As Sol's vascular dementia advanced, his children Ben, Talia and Simon disagreed strongly over whether he could continue to live in his own home or whether they should move him to a residential care facility. As Ben and Talia lived far away, Simon and his wife, Ruth, made the decision, moving Sol to an assisted living facility with the costs to be split between the three children. Ben and Talia and their spouses were angry at the decision and this caused a rift in the family. Being in a sandwich generation can be difficult. As people live longer and have children later in life, concurrently caring for children and parents is a more common occurrence. In some cases, people who are already grandparents ready to embark on their golden years of enjoying their families and retirement are held back by the steep financial and emotional burden of caring for their elderly parents. In best-case scenarios, adult siblings can share the cost and emotional weight of caring for parents, but disagreements between siblings can place an even greater stress on an already complex situation. When adult children don't get along, avoidance is often the key coping mechanism. They may have to mingle at family occasions but they can, for the most part, avoid conflicts. The situation can deteriorate rapidly when children have to come together to make consequential decisions about an aging parent. Family members can quickly regress to old roles such as the “eldest child” and the “spoiled child” and the old jealousies and issues can bubble to the surface. Emotional aspects of watching your parents' health fail, together with logistical, financial and practical considerations can be overwhelming. Discussing elder care with parents years before such issues arise can avoid a lot of problems. Many difficulties happen when children advocate for what they “believe” their parent would have wanted. Having a clear idea of what was desirable even if it is not practical can be a good guide for how a care plan can be worked out and can remove the emotional “Dad would want” aspect. Even where a parent has not left instructions, it is a good idea for children to discuss these issues with each other before they arise. Unfortunately, in most cases, children are left without guidance and decision making happens only when a crisis arises, putting a lot of stress on all. It is important that a real discussion is facilitated in which all parties are involved, preventing problems that arise when multiple private communications are held. It is helpful to have an agenda that addresses all the issues that may arise and allow each person to explain what they believe is best and why they think the decision they are advocating is the optimal choice to make. Tips for the conversation: 1. Listen to each person, even when you feel that their views do not hold weight. 2. Tolerate venting and frustration. By allowing people to express how they feel, the air can be cleared and allow for decisions to be made without anger coming through. 3. Find out the interests of all involved and work together to recognize everyone's different interests. 4. Take professional advice. Listening to those such as geriatricians or social workers who work with the elderly and understand elder care may be helpful in making decisions. 5. Say yes to brainstorming and creative solutions that have not been brought to the table. Make notes about any decisions made and be clear that they are agreed upon by all. In some cases, the children cannot resolve these issues between themselves and it may be an idea to have a neutral third party, such as a mediator, facilitate the conversation, especially if previous conversations regarding these issues have ended in disagreement and argument. Sol's family came together with a mediator as they wanted to reconcile but felt tensions were high. The mediator spoke with the family about what each individual was looking for and needed. Ruth, Sol's daughter in law, explained that she had wanted Sol to move to a residential home because she was concerned for his safety and that he was lonely. Ruth has a full-time job and had just started her master's and could no longer spend time with him every day. Simon and Ruth both spoke about the hardships of being the ones to practically care for Sol and the responsibility of ensuring he was safe and well. They explained how they would have liked to share the burden but it didn't seem practical with the others living far away. Ben and Talia explained that they felt excluded and that their physical distance from their father should not translate to their views not being given the weight they felt they should have. The family spoke about different practical ways to deal with the issues. They decided that each sibling would have a five-minute Skype session every third day with Sol. In addition, they arranged for a Skype session between all the siblings once a week to discuss how their father was doing, providing a forum for any future decisions that may arise. As the average age expectancy grows (In Israel from 71.8 years in 1970 to 82.1 years in 2015) one hopes most will enjoy long and good health, however it is inevitable that the burden on the “sandwich generation” to care for elderly parents is part of the equation. The hardships that families encounter when caring for an infirm parent or spouse are many and can be extremely challenging. Coming together as a family and supporting one another is of vital importance at some of the most difficult of times. The writer qualified as a lawyer in the UK and then retrained as a licensed mediator both in England and Israel. She currently resides in Jerusalem, where she has a practice specializing in mediation for English speakers. hadassah@mediationinisrael.com; www.mediationinisrael.com
