's trying out a caregiver a few hours a day when she has no family member there with her, and I'm keeping my fingers crossed because what we intend to do is persuade her that "Yeah, it worked while you're on vacation, and you need to do that at home." And we'll probably get resistance but I think she's at a point where she may relent. Some parents do not, they just don't. And this fight goes on until there's a crisis.

Mikol: And that I think is very much universal because people are fighting to maintain their independence and accepting that they need help means, that you know, that they're one step in the grave and they don't want to accept that, and I think it's a real struggle for the adult child to be able to deal with that level of stubbornness when you know that your aging loved one is basically making decisions where they're going to be at increased risk of fall or some kind of danger. But unfortunately stubbornness continually gets in the way as it has with my 92 year old mom.
But we've got some different angles and pitches that we've been trying and some seem to be pretty effective. And I think the one that is universally effective is the one when we talk about, you know, "This is not for you mom, it's for us. It's really for our peace of mind. It's for our ability to sleep at night and know that there's someone there, you know, looking after, you know, we're not gonna find you dead on the floor someday. Uh, we couldn't handle that." So, sometimes the pitch towards, you know, "Do it for me mom" seems to be pretty effective.

Frank: Yeah, so, have you found that family members, brothers, sisters are open to the type of mediation that you do, or do you find push back?

Mikol: Well, it's mixed

Frank: Yeah

Mikol: And often the people that are contacting us, Frank, directly are the ones that obviously are very open and there's always a hold back in family. And so you know often what we wind up doing is providing a lot of information and somewhat coaching of the family members that do want to come to the table so to speak, how to deal with the one member or two members of the family that are dragging their feet and don't want to be involved.
So, that's really effective because you know often what we'll do is we'll have people come to us and say, you know, unless we can get everybody involved, it does not seem like it's going to be effective; and sometimes it's the situation where it's clear that the family just got to identity that there's going to be primary decision makers, the decisions have got to be made. If certain family members just want to drag their heels to not participate, that's their choice, but they can be provided the information of what the decisions are going to be made and how it's going to impact them going forward, and that seems to be an effective play.

Frank: So, I'm sure that there's cases like this, but we got a family that the brothers, sisters might be disagreeing on the direction that's being taken and one of them has Power of Attorney or Durable Power of Attorney and they go, "Well, I don't care what you think, I've got Power of Attorney and this is the way we're doing it." I mean, do you have those types or situations or is that...

Carolyn: Oh absolutely, absolutely!
The legal document gives the person full authority. If they've got power of attorney and it's unlimited, they can do whatever they want. But, one of the things I try to help people understand is, you may have legal authority, but if you do not want to trash your sibling relationships for the rest of your lives, it might be a good idea to include other people in the decision-making process to at least invite them to offer an opinion; "Will you agree with it or not?" And see if you can respectully allow them to weigh in because it's their parent, too.
That works sometimes with people who are emotionally mature enough to do it. But as Nicole said, these conflicts often emerge appearing to be about the care about mom or dad, appearing to be about the money, appearing to be about who's doing more work than someone else. But they're really about historic conflicts that go back much farther and they act them out in the guides of being about the problem at the moment.
What we try to do is make sure that we encourage people to reach agreements. This is not therapy when we're doing family mediations. We're not going to fix all those old wounds and we encourage them to just stay in the present. What we can do right now is focus on making life better for mom at this moment for the next month until the end of her life, whatever it is, and if we can keep them focused on that and try to be respectful and open, that helps. Another thing that helps is when it comes to the money, I've encouraged and informed a lot of people with Power of Attorney,
"You've got an obligation to let everyboy know how the money is being spent," you know. Okay, you're spending it on the caregiver, so you're spending it on whatever you need for your parent, but keep records, be transparent, share that with everybody, email it to them; let them all have access to the records, so that you don't make people suspicious because that quality of being suspicious about money is quite common.

Frank: Yes

Mikol: One of the unique things that Carolyn and I have recently been seeing much more prevalent is dealing with families that are in conflict about mom or dad and one of the adult children truly has a mental disease. And so they're having problems with their own mental competence and functioning, and often it's been going on for quite sometime. And the family at large is just as clueless on what to do and how to manage them.

Frank: That's a tough one. It's all tough, so.. You know Carolyn, you brought up money and Mikol brought it up earlier. I guess that's an area that really I guess gets me upset when I'm working with families.
So, how do you deal with a situation where you have, let's say, one of the adult children who kind of knows that either that money is going to go to mom or dad's care, but if you spend too much then they're going to see less when it's time for mom or dad, you know, for the end of their life and they're not wanting to spend the way it probably should be spent because of that reason. I mean, that kind of gets me upset. You must see that time and time again, unfortunately. How do you deal with that?

Carolyn: Yeah, it's very problematic. There's a certain greed factor, you know. What it boils down to very bluntly is, if you spend money taking care of mom or dad and paying caregivers or paying for assisted living, or paying for whatever it is they need, Im not going to inherit what's mine, that greed. And it's really very distressing to see it.
What we do to address that is to remind them that the parent does not owe them an inheritance, and that the inheritance they're expecting is not theirs until the parent is gone. And it is not appropriate or fair and in fact, it might even be abusive to withhold what the parent needs, so that it can be saved to give to the kids.
And the ironic twist in this is that aging parents often has no concept of how expensive it's going to be to pay for long-term care, in whatever form it takes. They're not prepared, they didn't plan on it. They didn't think they've live this long, they didn't know how much it's going to cost. People are living longer, and longer, and longer. It's great except they get infirmed and nobody has any idea how they're going to cover the cost.

Frank: Right, right

Carolyn: So, we just try to straighten them out on what the priorities are. We're very respectful in the way we do that, but you know, it is really the parent's money and we do remind them of that and if they don't have a right to it and that the parent definitely has the right to be properly cared for as they become less able to care for themselves. Frank: So...

Mikol: You mean the government is just not going to take care of mom or dad?

Carolyn: (laugh) The government ignores the long-term care problem, unfortunately, which is the worst Congresss ever, and we just don't have the will, the political will to do any sort of funding that needed to even help people get along a little better than they're doing now.

Frank: So...

Mikol: You mean the medicare bed in a nursing home wouldn't be so bad for mom?

Carolyn: Oh my

Mikol: That's the kind of thing that we get with people

Frank: Right

Mikol: that are just clueless about what the decision-making powers that they have and what the impact is going to be on the quality of life for the remaining years with their parents. They're just very much in denial.

Carolyn: Let me just address one thing you mentioned. You mentioned Medicare, but Medicare does not pay for long-term care.

Frank: That's right

Carolyn: Medicaid will. But the worst places are the ones that take long-term medicaid. And Mikol and I are working on a case right now trying to help the adult daughter who's only 25 get her mother out of a nursing home that I would say has not been kind to her, okay? There's some people trying but it has been really awful and she's essentially been in prison there, but she doesn't have very much money.
So fortunately, Frank, you were kind enough to refer me to someone who could help her transition and look for a low-cost boarding care situation in her community where she wants to stay at. That issue about money has really held her back and forced her to stay in a nursing home where she did not want to be.
And it's been a real struggle. It's tragic when you see how someone has to live. This worman is in her 60's. She had a stroke but she's going to be around for a long time, probably.

Frank: Right

Mikol: But she's been stuck there three years, right?

Carolyn: Yeah, it's just heart-breaking you know. She had a massive stroke; she's recovered substantially, couldn't get out cause she didn't have the money that could've totally got down to. You know, with the daughter working full-time now and able to contribute something, we'll be able to get her out.
But you know, having someone at the "ready" as you've been able to provide for us to at least help the daughter look for an appropriate low-cost place that isn't in nursing home. That's what she needed, that's the challenge, and that's what's going on.

Frank: I mean the fortunate thing in the state we live here in CA, there's a lot of options out there. So, it's just making people aware of those options. I'm glad that was able to work out.

Carolyn: Right

Frank: So, for those listening that are in a situation like we're talking about, they need to start thinking about what's going to happen with mom and dad. You might have a brother and sister that don't talk to one another and they're already envisioning problems, alright. What do you recommend to them and if they were to contact an organization like yours. What could they expect?

Carolyn: One of the first things we really plead with people to do, urge them to do, encourage them to do is to have a family meeting and to start making some plans. If you've got a parent with any kind of physical difficulty, especially if you have a parent who seems to be showing signs of memory loss which always is the lead-in to dementia. Memory loss does not necessarily mean you're going to develop dementia, but it is the first symptom of dementia when somebody is going to get it. And it's a caregiving burden to put it bluntly. It's a caregiving burden if someone has dementia they're going to lose independence.
So families need to take the time and get past their internal turmoils and start thinking about how they're going to care for this person. This parent who needs help is going to need more help over time, and then figure out how they're going to pay for it. Is everyone going to pitch in? Is the family home going to be sold to pay for care? Are they going to liquidate whatever assets the parent has? Do they have a choice? Can they keep the parent out of a nursing home? Is there a way to manage enough combinations of help with family members or caregivers who are paid to supplement that, to enable the parent to stay at home? You have to look at those questions and that's what we help them do. And we give them the facts; here's what it's going to cost you. Here are the options, here are the choices you might have if you want to keep dad at home. Here are the places, the kind of places mom could go to if she can afford that. We refer them to other people like say, a tax attorney, if they're thinking of selling the family home which has tax consequences.
And we also work very closely at the two things a lot of families don't have that they really need, and that is a Durable Power of Authority for finances and an Advanced Healthcare Directive.

Frank: Right

Carolyn: And a lot of people have the mistaken belief that you have to have a lawyer to get those and the mom does not want a case, so we didn't do it or for whatever reason they never got it done. They're free! You can download a Durable Power of Attorney on the internet.

Frank: Yeah

Carolyn: Yes, you need to read about it, and if you have questions you certainly can get legal advice from me or any other lawyer who you can talk to you about it. But it's an essential document because when the parent loses competency, someone's got to be in charge or you're going to end up in court having the judge impose a convervatorship or guardianship which is expensive, nasty, time consuming, and not necessary.
The other, the Healthcare Directive, should be signed by the parent. It could be gotten free from any doctor that have them on the internet as well. And going through the questions about what the person wants saves a lot of family conflicts. Of course the parent has to be competent to sign these things, and it's really important that families do this before the parent loses competency cause you don't know when that's going to be.

Frank: Exactly. I know that...

Mikol: So, the real message is they're not going to be, you know, if you're not going to step up and be proactive and deal with something that most of us don't want to deal with, then the options that are going to be available that are going to be forced upon you are few and far in between.

Frank: Right. We did a show just last week. So, anybody wants to learn a little bit more. I mean, certainly, you can contact Carolyn and Mikol, but we did a whole show just on Power of Attorney and why it's so important. We did it with an attorney. So, you can check that out as well. But I think those are just great points.
So, we just have about a minute or so left, but what can you leave our listeners with and a recommendation what works, what does not work, I mean, any words of advice?

Carolyn: Sure, I think the first thing is, you know, there's one leader in the family usually and that person might suggest the family meeting. If people don't get along you can do the meeting by telephone. You can also communicate by email. But the point is to communicate and if you struggle with your other family members and don't get along, you know it's going to be difficult, get some help, reach out.
There are advisors, social workers, counselors, people like us who bring several professions to the table to help you. The investment is small compared with the benefit and the burden is horrible if you don't do it and it can get expensive financially if you end up hiring lawyers and getting into combat.
So, we advise people to prevent that by using common sense and being proactive.

Frank: Right, and how would someone get a hold of either of you, how would they go about doing that?

Carolyn: Our website is www.agingparents.com and our email address is: clrosenblatt@gmail.com or drmikol@gmail.com, and either of those email addresses are available. We're more than happy to respond to you if you go on our website  at AgingParents.com. You can get a free 15 minute consultation and you can sign up for that automatically and even pick a time on our calendar automatically. So, there's no..., you're there.

Also, we have a toll free number for those out of the area and that number is 866-962-4464. That's 866-962-4464.

Frank: Great! Mikol, Carolyn thank you so much for joining us. Happy Anniversary!

Mikol: Thanks Frank

Frank: We'll have you on again, there's always so much to talk about

Carolyn: Thank you very much

Mikol: We appreciate it

Frank: Thank you all for listening. Thanks for all your support. You can certainly go to Itunes and subscribe to the Aging Boomers; you can go to the website at Agingboomers.com. Also new, we just found out we're going to be on I Heart Radio as well. So, lots of different options. You could download the app, aging boomers app on your iphone or android phone as well and listen to all the shows.

So, thanks so much for joining us. Be safe out there and we'll talk to you all soon. (music playing)