Poor Meg Ryan. She’s ministering to her ailing father’s every need while running a family and a business. Her older sister, a celebrity, is far too busy to help out, although she manages to lecture Meg by cell phone from her empire at a vapid women’s magazine. The youngest sister also watches from the sidelines: She’s obsessed with perfecting the soap opera character she plays on TV. Naturally their father, an irascible old guy, has only praise for the absent daughters and plenty of criticism for the one taking care of him. Eventually Meg falls apart; the negligent sisters mend their ways, and hugs are distributed all around as Dad breathes his last.

It’s only a movie — the recently released film “Hanging Up” — and if it sounds like a silly romp through one of the most emotionally wrenching experiences on Earth, it is. But for all its banality, the film flags a troubling issue: It is often one sibling, and one alone, who takes on the lion’s share of caring for an older parent.

A 1998 National Family Caregivers Association survey found that 76 percent of family caregivers say they don’t receive help from other family members. In most cases, that caregiver is a woman who is middle-aged or older. In almost all cases, she is the sibling who takes on most of the responsibility for parent care, from prime decision making to hands-on tasks. Geographic distance, family history, work and family obligations, and tight finances can all lead to one sibling bearing the brunt of caregiving.

Licensed clinical social worker Beth MacLeod of San Francisco (no relation to this story’s author) says family dynamics often dictate the involvement of adult children in parent care. “Foremost are personality and the child’s role in the family. For some people, taking on and giving has always been their role. Some can handle difficult emotions and others just can’t. There also may be a sibling with a spouse who’s jealous or ungenerous and who restricts the availability of the sibling.” The sibling living closest may also make most of the decisions, which can be a problem if you live far away and don’t agree with the philosophy and style of the local caregivers. The person who controls the money may also wield undue influence.

Parent care, it seems, can bring out the best and worst in sibling relationships: Old rivalries can flare up, old wounds can be reopened. Yet caregiving can also strengthen bonds and provide ample opportunity to nourish your relationships as adults with a common, important purpose.

The family meeting

Because the primary caregiver isn’t always the sibling who lives closest to the parent who needs care, experts recommend holding a family meeting — in person, by e-mail, in private Web chat rooms, or through telephone conferencing.

In the meeting, try to clarify goals and responsibilities, air feelings (without attacking others), and ask for support. If it’s your sibling who is the primary caregiver, offer support and ask how you can help. Though it helps to meet with just your siblings, at least initially, involve your parent as soon as possible in all decision-making. If tensions are running high, it may be best to bring in an objective third party, such as a counselor, certified financial planner, or private geriatric care manager.

Experts say the earlier this meeting can take place, the sooner family members can identify their goals and tasks. “If this is done with a professional facilitator,” says MacLeod, “he or she can help dispel what may be a lack of information about both the illness and the long-term care system, and what options are available in the community.

“The sooner you can make this process of caregiving a family decision, the sooner you can break down that barrier of somebody’s having to carry the bulk of the burden alone,” she says. “Don’t hold off having a meeting because one person won’t get involved; go ahead and do what you can as soon as you can. Then be specific in your requests — like ‘I need you to take Mom to her doctor at 3 p.m. Thursday because I have to work’ — rather than a general statement such as, ‘I wish you’d help out more.'” Other therapists recommend asking long-distance brothers and sisters for respite care — if you need more time for your own family, perhaps they can pay for your parent to fly to their homes for an extended vacation.

In the book How to Care for Your Aging Parents, author Virginia Morris offers these guidelines for holding family meetings:

  • Agree to rules in advance, such as not allowing anybody to dominate the meeting. Agree on a time limit for each person’s input, and — hard as it may be– listen without interrupting.
  • Avoid accusations and blaming.
  • Keep the discussion focused on parent care rather than on sibling issues.
  • Let everyone’s views be aired. If there are questions, ask that the statement be repeated or rephrased.
  • Discuss the parent’s diagnosis and prognosis, what the major concerns are (both now and in the future), and decide what needs to be done.
  • Make a detailed list of all tasks, such as paying bills, researching resources in the community, interviewing home health aides, touring senior day care or assisted living facilities, talking with financial and legal professionals, and organizing important documents.
  • Appoint one sibling to serve as the family’s voice when talking with health care professionals. This person may or may not also be the primary caregiver.
  • Divide the duties. Start by letting siblings volunteer. Even those who live far away can handle bills, make phone calls, or do some paperwork. If caregiving is causing you financial as well as emotional hardships, ask your siblings for help. Many will contribute if they are able to.

“Few families are so cooperative that there is no discord, or so chaotic that older relatives get ignored or abused,” write aging specialists Donna Cohen and Carl Eisdorfer in Caring for Your Aging Parents. Some families may appear to be too contentious and bitter to cooperate, they add, but that same family may rally together during a life-threatening crisis.

Ultimately, experts say, if siblings still fail to get involved, reach out to the larger community. It’s important for primary caregiver to build up support networks beyond family — whether at work, in community support groups or on-line chats and forums. And don’t give up hope that your siblings will come around.

“Many clients tell me that, over time, they’ve discovered many rewards in caring for aging parents,” says social worker MacLeod. “Adult children can heal old wounds and show new strengths as individuals. It’s important to hold the mind and the heart open to change. As much as possible, maintain an open invitation.”

Further reading

Donna Cohen and Carl Eisdorfer, Caring for Your Aging Parents: A Planning and Action Guide. New York: Jeremy P. Tarcher/Putnam, 1995.

Virginia Morris, How to Care for Aging Parents: A Complete Guide. New York: Workman Publishing, 1996

All rights reserved. This article first appeared in Consumer Health Interactive.

Beth Witrogen McLeod


  • Beth Witrogen McLeod is an author, journalist, speaker and consultant on caregiving, end-of-life issues and renewal at midlife, especially for women. She is a double Pulitzer Prize nominee, and has won many national and regional awards for her work. She has written for Good Housekeeping, SELF, Family Circle, and The Wall Street Journal, among others. Her latest book is Caregiving: The Spiritual Journey of Love, Loss, and Renewal

    Her expertise grew out of personal experience caring for her parents who were simultaneously terminally ill 1,200 miles away. With a father dying of a rare form of cancer and a mother with Lou Gehrig's disease and dementia, McLeod learned firsthand about the traumas and blessings of this mid-life rite of passage. She turned her experiences into a passion for public service, first writing and producing an award-winning newspaper series, "The Caregivers," for The San Francisco Examiner in 1995. It was nominated for a Pulitzer Prize. She developed a weekly column for The Examiner that often appeared on the New York Times Syndicate Web site. Honors for the series included National Hospice Organization, Pew Charitable Trusts, American Legion Auxiliary, Society of Professional Journalists, and many regional and local social service organizations.

    Beth is an Empowering Caregivers featured expert: learn more about Beth