Caregiving demands can impact the quality of family relationship which include sibling relationships and relationship between the adult children and their older parents. Have you ever wondered how is it that in some families, despite the demands in caregiving, family members are able to rally together and work things out for their loved ones while in others, the responsibilities of caregiving are seen as burden and being pushed around? Family disagreement and conflict do arise due to many reasons including differences in opinion on how the caregiving tasks should be undertaken, issues of equity as in how the tasks should be more fairly divided and the roles of individuals in managing care. While disagreement is normal in human interactions, how should family members build and maintain quality of relationships so that they can collectively play a part in shared caregiving responsibilities? This article provides insights on how the strengths of parent-child and sibling relationships can impact caregiving of older adults and shares how family members can harness the strengths of members in caregiving support.
Who is considered family?
Very often when we think of family, we tend to focus on the nuclear family; that is the parents and their children living under one roof. However, we find that the model of the nuclear family is less applicable with emerging phenomenon of divorce, remarriages, singlehood, single parenthood, and couples opting not to have or have fewer children. The familial structures in later life stage are a result of life course transitions by family members and it reflects the forms of diversity in society. The definition of family membership should hence be broadly embraced to include active participants who are children, nieces, nephews, siblings, aunt, uncle, and cousins. In some contexts, individuals consider their closest friend as “family”. In taking a broader perspective on the definition of family, we would not be too microscopic in having missed opportunity for support from someone who acts as family and not be too fixated in forcing the older adult to rely on an unreliable family member simply because he or she qualifies as closest ties (biologically or legally) in the definition of a family.
What is the state of family relations in society?
Research has shown that intergenerational ties and relationships remained strong and cohesive in societies[i]. Despite structural changes in family structures, intergenerational family relationships remain intact with evidence of frequent interaction and exchanges between parents and adult children[ii]. Family relations in the East Asian cultures embrace obligation, reciprocity and reliance and family care is much a preferred option by family members[iii]. This is because family care enables older adults to maintain social connections with their loved ones and it also preserves a sense of dignity for them.
In Singapore, the family remains a key source of support for physical, financial, and emotional support for older members. In a 2019 Social Attitudes of Singaporeans survey conducted by the Ministry of Social and Family Development, 93% of persons aged 65 years and above reported having a close-knit family[iv] demonstrating a strong sense of closeness to their family. 97% of the respondents also agreed it is important for grandparents and their grandchildren to maintain close ties with each other. This signals the importance held by the older persons on building and maintaining intergenerational ties. It is noteworthy that 96% of respondents aged 15 to 64 years old agreed that it is their duty to take care of their parents regardless of their qualities and faults; highlighting that filial responsibility remains strong in local context. The strengths of families are valuable resources to be tapped for the caregiving journey of older adults.
How does the state of parent-child relationship impact caregiving of older parents?
We can take a life course perspective to better understand how family relationships are formed and shaped over time and the impact on caregiving. The dynamic interaction between parents and children from growing up years will have a lasting impact on parent -child relationships and how future interactions are formed[v]. Adult children formed their perceptions and interpretations of the relationship through time, and this will have implications on how they construct the meaning of intergenerational reciprocity and their obligations in caregiving. When the children enjoy close relationship with their parents, they are driven by an innate desire to reciprocate their filial obligations[vi]. Conversely, when there are unresolved conflicts and distant parent-child relationships, there will be an adverse impact on perceptions of caregiving for the older parents.[vii] However, research has also alluded that adult parent-child relationships have the potential to change and adjust over time[viii]. This means that there is need to invest in building and maintaining good parent -child relationships even in situations where life events happen such as divorce. Building parent-child relationships could take simple forms such as having meals together, going for outings or celebrating special occasions.
Parents should be mindful to not get caught in having a preferred child syndrome in the parenting journey as this will have detriment effects on relationships within the family. The “preferred child” is one whom the parents dote on and treat better than other siblings. Parental favouritism can lead to conflict and unhappiness amongst siblings and negatively impact how respective adult children perceive caregiving for older parents[ix].
How does the state of sibling relationship impact caregiving?
The state of sibling relationships and their emotional closeness have a significant bearing on how caregiving is negotiated for older parents[x]. Emotional closeness enables siblings to enjoy interdependent relations that are nurturing and constructive. The nurturing of sibling relationship in early life is important as research showed that when the sibling bonding is strong, even if they do not maintain physical contacts or spend as much time together due to changes in life cycle, their commitment remains, and the relationship still exists in their minds[xi]. In close sibling relations, negotiating caregiving for older parents will be much on a “give and take” basis and willingness to embrace greater responsibility in caregiving. Conversely when sibling relations are strained or distant, the notion of fairness will take centre stage in caregiving negotiation which can lead to resentment when caregiving tasks are not meted out equitably[xii].
How should we manage conflicts in the family?
It is normal for conflicts to arise in human relations. What is important is not to let the interpersonal conflicts remain unresolved, breed unhappiness and destroy relationships that have been built over years. It is critical to listen actively, talk things out calmly and find common goals that parties could collectively work on. If need to, tap on the extended family network by asking a respected member to mediate the situation. Families can also consider tapping on formal services like the Family Service Centres to seek support and advice from social workers on how best to address the conflictual familial issues. By keeping the unhappiness to ourselves and not addressing them can lead to resentment and prolonged anger and impact our health and mental well-being. Family relations that are so precious in human relations will also be destroyed.
How can we harness the strengths of family in caregiving?
Caregiving can be a shared family responsibility if members discuss and negotiate on how caregiving decisions and tasks could be made and carried out with the best interest of the older member in mind. Rather than based on the principle of equity, the sharing of caregiving responsibilities can be based on the strengths and abilities of members. Simply put, do what you are good at and contribute positively. Let me illustrate this using the case of the Lim family on how the members successfully negotiated a shared care plan for their terminally ill mother.
The Lim family
The Lim family has 3 adult children (2 daughters and 1 son). The older parents reside with the son and a daughter, both single, in a 5 -room HDB flat. The eldest daughter is married and staying apart. The family was devastated when their mother (aged 72) was terminally ill with cancer. They huddled together for a family meeting with the father and shared their views of how they should care for mum. They decided to ask mum as they felt that she has the right to know and to make preparations to live life meaningfully. Mum expressed her wishes to remain at home till her end of life and told her children to be strong as death would strike everyone someday. It was initially hard for the adult children, but mum’s acceptance of her end stage of life gave the children strength to move ahead to support mum’s wishes to be cared for at home. Together with their father, the siblings discussed how they could put in place a shared care plan bearing in mind mum’s condition would deteriorate over time. The shared care plan included the following:
The family obtained a referral from the doctor to apply for home hospice services so that they could be supported in the caregiving journey. Under the service, a nurse would visit mum at home and advise the family on managing her medical conditions including pain management. If need to, the family can gain easy access to the doctor from hospice care for advice. This will cut down multiple visits to the hospital for follow up.
A joint bank account was set up by the son and daughter and all three siblings agreed to collectively contribute a sum so that they could tap on the funds for mum’s medical and other expenses. The son would issue a monthly statement of account to update siblings on the spending and the need to top up the account.
A WhatsApp chat group was formed to facilitate communication and for members to update information and to ask for help if issues arise.
The son volunteered to fetch mum to visit some relatives and close friends as mum said she would like to get in touch with them soon. He would also help mum run errands etc.
The daughter who is married and staying apart, is self-employed and has some flexibility in managing her time. She offered to support mum in her personal care which include support in bathing and dressing especially when her condition worsened.
A neighbour was engaged to help cook porridge for mum during the day.
Dad would help mum with her medication and meals.
The siblings contacted their maternal aunt (mum’s younger sibling) and mum’s close friend to visit mum occasionally during the weekday so as to keep mum company when all siblings are at work.
The daughter residing with mum would take care of dinner when she returned home from work.
A part-time helper was engaged to help with housework chores.
The siblings would gather over the weekend and have meals with their parents.
The siblings had a deal that if there were concerns and unhappiness, they should voice out and talk over it.
Subsequently as mum’s condition deteriorated, the family had to adjust the care plan and intensify their care for mum. Mum finally passed on peacefully at home. The siblings and father drew on one another for support during the difficult period.
What are the factors that contribute to a successful shared family care plan?
The caregiving journey is by no means easy as the siblings have to manage work and their caregiving tasks. Also, differences in opinion could arise resulting in conflict. The Lim family managed to pull through caregiving successfully due to the following key factors:
The parent-child relationship is strong. Mum’s resilience and her advice to her children to accept that death is imminent in turn helped the children to better cope with the situation and get their act together.
Mum’s wishes and opinion were heard, and she could express her desire of how she wanted to live life at end stage.
The siblings’ relationship was close and there was open communication. By incorporating in the shared care that the siblings would proactively share any unhappiness and concerns and that this would be heard respectfully, it addresses potential problems that may arise due to personal grievances.
There is “give and take” attitude amongst siblings as they drew on their own strengths and resources to contribute to caregiving. Flexibility was exercised in adjusting the care plan and there was willingness of siblings to extend a helping hand when the need arose.
The family was resourceful in tapping on informal network of support like asking the neighbour and aunties for support.
The tapping on formal services like home hospice care and housekeeping services helped alleviate the stresses in caregiving.
Concluding Remarks
Family relations is central in human relationships. Attention needs to be paid to managing the intricacies of parent-child relationship as this has an impact on the extent of fulfilment of filial obligations by adult children in later life. The building of close sibling relationship has a bearing on interdependency and how decisions are made on shared caregiving responsibilities. The maintaining of emotional closeness will go a long way to preserving sibling relations which are key resources for the family. It is important to recognise that conflict is normative in human relations. Hence there is a need for families and individuals to manage their familial issues which is critical to the investment of building strong family ties.
Dr Corinne Ghoh
Adjunct Associate Professor
Department of Social Work
National University of Singapore
[i] Lowenstein, A.(2007) Solidarity-conflict and ambivalence: Testing two conceptual frameworks and their impact on quality of life for older family members. Journal of Gerontology: Social Services, 62B(2), S100-S107; Silverstein, M. & Giarrusso, R. (2010), Aging and family life: a decade review. Journal of Marriage and Family, 72(5), 1039-1058.
[ii] Lowenstein, A, (2005). Chapter 5.1 Global ageing and challenges to families, In M. Johnson (Ed). The Cambridge handbook of age and ageing: Cambridge University Press; Reisman, D. (2009). Social policy in an ageing society: Edward Elgar Publishing Ltd.
[iii] Izuhara, M. (2010). Housing wealth and family reciprocity in East Asia. In M. Izuhara (Ed). Aging and intergeneration relations. Family reciprocity from a global perspective. UK: The Policy Press.
[iv] Ministry of Social and Family Development. Ageing Families In Singapore, 2010 – 2020. Insight Series Paper 01/2022.
[v] Kuczynski, L. (2003), Beyond bidirectionality, Bilateral conceptual frameworks for understanding dynamics in parent-child relations. In Kuczynski (Ed). Handbook of dynamics in parent-child relations: Sage publications.
[vi] Ghoh, C. (2016). When ambivalence and legal responsibility crossed: examining and theorising adult children’s perception of caregiving for elderly parents. PhD thesis. Department of Social Work, National University of Singapore.
[vii] Ghoh, C. (2016). When ambivalence and legal responsibility crossed: examining and theorising adult children’s perception of caregiving for elderly parents. PhD thesis. Department of Social Work, National University of Singapore.
[viii] Duck,S. (1994). Meaningful relationships. Talking, sense and relating: Sage Publications.
[ix] Ghoh C. (2016). When ambivalence and legal responsibility crossed: examining and theorising adult children’s perception of caregiving for elderly parents. PhD thesis. Department of Social Work, National University of Singapore.
[x] Connidis,I.A, & Kemp, C.L. (2008). Negotiating actual and anticipated parental support: multiple sibling voices in three generation families. Journal of Aging Studies, 22, 229-238.
[xi] Rittenour et. al, (2007). Commitment and emotional closeness in sibling relationship. Southern Communication Journal, 72(2), 169-183.
[xii] Connidis,I.A, & Kemp, C.L. (2008). Negotiating actual and anticipated parental support: multiple sibling voices in three generation families. Journal of Aging Studies, 22, 229-238.
All information is accurate at the time of publishing.