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Dear Dr. Yael,

I am wondering how to handle a situation in which a number of siblings are caring for elderly parents. Who has the final say? Should there be a vote or should the primary caregiver, who, we assume, understands all the nuances, make the decisions? What is the role of in-law children, especially when there is a disagreement about care?

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I am my parents’ primary caregiver and it is hard for me to deal with my siblings. They never let me know when they are going on vacation, so I can’t plan any time away for my family. It’s as if they think I will always be there.

I wish there were some appreciation on their part for what I deal with on a regular basis.

I know what a privilege it is to care for my parents, especially after all they have done for us. We became the caregivers by default and the stress is overwhelming sometimes.

If you can share some tips and suggestions on ways to find balance, I think it would be helpful.

Much Appreciative

Dear M.A.,

Very often the burden of caring for elderly parents falls on one child, usually the one who lives closest. If that child is not able to provide the care, then it falls to the person who is most capable. However, there needs to be assistance from the siblings. In a perfect world, that help would be automatic, but, when its not, it must be asked for.

One should not assume that his or her siblings don’t care – it may just be that they don’t know how overwhelmed the caregiver sibling is.

I don’t know the specifics of your situation, so I can’t comment on it. I will just give you some generalizations.

Even though it could be uncomfortable, ask for the help you need – and be specific.

While all siblings can and should be involved in decision-making – when there is a conflict, the final decision should fall to the person who speaks to the doctors, therapists, etc.

In terms of in-law children, the one married to the primary caregiver should have a say, but other than that person, it really does depend on family dynamics and expertise. If there is an in-law child in the medical profession, his or her opinion on medical issues could be helpful.

Siblings: Remember, it is unfair of you to offer advice and opinion if you are not involved in giving care. You cannot expect one person to do all the work yet, feel you have a right to say how things should be done.

In terms of appreciation, that is one of the most difficult. In a perfect world, that appreciation would be automatic. However, when it is not forthcoming, know that you are performing a great mitzvah and the sechar is without measure.

Do have a conversation with your siblings and explain to them that you can’t do it all on your own. Maybe someone can create a calendar for vacations so there is always someone around to take over when you can’t.

It is imperative to stay calm when you have this conversation, and speak in an “I feel” message/tone, rather than blame. If you feel you cannot say what you wish in a calm and effective manner, send a text message. Hopefully, they will understand and be more considerate in the future.

Research suggests that siblings work well together when there is a formal care plan. A google doc is a good way to do this, so everyone can have access. You can also create a family calendar where doctors’ appointments are listed and different people can sign up to take your parents.

If nothing else, at least your siblings will see how much you are actually doing, which may make them more appreciative.

Hatzlocha.

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Dr. Yael Respler is a psychotherapist in private practice who provides marital, dating and family counseling. Dr. Respler also deals with problems relating to marital intimacy. Letters may be emailed to deardryael@aol.com. To schedule an appointment, please call 917-751-4887. Dr. Orit Respler-Herman, a child psychologist, co-authors this column and is now in private practice providing complete pychological evaluations as well as child and adolescent therapy. She can be reached at 917-679-1612. Previous columns can be viewed at www.jewishpress.com and archives of Dr. Respler’s radio shows can be found at www.dryaelrespler.com.