How to Coordinate Care for Your Elderly Parents With Siblings

Coordinating care for your elderly parents can be a challenge when siblings are less willing to help. Learn how to work with them.
By Lisa Esposito and Elaine K. Howley | Dec. 16, 2022

This article is based on reporting that features expert sources.

When it becomes clear that an aging parent needs caregiving, it’s uncharted territory for most adult children. Ideally, brothers and sisters rally together to recognize a parent’s needs and challenges, make plans to address them and volunteer for essential caregiving tasks. But it doesn’t always work out that way.

Adult siblings may have clashing ideas about how much care a parent needs and who should provide it. They may have different perspectives on what their own roles should entail. Individual brothers or sisters may step up to take on caregiving responsibilities while others step back. In many families, sibling caregiving roles are never explicitly discussed.

This can all lead to conflict, “especially if the siblings disagree about what to do,” says Monica Macias, a social worker and director of the Program of All-Inclusive Care for the Elderly at CalOptima Health, a community-based health plan serving low-income people in Orange County, California. “This can blur the focus from where it needs to be – on the aging parent’s needs.”

But with some effort and careful communication, siblings can resolve these issues and pull together to support their aging parents in a way that’s supportive for everyone in the family. Below, family caregiving experts share insights and tips on how adult children can navigate this difficult terrain – and avoid emotional pitfalls that strain and damage sibling relationships.

A Common Challenge

It happens to many families every year – the parents are no longer able to be as independent as they used to be, and it falls to their adult children to arrange care and support. It’s an exceedingly common situation, but it’s far from easy, says Dr. Deena Goldwater, a geriatrician and cardiologist who serves as vice president of care delivery for Welcome Health, a Whittier, California-based primary care practice for people aged 65 and over.

“Caring for aging parents is nothing short of overwhelming. The term ‘sandwich generation’ describes this very well; it means that people are pulled in two directions, attempting to balance the needs of their children with the needs of their aging parents. Families face financial burden, emotional challenges and difficult time demands,” Goldwater explains.

There are some steps loved ones can take to ease the transition from family member to a caregiver, including:

One of the first things that should be done, Macias says, is to get the appropriate paperwork in place. “Before an urgent situation arises, make sure you have your parents’ guidance documents completed, including a POLST and advance directive.”

She explains that a POLST has “different names in different states, but in general, it is a portable medical order that goes with a frail person as they are being treated so the doctors know what to do.” You can access more information about this process at the National POLST site.

“Another key document is an advance directive, which reflects what your aging parents’ wishes are,” Macias says. Also sometimes called a living will or health care proxy, “this simple, straightforward document allows them to express their wishes if they become incapacitated and unable to communicate. Advance directives are recognized in every state, and millions of Americans have them as part of their medical records.”

If you need help navigating any stage of caring for an aging parent, Macias recommends reaching out to a local elder care agency or another provider who can support you. “Also, in many states, dialing 211 provides families in need with a shortcut through a maze of health and human services agencies. By dialing 211, those in need of assistance can be referred to or connected with appropriate agencies and community organizations,” Macias adds.

Goldwater says that enlisting the services of a geriatric care manager can help if you’re overwhelmed. “These care managers are trained to help families navigate the complexity of health situations. They are also incredibly helpful with respect to identifying community resources to tap into to help an aging parent.”

Another challenge that many adult children face when an aging parent needs care is the wide range of options available. Dr. Michael Tehrani, a geriatric physician with Brand New Day HMO, a California Medicare Advantage plan, recommends researching what types of senior care options are available locally to see what might match with your parent’s needs and values. Doing this legwork before the parent becomes incapable of expressing their own wishes is key because their preferences can help guide your choices.

For additional support, Tehrani recommends working with “a trusted placement agent. A good placement agent is like a matchmaker. They know the different types of communities well, get to know the loved one well and match them to the community they feel is the best fit.”

And take care to ask lots of questions to make sure you understand your options and obligations and to stay a part of the process.

As a parent’s condition changes and care decisions need to be made, it’s important the adult siblings keep each other updated as much as possible on the situation – what to expect, tasks needed and requests for help. This communication and cooperation, however, can be a major caregiving challenge. “Coordinating care for aging parents takes a village – one person cannot do this alone,” Macias says.

To stay organized and keep siblings in the loop, you can use informal channels like quick calls or texts or turn to systems created to enhance family caregiving:

  • Apps. Create a free, personal CaringBridge website that everyone – parents, siblings and extended family – can use to instantly stay in touch and up to date. Often designed by caregivers themselves, online apps, such as CareZone, Lotsa Helping Hands and Caring Village, help you manage the countless aspects of caregiving.
  • Virtual family meetings. When crucial caregiving decisions must be made, it helps to have everyone together and focused. Family Zoom meetings or conference calls are opportunities for siblings to hear each other’s voices and interact from afar.
  • Checklists. Spelled-out tasks and responsibilities can bring clarity and reduce friction. You can download a variety of caregiving checklists online.

When talking about communication, it’s important not to overlook that your aging parents will have preferences and should be involved in the decision-making process as much as possible. Macias encourages adult children to “ensure that you’re having conversations with your aging parents regarding their wishes and reminding yourself that these are their wishes. Often, we see siblings in disagreement, and then documents get changed based on the siblings’ wishes, not their aging parents’ requests,” she explains.

Goldwater agrees that it’s important to talk with your parents early on to understand their values so you can make decisions in line with their wishes. “Often, siblings find themselves caring for parents who are no longer able to make decisions for themselves due to diseases such as dementia or stroke. Understanding your parents’ values, and things that matter most to them, eases the burden of challenging or complex medical decisions that will inevitably arise.”

Prepare for a Daunting Responsibility

You don’t realize how much goes into caregiving until you’re already immersed halfway up to your elbows with multiple responsibilities to meet.

“It was like a mudslide to see my parents’ health declining,” says Elizabeth B. Miller, a certified caregiving consultant, founder of the Happy Healthy Caregiver online community and blog and host of the Happy Healthy Caregiver podcast on the Whole Care Network. Both of her late parents had multiple and debilitating chronic health conditions.

Miller, one of six adult children, frequently took lengthy road trips back and forth from her Georgia home to help her parents, then living in Florida. “I found myself squeezed: caring for kids and aging parents while working on a full-time job,” she recalls. “My husband was also caring for his mom with lung cancer. We were losing our minds. It was the hardest part of my life, to date.”

For a time, Miller and her siblings relied on a CaringBridge website to document their parents’ health status and enhance family-wide communication.

“Keeping everybody in the loop is its own job,” Miller says. “CaringBridge really helped with that. It helped also with the power of prayer and sharing memories and photos with our family members.” As her father became severely ill, CaringBridge gave Miller’s mother a place to channel her worries and thoughts. “That just helped her process what was going on, and being able to connect.”

When Miller’s father passed away in 2014, her ailing mother’s situation at home became untenable. “We were in a real pickle situation where we had to move my mom,” Miller says. “She could not stay in the place.” Her mother needed help, the financial situation was worse than expected and the family realized, “We are going to have to make some decisions – and fast. It was a nightmare figuring it out.”

Sharing care among busy siblings was like putting together a puzzle, says Miller, who now coaches family caregivers in similar circumstances. Among other resources, her Happy Healthy Caregiver website offers downloadable worksheets, including one that spells out myriad caregiver responsibilities with the second column left blank for whichever sibling is assigned to undertake each one. An only partial listing of caregiving tasks includes the following:

  • Administering medications.
  • Communicating with the long-term care facility.
  • Coordinating occupational and physical therapy.
  • Individual household chores.
  • Meeting with attorneys, purchasing clothing and completing administrative and logistical tasks.
  • Replenishing medical and personal supplies.
  • Scheduling doctor’s appointments and transporting the parent (or another loved one) there.

Many additional tasks also likely need to be completed, depending on the situation.

How to Help Out From Afar  

Some caregiving tasks must be performed in person, but many can be done from a distance. If you’re a long-distance sibling, these are just some of the ways you can make a meaningful contribution to family caregiving:

  • Helping with financial management.
  • Filing insurance claims.
  • Engaging in FaceTime chats or phone calls with parents.
  • Researching long-term care options.
  • Dealing with Medicare/Medicaid issues.
  • Ordering medical and personal supplies.

Thoughtful gestures matter, too. “There are many things a long-distance caregiver can do to help,” Miller says. “Pay for the lawn care, or send a DoorDash or a gift card.”

Primary Caregiver in Charge

Primary family caregivers tend to emerge when an aging parent becomes vulnerable. Parents may have already singled out an adult child to act for them. Or, a son or daughter simply sees that a parent needs help and so naturally fills the void. Whether it’s researching long-term care facilities, hiring at-home caregivers, checking in on parents, supervising their medication or providing hands-on care, somebody has to do it.

“There’s a saying, both among caregivers and often among senior living staff and medical professionals, that there’s always one,” says Liz O’Donnell, founder of Working Daughter, an online community for women balancing eldercare, careers, kids and more. “So, whether you’re an only or one of eight siblings, there tends to be one adult child who takes the lead. And in my case, it was me.”

Navigating Sibling Dynamics

As adult children struggle to adjust when their previously independent parent needs assistance or caregiving, sibling dynamics can move in unexpected directions.

“If you are the one who’s designated by your parents – they asked you to be the health care proxy or they asked you to be the power of attorney – then own the role,” says O’Donnell, who is also the author of “Working Daughter: A Guide to Caring for Your Aging Parents While Making a Living.” “Your parents picked you for a reason. It may not feel fair or comfortable to everybody else in the family, but for whatever reason, they picked you. So, don’t be afraid to be in charge. Somebody has to be in charge.”

Cooperation may become difficult as family ties are tested in entirely new ways. Sibling hierarchies can reassert themselves with oldest/youngest/middle child dynamics. Adult children filling the lead caregiving role may take feedback from long-distance or less-involved brothers or sisters as not-so-constructive criticism.

“The way I tell people to operate in that role, if they’re choosing to try to maintain healthy relationships with everybody involved, is high input/low democracy,” O’Donnell says. “So, if you want to gather input from the other siblings in the family – ask them what they’re seeing, what they think – that’s great. It’s great to feel heard as a sibling who isn’t the one who’s in charge or wasn’t assigned proxy. But, ultimately, that sibling who is the proxy or the power of attorney has to make the decisions.”

Balancing Unequal Roles

Carol Bradley Bursack, a columnist, blogger and author of “Minding Our Elders: Caregivers Share Their Personal Stories,” interacts with family caregivers across their country and responds to their heartfelt concerns.

An issue that resonates strongly for Bradley Bursack’s audience is when other family members offer seemingly self-serving reasons for staying detached from caregiving or not visiting, whether the parent is living at home or in a long-term care facility. She says these common excuses are often the most grating:

  • I don’t have the time.
  • I don’t have the money.
  • I can’t bear to see Mom/Dad like that.

In terms of time, “somebody who has both young children plus needy in-laws, maybe their own health issues and a busy job or something – the idea that they’re going to actually physically help in any way, especially if there’s a distance, might be unrealistic,” Bradley Bursack says, adding that this issue is something to ask about.

More often, she explains, the issue is a lack of time among all of the family members. “So, we can be better off with (saying): ‘OK, I live closer; I’m in my parent’s community. I will do my best to do hands-on managing. You can take over the financial thing.’” Many scheduling and other time-consuming chores can be done online, she notes. “So, you can assign things or say: What can you do to help?”

Lack of funds can be a valid reason not to chip in, at least financially. “Some people, quite frankly, just have better-paying jobs than others,” Bradley Bursack says. Traveling to visit or helping to pay for a parent’s supplies may not be feasible for some children. However, she adds, that person can still take on important responsibilities, such as online research or filing a parent’s income tax.

When a parent is losing ground – physically, cognitively or both – it’s hard for adult children to witness, and some shy away. “They hate to see this decline,” Bradley Bursack says. But, she adds, involved caregivers may wonder: “They don’t see it’s ripping our guts out, too?”

Some people may be more emotionally equipped to handle a parent’s physical or mental decline than others. It can be helpful to seek out support, such as individual counseling or joining a support group for long-distance caregivers.

Play to Each Sibling’s Strengths

Almost everyone has what it takes to pitch in with at least one or two essential caregiving aspects.

“Play to your strengths,” O’Donnell says. “We all have them. We’re all different as siblings, so any way you can farm (tasks) out and everyone has a role, then there’s less frustration.”

One sibling may be quick to forge ahead with communicating with health care providers, making decisions, mobilizing resources and working out caregiving logistics, says O’Donnell, who instinctively took on those roles along with hands-on caregiving. Eventually, she realized it was “magical thinking” to expect her sisters to work at her pace or to look at matters exactly as she did. Instead, one sister took on long-term, sensitive projects. And the other put her talkative nature to work.

“I was never the daughter who wanted to call my parents every night,” O’Donnell says. “So, (my sister’s) role became: You call them and chat with them every night. And if you hear anything, feed it back to me. But I’m going to go all day long and meet with the elder law attorney, and talk to the doctors and run the errands. And at the end of the night, I want to go home and be with my husband and kids. I don’t want to be on the phone.”

Miller notes: “We all have different strengths. My oldest sister is the nurturer – she’s a wonderful caregiver. I’m a better caregiver cheerleader and more of a tough-love kind of person.” Each of her siblings brings different capabilities to the table, she says.

Walk in Your Sibling’s Shoes

“Families are more dispersed now than they have ever been,” O’Donnell says. “Tensions can easily arise between the local caregiver and the long-distance caregiver.”

Clearing the air and some mutual empathy can make the way smoother. “It’s really helpful if those two roles can have some compassion for each other or really try to listen to each other,” O’Donnell says. For instance, the local sibling may become gradually accustomed to a parent’s physical and mental changes – but it’s an abrupt shock for the other sibling.

“Maybe the long-distance caregiver comes into town for the holidays and observes a massive decline, but the local caregiver isn’t seeing that decline as much because they’re seeing their parent every day,” O’Donnell says. “Or, they’re totally aware of it, but they’re doing the best they can, and the long-distance sibling comes in and says: ‘Whoa, Mom’s really looking frailer than she used to.’ The local caregiver can take that very personally.”

Instead, O’Donnell advises, try to not take it personally. “Maybe it’s just a really helpful observation – or a not helpful observation, but their observation,” she says. “So, as much as you can, respect the other person needing to have a point of view.”

What Works

Nobody plans ahead to become their parents’ caregivers, and it takes time to make sense of the situation. Caregiving experts who’ve been there point to helpful attitudes and actions:

  • Playing to each sibling’s strengths.
  • Fostering compassion for each sibling’s situation.
  • Keeping communication going so family members can stay informed.
  • Allowing space for non-dominant family caregivers to express themselves.
  • Consulting with professionals, such as an elder-care attorney or geriatric care manager.
  • Engaging in self-care and self-preservation – putting on your own life jacket first.
  • Making peace with how it is.

Even if you’re disappointed or frustrated with a sibling’s response, it may be worthwhile to stem the emotional draining and move on. “Just try listening to them,” Bradley Bursack suggests. “Listen well, and listen with an open heart. And try not to remember grudges.”

Connecting as a Family

How will you and your siblings feel about one another during the caregiving period and in the aftermath?

“If you can get to the point that none of the dynamic really matters, all that really matters is: There’s an incredible opportunity to show up for someone who’s vulnerable, and you can see that caregiving is something that can give to you, not take from you, then that’s where you can really start to connect as a family,” O’Donnell says.

Caregiving has made her family even stronger, Miller says. “My parents had that ingrained in us. ‘Blood is thicker than water’ and ‘nobody’s going to love you like your family.’” Now, she says, “we pretty much feel like we can conquer anything.”

Caring for the Caregivers

Lastly, it’s important that adult children caring for aging parents take some time to look after themselves. Goldwater notes that “similar to raising children, caring for aging parents can be deeply rewarding but also incredibly challenging. Be sure to find time to take care of yourself.” Make time for exercisemindfulness or meditation practices to reduce stress.


    The U.S. News Health team delivers accurate information about health, nutrition and fitness, as well as in-depth medical condition guides. All of our stories rely on multiple, independent sources and experts in the field, such as medical doctors and licensed nutritionists. To learn more about how we keep our content accurate and trustworthy, read our editorial guidelines.

    Carol Bradley Bursack

    Bradley Bursack is a columnist, blogger and author of “Minding Our Elders: Caregivers Share Their Personal Stories.”

    Deena Goldwater, MD, PhD

    Goldwater is a cardiologist, geriatrician and vice president of care delivery at Welcome Health, a Whittier, California-based primary care practice that specializes in aging.

    Monica Macias, MSW, LCSW

    Macias is director of the Program of All-Inclusive Care for the Elderly at CalOptima Health, a community-based health plan serving low-income people in Orange County, California.

    Elizabeth B. Miller

    Miller is a certified caregiving consultant, founder of the Happy Healthy Caregiver online community and blog and host of the Happy Healthy Caregiver podcast on the Whole Care Network.

    Liz O’Donnell

    O’Donnell is the founder of Working Daughter, an online community for women balancing eldercare, career, kids and life, and author of “Working Daughter: A Guide to Caring for Your Aging Parents While Making a Living.”

    Michael Tehrani, MD

    Tehrani is a geriatric physician with Brand New Day, a California Medicare Advantage plan.

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