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Caregiving When You’re an Only Child: Without Siblings, Decisions About Caring for a Parent Will Fall to You

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Here on the AgingOptions Blog, caregiving is one of our most frequent topics, for one simple reason: some time in our lives, most of us will either need a caregiver, or be a caregiver – or both. For tens of millions of American adults, caring for an aging loved one is a daily reality. Usually, the caregivers we write about also have adult siblings, and the articles we share typically highlight ways in which brothers and sisters can work together to make sure mom and dad are getting the care they need.

But what if there are no siblings? If you’re an only child with parents growing older by the day, you’re likely facing the prospect of caregiving solo, without the support – emotional, financial, and practical – that siblings can provide. How do you navigate the uncertainties of being a solo caregiver?

We found some helpful answers and some good food for thought in this article published late last year by NextAvenue. In it, freelance writer Gary Stern walks us through the caregiving journey from the perspective of an adult only child. We hope this article helps you or someone you know to be better prepared for the most challenging task most of us will ever undertake.

Caregiving is a “Rite of Passage” for Millions

In his NextAvenue article, Stern begins with the reminder that adult children becoming caregivers for their aging parents is such a common occurrence that you could even call it “an inevitable rite of passage.” He continues, “But only children who have to be caregivers face a different burden compared to those who were raised in a family with one or more siblings willing to share the duties and stressors. Only children often have to do it all.”

After interviewing several experts for his article, Stern encourages only children to prepare early for their parents’ eventual caregiving needs in every possible way, including financially and emotionally, beginning with meeting with an attorney to gain clarity about power of attorney and the content of their parents’ wills.

Caregiving Without Siblings: Both Easier and Harder

“Caregiving is so prevalent,” Stern writes, “that the New York Times reported that one in five adults (or as the article states, according to AARP, more than 50 million) is providing unpaid health or support to a loved one, such as an aging parent or a spouse with an illness or disability.” (Note that a subscription may be required to access the New York Times article.)

Moreover, every caregiving situation is different. Brenda Avadian, founder of The Caregivers Voice, a website for helping caregivers of dementia sufferers, says, “Looking at it comparatively from a child who has siblings compared to a single child, sometimes it’s easier and sometimes it’s not.” 

She adds that an only child “can step up, make the decision and get the work done,” as opposed to conflicting sibling dynamics, which can hinder decision-making, especially if there is one primary caregiving sibling and the rest just argue with them.

Avadian notes that she has even observed families of as many as ten siblings who have learned to cooperate and all take turns caring for their parent. However, she cautions, these situations are the exception. A family with multiple adult siblings may be more likely to face conflict over a parent’s care, and they require much better intra-family communication.

What to Watch For: Signs of Decline

Stern describes the particular burden of a parent’s decline on the only child.  “According to Avadian, if the only child sees signs that the parent is faltering, such as forgetting appointments, neglecting to take their medicine or being unable to balance their checkbook, it’s likely time to intercede. She advises asking the parent open-ended questions, which aren’t judgmental, to determine if they’re forgetting things, or facing daily difficulties.”

This doesn’t mean that the only child should act rashly. Depending on a parent’s mental state, they should be listened to and consulted about their desires and included in any decisions made.  “Avadian advises that the best place to start is by learning as much about the parent’s failing health or emerging dementia as possible, about the disease’s progression, and behaviors associated with it,” Stern explains. “That way, the adult child can know what to expect and better prepare for the parent’s future options.”

Getting the Right Professional Advice

The only child has a few best steps to follow once they notice that their parent is faltering, according to experts. Your first stop should be your parent’s primary care physician. Prepare two or three questions based on your own research, and assess the situation with the physician’s help. “At that point,” Stern writes, “it’s a good idea to meet with your parent’s attorney to discuss their will, see if you can obtain power of attorney, determine if your parent has a health care directive and then ultimately become executor of their will or estate if necessary.”

This begs the question: when is the appropriate time to consider placing the parent in independent or assisted living? Avadian answers: “When you find a parent is a risk to himself or herself, then it may be time to consider other options.” (Risks, in this case, include behaviors such as leaving heaters on or consistently having expired food in the refrigerator. A parent who is becoming frail may need to move from a large multi-story family home into a safer environment.)

When the parent lives a significant distance away, experts advise the bold step of inviting the parent to come and stay with you. “See if that eases their burden,” Stern writes, and adds that “perhaps living together, or in proximity, can be a possibility for a while.”

Caregiving Can Be Isolating for an Only Child

As an only child, the responsibility falls to you to walk a line between respecting your parents’ autonomy and assuring their safety. This is especially difficult if both parents are in need of care, as one may need more care than the other.

Aaron Blight, founder of Virginia-based consulting service Caregiving Kinetics, says, “It’s quite a balancing act. It can be very isolating and lonely. You feel everything about your parents’ well-being rests on your shoulders. You have no siblings to relieve one another.”

For this reason, Blight encourages the only child to seek self-care through counseling, support groups, hiring a professional caregiver for help, or even seeking assistance from their spouse.  “You have this Herculean task, and you have your own life and responsibilities, and now the needs of your parents can encroach on your existing life. Somehow you have to manage that with the needs of your parents,” Blight says.

But this is possible to juggle, and it takes real resilience, adaptability, and the ability to make adjustments to meet changing demands. Blight reminds us that “there’s no handbook that comes with being a caregiver for your parent. Each situation is unique.”

Consider the Financial Resources Available for Care Costs

The decision to place a parent in an assisted living facility comes with a few factors to consider. Stern says that it’s important to think about what kind of caregiving support a parent might need and how they match what services the facility provides. The single child has to decide whether the parent’s needs exceed the level of help that the child can provide, and—perhaps most importantly—the child must assess the parent’s wishes, since many will strongly prefer not to enter assisted living if they can be cared for at home.

Another pressure, and perhaps the most important one, is the cost of assisted living care. Planning early for potential caregiving costs is key. Carol Levine, senior fellow at The United Hospital Fund, says, “Some parents have a lot of money and are willing to spend it on care. And some parents say, ‘no, this is my money, why do I need to spend on it a stranger whom I don’t trust?'” Levine says.

The Quality of the Existing Relationship is a Key Factor

The relationship between an only child and a parent plays a key role in what transpires as the parent ages. Levine says, “If it’s been close, open and transparent, even with ups and downs, it’s more likely that the relationship will change but continue to be close. [If the relationship has been difficult] it’s hard to build a relationship when both people are stressed, needy and not sure what’s going to happen.”

But it’s also important to note that caregiving can come with surprising rewards, especially for an only child. The time spent with your parent, learning more about them and their life can be very satisfying. Stern reminds us that even if you’re an only child, caregiving should never be a one-person job. It’s important to seek support for yourself and make sure you have help when you need it.

Avadian agrees. “Caregiving is exhausting. It’s often 24-hours, seven days a week, and it’s a thankless job.” But there are positives, she says: “[For example,] the only child gets to give back to parents, which is very satisfying, masters the art of patience and ultimately learns a lot about himself or herself.”

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(originally reported at www.nextavenue.org)

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