1. For more than 75 percent of family caregivers it was the act of helping their loved one with personal care that contributed to their self-identification. (Source: National Family Caregivers Association) 2. The value of the services family caregivers provide for "free" is estimated to be $306 billion a year. That is almost twice as much as is actually spent on homecare and nursing home services combined ($158 billion). (Source: Care Coordination and the Caregiving Forum, Dept. of Veterans Affairs, NIH)

It's clear Mom can't live alone anymore. But should still-single younger brother move in? Can not-working wealthy sister spring for an assisted living facility? What about far-away brother, who was always Mom's favorite? Should always-in-charge oldest sister make the ultimate call?

A family crisis can magnify family dynamics forged over decades, and if that communication was dysfunctional, the decision-making will be as well.

Family members are advised to "accept the contributions each one makes rather than be extremely critical of what others are doing."
— Sarah Matthews, Ph.D., professor of sociology, Cleveland State University

Reaching a solution that works for everyone is not easy, and it's not a one-time thing. Families that hope to navigate these waters successfully often need to brush up on their communication skills and find ways to work together toward their common goal: ensuring a loved one's health and safety.

These tips will help families find their way to a better communication style:

1. Recognize different perspectives. Each family member evaluates the situation from his or her own point of view. In her research on 149 pairs of siblings with aging parents, Cleveland State University professor of sociology Sarah Matthews, Ph.D., found sisters tended to believe their brothers weren't doing enough, while brothers tended to work independently, doing tasks they felt their parents needed but not claiming credit for them. Brother-sister pairs had the hardest time communicating, while sister-sister pairs were most likely to investigate, talk and address problems.
   
   Family members are advised to "accept the contributions each one makes rather than be extremely critical of what others are doing," advises Dr. Matthews.


2. Acknowledge that contributions will not be equal. Differing work situations, finances, geographic distribution, personalities and other factors mean contributions will be uneven, and any plan will be imperfect and unbalanced. "Sometimes it is important to accept approximations of a good solution," according to the Family Caregiver Alliance's Fact Sheet: Holding a Family Meeting. Most of the time one adult child will be the primary caregiver for the parent and will appreciate support from siblings whenever possible.


3. Gather information regularly and independently, then share notes. Each family member needs to gain complete information on the situation and options, in order to make for informed communication. "Visit Mom and Dad more frequently to assess what is the real problem," advises Aileen Morales-Rabizadeh, elder care liaison for Dignity in the Golden Years in Rockaway, New Jersey. Facts include not only living and health situation, but the finances and insurance that will impact decision-making.


4. Meet regularly as a family. In person is best, but regular contact via phone, email or Skype also works, especially where distance is a factor. Siblings may want to meet first separately in order to create a united front when approaching parents. Families vary on how wide a circle participates in these discussions, such as including aunts, uncles and in-laws. It's helpful to have an agenda and limit meeting times, to keep things moving along and ensure future participation, the Family Caregiver Alliance advises.


5. Brush up on communication skills. Really listen to another's concerns, and then restate them to ensure understanding. "We like to reflect back what we hear, and reframe it to make it less a flashpoint and more reflective of the interests we have in common," says Arline Kardasis, partner in Elder Decisions/Agreement Resources, Norwood, Massachusetts. For example, a good reply to "This is a really stupid thing to do" might be: "You're very concerned about this, can you say why?"

   Conflict resolution skills can also come into play, particularly where emotions run high. Adult education programs and other local resources may offer conflict resolution training. It's important to keep the ultimate goal in mind: not to resolve decades-old issues or prove how right someone is, but to learn to make decisions together that are in the best interest of the parent.

6. Consider outside help. Third parties, especially those trained to facilitate groups, can be invaluable in keeping family members on track. Resources abound, from clergy to nurses, social workers, case managers, discharge planners and therapists.
   
   The relatively new field of eldercare mediation has emerged to help families get past the sticking points that prevent good decision-making. "We want to get families to start making decisions together and develop a dispute resolution system that they help design," says Elder Decisions' Kardasis.
   
   Prepare to spend $150 to $500 an hour and up to approximately eight hours for such services. There are several hundred trained eldercare mediators — really another name for facilitators.

Mediate.com at: www.mediate.com (under elder issues) Association for Conflict Resolutions at: www.acrnet.org.