Being the “Shot Caller”

By August 28, 2018December 31st, 2020Caregiving Well-being
3 conversations to have if you’re facing a family role reversal.

I was one of those kids who wanted to race through childhood. I chafed at obeying my parents’ decisions, and relished being mistaken for older than my age. In college, I breezily told people I couldn’t wait to be thirty, and when I actually did turn thirty, I got to brag that I was right all along: getting older was just as good as I thought it would be.

But the truth is, I still call my dad any time I see a new doctor, get an appliance repaired, or make decisions about my 401K. The few times I’ve had to make a truly adult decision on my own, like planning for a beloved pet’s end of life care or choosing a mortgage lender, I’ve felt like a fraud. Where are the grown-ups? Why is everyone here acting like I’m a real adult? Somehow, growing older has only increased that surreal feeling, rather than reducing it.

How to Handle a Family Role Reversal

The role reversal that comes with being a caregiver can multiply this feeling, which is sometimes called imposter syndrome because of the way that it causes successful, accomplished people to feel like they haven’t earned their status. As a caregiver, you may be responsible for making big decisions for the same people who used to make big decisions for you. No matter how old you are, or how many milestones you’ve passed, it’s hard to feel ready for that, and your loved ones may not feel ready for it, either.

So how do you make the shift and start calling the shots? If you’re taking over financial and medical decision-making for someone who can no longer make those decisions for themselves, you don’t have to do it alone. You’ll need to communicate openly and often, and be willing to accept professional help navigating the family role reversal you’re facing.

Talk with your family

In many families, responsibility for the care of older adults is shared among a few different people. If that’s the case for your family, you’ll need to sit down and talk about how major decisions will be made. Unfortunately, it’s not usually feasible for nursing staff or tax preparers to brief everyone about an individual’s care, so you’ll need to identify a point person who can be in contact with each of the various professionals who are part of your family member’s care team.

More importantly, though, you’ll need to talk about your approach. If one sibling wants their parents to continue making their own decisions and another disagrees, there may be conflict. Facing a loved one’s aging can be very emotional. Be open about your fears and realistic about what you can handle. Just because you’re a point person doesn’t mean that you should do everything.

Talk with a social worker

If your loved one is receiving care at a hospital or nursing home, there will be social workers on staff to support families. You can also find a social worker in private practice who works with families to help navigate through challenging situations. A hospital or nursing home social worker can discuss your family’s situation with the doctors and give you concrete guidance on how to coordinate care, prepare your home for an older adult with changing needs, and navigate the emotional side of caregiving.

Social workers can also help mediate conversations with older adults who may have trouble accepting help. The transition is just as difficult for a parent or grandparent facing declining health, and it may help to have a professional suggest some of the necessary changes. You may also find that talking one-on-one with a counselor or social worker can help you manage any feelings you may have about caregiving.

Talk to a lawyer

Sometimes the family role reversal happens overnight, and other times you’ll be able to see it coming. Either way, as soon as you can, talk to a lawyer about setting up legal protections for your loved ones. The federal Health Insurance Portability and Accountability Act of 1996 (or HIPAA) protects patients’ right to privacy regarding their medical information. Health care providers are prohibited by law from providing information about a patient’s health or treatment to anyone who hasn’t been expressly named. The safest and surest way to make sure that you can make medical decisions for an older adult is by having a lawyer draw up a durable power of attorney (POA). A POA makes you the “personal representative” for an individual. I can’t tell you if a POA is right for your situation – I’m not a lawyer – but it’s worth asking a professional. POAs can also cover financial decision-making, which means you can arrange to work with banks, creditors, and the IRS on behalf of an older adult. This will save you a lot of extra legwork.

The Family Role Reversal Doesn’t Have to be Total

When you become a caregiver for a parent, it can feel like you have truly swapped roles. That isn’t always true. Many older adults, even some facing cognitive changes, still have lots of love and support to give. You may be arranging for everything from their groceries to their surgeries, but they can still take a parental role in caring for and comforting you in their own ways. If you can strike a balance between taking on responsibility and allowing your older family member choice, flexibility, and agency, you’ll both feel better about the arrangement. And don’t be afraid to change things that aren’t working. Sometimes being the grown-up means making mistakes, after all.

 

Mara Hughes

About Mara Hughes

I work in Medicare Marketing at Independence and blog about navigating life with chronic illness and other issues relevant to caregivers and health care consumers of all ages.