Who Cares More for Mom?

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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.