You had hoped that your parent would be able to care for him/herself throughout lifetime, but it looks like the time has come when elderly parent will need long term care assistance and some important decisions will need to be made.  Often times, we see families struggle with decisions such as whether the parent remains at home, who will be the caregiver and what help is needed, whether the parent will move to assisted living, and if so, where, just to name a few.  These decisions often involve family dynamics between the parent, “well spouse”, and adult children, assessment of medical needs, and understanding of financial constraints.  Since every family is uniquely different in how they approach this situation, different options should be considered to help resolve conflict concerning caring for the parent who needs assistance.

First, it is important to focus on the fact that this is really about what is in the best interest of the parent.  The parent’s wishes should control, if practical. If the parent is not able to make decisions or provide input themselves, the children should consider what the parent would want if able to make the decision.  Oftentimes, other factors will come into the decision-making process that causes the children to lose focus on what the issue is.  Those factors may involve their relationship with one another, their perceived notion of fairness (i.e. the other sibling is the parent’s favorite child; the other sibling is bossy and always gets his/her way, etc.), and social status (i.e. the other sibling cannot afford to contribute to parent’s care, the other sibling has enough to deal with on own, etc.).  It is important not to lose focus on what the real reason is behind the sibling interaction – decisions need to be made relating to a parent’s care.  In events of crisis, these decisions may need to be made quickly, which can escalate into hurt feelings from other siblings not involved in the decision-making process as to why they were not consulted.  Open communication is vital in this situation – explanation as to why the decision had to be made quickly and that things can be changed later as most decisions are not set in stone. Of course, not everything is controlled by majority or unanimous vote; the agent under valid health care power of attorney has legal authority to make decisions when the parent cannot communicate for themselves.

One available option when children disagree about a parent’s care is the decision to hire a professional to assess and provide input about the care.  Many people are unaware of the option to hire a geriatric care manager;  this is usually my first recommendation. A geriatric care manager can provide invaluable insight and resources relating to your parent’s true needs and best care options available.  They are knowledgeable about different types of placement (independent living, assisted living, group home, memory care, etc.), benefits/disadvantages of a particular placement, medical professionals your parent should be seeing, whether care can be managed at home and what accommodations need to be made (meal service plans, handicap modifications to age in place, fall prevention, etc.)  The care manager can even act as the liaison between the siblings or with the care facility and other medical providers.

If there is significant conflict and the parent is incapacitated, you might consider seeking guardianship through the court. The court will appoint the individual or entity the court believes is in the best interests of the incapacitated parent to make the parent’s medical and personal decisions.  In some cases the appointment of a third party (such as a professional licensed fiduciary or neutral family member) may be appropriate where the sibling children simply can never agree on anything.  The guardian will have sole decision making authority, but must act in the best interests of the parent and continue to facilitate contact with the parent and individuals with whom the parent had significant relationship (i.e., other children/family members).  Of course, should family believe the guardian is not acting in the best interests of the parent, those concerns may be raised with the court.  The court can make determinations regarding specific medical decisions, such as placement, if necessary. In some instances, mediation is useful in guardianship matters to help resolve conflict among family.

In most circumstances, everyone wants what is best for mom or dad, but simply has a difference of opinion as to what that is. We find that education about the parent’s true needs, alternatives to meet those needs, and open communication facilitated through counsel can often help resolve matters without the need for court involvement. However, in some unfortunate circumstances, guardianship is needed to protect a vulnerable parent from poor decisions or detrimental acrimonious behavior. Our attorneys have substantial experience in handling these types of matters. If you or your family needs help in helping your elderly parent please call our office to get the legal and practical advice you need to seek and obtain the best quality care for your parent.

-Stephanie A. Bivens, CELA, Esq.