Entry 06 of 08 · The people

How to divide caregiving tasks among siblings when fair is not equal

A task inventory matched to distance, time, money and skill. The out-of-town sibling gets the phone jobs and the money jobs.

How to divide caregiving tasks among siblings is not a question about fairness. It is a question about inventory. If you are the only one taking care of Dad, or of Mom, that is a list nobody else has seen, not a personality. Families that start with "fair" argue about character; families that start with a list argue about Thursdays. Fair is not equal. Fair means the whole list gets covered, every name is on it, and the person who lives closest is not the default. Resentment toward siblings is the heat that comes off an unwritten list. Write the list.

Why does the closest sibling end up with everything?

Because nobody decided. The Family Caregiver Alliance says that one sibling generally takes on the primary role because they live closest, are seen as having fewer obligations, or are considered the favorite child, and that discord most often surfaces from the unequal division of caregiving duties. It is a drift, not a decision, and it started the first time you were the one who could get there in ten minutes. A drift can be stopped by writing the list down. It cannot be stopped by being angrier about it.

The task inventory

Write every job Mom needs done in a week. Not categories, jobs. Here is a starting list; yours will be longer.

• Rides. Each appointment, each store run, church. With the day and the hour.
• Meals. Cooking, or the delivery that replaces it, and who checks the fridge.
• The pill box. Not deciding what goes in it; that is the pharmacist and the doctor. Picking up the refill and reminding her it is Tuesday.
• The house. Laundry, the yard, the gutter, the furnace filter, the light on the stairs.
• Bills and paperwork. Opening the mail, paying what is due, the insurance letter that needs a phone call.
• The phone jobs. The doctor's office, the pharmacy, the insurer, the state assessor, the aide agency.
• Nights. Who is in the house, or reachable, between ten and six.
• Company. The visit that has no task in it. This is a job too, and it is the one nobody writes down.
• Relief. The weekend the primary caregiver is somewhere else.

Match each job to distance, time, money and skill

Now go down the inventory with four questions per line. Does it need a body in the house? How many hours does it take? Does it cost money instead of time? Does it take a skill one sibling has and another does not? FCA's rule is to allow siblings to help in ways they are able and divide tasks according to individual abilities, current life pressures and personal freedoms. The brother who negotiates contracts for a living is the one who calls the insurer. The sister who cannot lift is not the one on the stairs. The daughter with two kids and a job in Ballwin is not the default for every ride just because she is close.

The out-of-town sibling gets the phone jobs and the money jobs. This is the line that changes families. Distance is a real limit on rides and nights. It is no limit at all on a phone call from Dallas at lunch. The National Institute on Aging says a long-distance caregiver, meaning anyone an hour or more away, can take on money management, arranging in-home care, providing respite for a primary caregiver, and planning for emergencies. Hand him the bills, the insurer, the pharmacy's phone tree and the aide agency's schedule. That is hours every week that leave your calendar and land on his, and he never has to get on a plane.

Three seats at the table: here, away, and commenting

Every sibling fight has three seats. The sibling who is here, and does. The sibling who is away, and could do more than they think. And the sibling who comments. The third seat is the one that burns a family down, because commentary is free and every other job costs something. The fix is not to argue with the comments. It is to hand the commenter a line on the inventory and a date. If she takes it, she has moved to a real seat. If she declines, the family has learned something it needed to know, and FCA's advice applies: be realistic in your expectations. Record the gap. Do not fill it with your own hours out of spite.

Relief is a task, not a favor

Put the primary caregiver's weekend off on the inventory like the furnace filter, with a name next to it and a date. The National Institute on Aging describes respite care as short-term relief for primary caregivers that may last anywhere from a few hours to several weeks, at home, in a health care facility, or at an adult day care center, and it warns that caregivers are less likely than others to get preventive health services and tend to have a higher risk of physical and mental health issues, sleep problems, chronic conditions such as high blood pressure, and even premature death. That is the line to read aloud when a sibling says a weekend off is a luxury. It is a line item. It costs whoever covers it two days.

What about the sibling who simply will not?

Then the inventory shows a gap, and the gap gets covered the way every other gap does: with Mom's money first, then with a split the family agrees on. A sibling who takes no line owes on the money line, and the ledger says so in a column he can read. If he refuses that too, the family stops planning around him, without drama, and the notes say "declined" next to his name every month until he changes his mind. Some do. The aide who takes Thursday nights is one seat at this table that does not argue, does not comment, and shows up on the day written down. New Plan Care, the paid placement on this site and an independently owned non-medical in-home care company in Chesterfield, schedules exactly that kind of seat. Whether the family pays for it, and how, is still yours to decide.

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