The Closest Connections: Family Relationships in Later Life

1. The Closest Connections: Family Relationships in Later Life Sue Sweeney, MPH, MA Gerontology Department Madonna University ssweeney@madonna.edu

2. Society/Culture Address universals of human existence Time, space Birth, death Aggression Sex, partnering Parenting, family relationships Distribution of resources Defining in-group/out-groups

3. Society/Culture Social roles, ideals, values/mores, folkways, traditions World view that acts as a filter of external reality

4. Society/Culture Results from environment, history, experiences, outside influences on the group

5. Family Culture • Transmission of larger culture on microscopic scale • Results from family’s history, experiences, outside influences, place in larger society

6. Family Culture Attachment Nurturance, love, esteem Independence, autonomy Respect, belonging Rivalry, jealousy Separation, individuation

7. Family Culture • Feelings, thinking, expression • Group vs individual • Generations • Use and distribution of power • Use and distribution of resources

8. Family Culture • Interpersonal relating • Gender roles, sexuality • Work ethic/leisure • Activity/passivity • Expression of aggression

9. Family Culture Materialism/spirituality Legacy Antecedents Descendents Open/closed group Flexibility/rigidity

10. Filial Maturity • Adult developmental achievement • See parent as peer, not idealized • No longer retain fantasy of being cared for • Accept sexuality of parent(s)

11. Later Life Family Relations • Family culture played out among the challenges of aging & changing rules • Empty nest • Grandparenthood • Retirement • Illness/death of parent • Dysfunction, disability, dependence of family member • Additional responsibilities • High stakes decisions

12. Empty Nest/Retirement • Renewed focus on couple • Redefinition of self • Unstructured time • Travel, avocations • Relocation

13. Grandparenthood • Taking over grandchildren • Raising grandchildren • “Stuck” with child care • Patriarch/matriarch

14. Parental Romances • It’s too soon • Replacing dad/mom • You’re too old for this • You do what? • What does he/she really want?

15. Blended Families • Later remarriage • Acceptance of deceased spouse • Holidays • Traditions • Location • Inheritance of “steps” • Care/end of life decisions

16. Relocation • Who is leaving whom? • Who is favored/burdened with parents’ presence? • Downsizing: Who gets what? • Violation of family roles/rules?

17. Co-residence • Whose idea was this? • Expected, planned, no choice • Resources • Power • Space allocation • Task assignment • Care required • Reciprocity

18. Abusive/Neglectful Parent/Spouse • Avoidant/cowed adult child/spouse • Non-abusive parent • Blamed • Failed to protect • Resentful eldercare • Risk of elder abuse • Risk of CG abuse

19. Family Caregiving • Mom/dad takes care of it • Sibling involvement • Jealousy • Resentment • Fairness • Differential resources • Long distance/right here

20. Designated Primary Caregiver • Spouse - expected • Oldest (sister or brother) • Health professional • Unmarried sib • Gay sib • Unsuccessful, less separated • Sib who takes care of others as family role

21. Family of Caregiver • Resentment • Loss of income • Loss of attention • Loss of family time • Loss of privacy • Growing up too fast • “Dance between guilt & resentment”

22. Caregiver Abuse • Excessive demands • Inadequate sleep • Basic needs not met • Loss of self

23. Institutional Care • Abandonment • Guilt & conflict • Adjustment difficulties • Uncertain role • Continuing needs • Less control -> frustration • Staff challenges

24. End of Life • Who notifies, who is notified • Keeping vigil • Care decisions • Funeral decisions • Inheritance, disposition of property

25. Practitioner Attitude • Suspend conclusions • Observation • Questions • Hypotheses • Varying points of view • Open formulations • A picture that becomes larger and sharper over time

26. Practitioner Attitude • What’s important to each person? • What does each expect to happen? • What is the optimal outcome, for each? • What is next best? • What empowers family? • Encourage open sharing

27. Practitioner Attitude • “If I had an hour to solve a problem I'd spend 55 minutes thinking about the problem and 5 minutes thinking about solutions.” ― Albert Einstein

28. Practitioner Attitude • No “right” answers • What works • What does no harm • What does least harm • Not what’s equitable or just • Only see the present result of a whole family history

29. Family Education • Normative events, experiences • Course of illness • Treatments • Alternatives • Resources • Communication

30. Limits • Acknowledge and accept… • Lack of internal resources • Lack of material resources • Lack of social support • Lack of role models

31. Limits • Cannot compensate for a lifetime of poor choices • Cannot compensate for misfortunes of a life

32. Acknowledge the Elephant • Sibling rivalry • Substance abuse • Other abuse • Exploitation • Tragic loss • Blame, guilt, shame • “It’s common in these circumstances for families to….”

33. Suggest Alternatives • Acknowledge family culture • Describe changes that invite departure from past pattern • Point out cost/consequences of retaining past patterns • Model of alternative • “I wonder if….”

34. Find Middle Ground • Use cultural/religious/personal values • Use what they’ve described as important • Ask what model they want their children to have

35. Find Middle Ground • Ask if they can live with possible outcomes • Ask if they’ll have regrets later • What would be “right” if it were someone else? • Don’t have to like it

36. Negotiation • Hold a family meeting • Suggest formal mediation • Community Dispute Resolution Program • http://courts.michigan.gov/scao/resources/other/cdrpcenters.pdf

37. Involve Respected Authorities • Religious leaders • Cultural/community leaders • Trusted professionals • Friends of the family • Fictive kin

38. Predictive Interpretations • Describe possible reactions • “Frequently people test the limits by….” • Encourage to persevere in spite • Helps prepare/plan

39. Substitute Decision Making • Informed consent • Accountability expected • Bonding, report to court • Harder to back out

40. Mark the Transition • Written agreement • Formal documents • Web site • Ritual or ceremony • Family gathering • Acknowledge the accomplishment

41. Follow Up • Reinforce agreements • Support and encouragement • Start over if not working

42. Case Study – Mr. Constantine • What cultural issues may be influencing family dynamics? • How is power distributed in the family? • What other themes of family culture are pertinent to this case?

43. Case Study – Mr. Constantine • How has Mr. Constantine’s personal history affected this family? • What kinds of intervention could be helpful? • How would you start a dialogue?

44. References • Lustbader, W. (1991.) Counting on kindness: The dilemmas of dependency. New York: The Free Press • Lustbader, W. & Hooyman, N. (1994). Taking care of aging family members: A practical guide. New York: The Free Press • Smith, G. C., Tobin, S. S., Robertson-Tchabo, E. A. & Power, P.W. (1995). Strengthening aging families: Diversity in practice and policy. Thousand Oaks: SAGE Publications, Inc.