The Closest The Closest Connections: Family Connections: Family Relationships in Later Relationships in Later

LifeLifeSue Sweeney, MPH, MASue Sweeney, MPH, MAGerontology DepartmentGerontology DepartmentMadonna UniversityMadonna Universityssweeney@madonna.edussweeney@madonna.edu

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

Society/Culture

Social roles, ideals, values/mores, folkways, traditions

World view that acts as a filter of external reality

Society/Culture

Results from environment, history, experiences, outside influences on the group

Family CultureFamily Culture

Transmission of larger culture on Transmission of larger culture on microscopic scalemicroscopic scale

Results from family’s history, Results from family’s history, experiences, outside influences, experiences, outside influences, place in larger societyplace in larger society

Family CultureFamily Culture

AttachmentAttachment Nurturance, love, esteemNurturance, love, esteem Independence, autonomy Independence, autonomy Respect, belongingRespect, belonging Rivalry, jealousyRivalry, jealousy Separation, individuationSeparation, individuation

Family CultureFamily Culture

Feelings, thinking, expressionFeelings, thinking, expression Group vs individualGroup vs individual Generations Generations Use and distribution of powerUse and distribution of power Use and distribution of resourcesUse and distribution of resources

Family CultureFamily Culture

Interpersonal relatingInterpersonal relating Gender roles, sexualityGender roles, sexuality Work ethic/leisureWork ethic/leisure Activity/passivityActivity/passivity Expression of aggressionExpression of aggression

Family CultureFamily Culture

Materialism/spiritualityMaterialism/spirituality LegacyLegacy Antecedents Antecedents DescendentsDescendents Open/closed groupOpen/closed group Flexibility/rigidityFlexibility/rigidity

Filial MaturityFilial Maturity

Adult developmental achievementAdult developmental achievement See parent as peer, not idealizedSee parent as peer, not idealized No longer retain fantasy of being No longer retain fantasy of being

cared forcared for Accept sexuality of parent(s)Accept sexuality of parent(s)

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

Empty Nest/Retirement

Renewed focus on couple Redefinition of self Unstructured time Travel, avocations Relocation

Grandparenthood

Taking over grandchildren Raising grandchildren “Stuck” with child care Patriarch/matriarch

Parental RomancesParental Romances

It’s too soonIt’s too soon Replacing dad/momReplacing dad/mom You’re too old for thisYou’re too old for this You do what?You do what? What does he/she really want?What does he/she really want?

Blended FamiliesBlended Families

Later remarriageLater remarriage Acceptance of deceased spouseAcceptance of deceased spouse HolidaysHolidays

– TraditionsTraditions– LocationLocation

Inheritance of “steps”Inheritance of “steps” Care/end of life decisionsCare/end of life decisions

RelocationRelocation

Who is leaving whom?Who is leaving whom? Who is favored/burdened with Who is favored/burdened with

parents’ presence?parents’ presence? Downsizing: Who gets what?Downsizing: Who gets what? Violation of family roles/rules?Violation of family roles/rules?

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

Abusive/Neglectful Abusive/Neglectful Parent/SpouseParent/Spouse

Avoidant/cowed adult child/spouseAvoidant/cowed adult child/spouse Non-abusive parentNon-abusive parent

– BlamedBlamed– Failed to protectFailed to protect

Resentful eldercareResentful eldercare Risk of elder abuseRisk of elder abuse Risk of CG abuseRisk of CG abuse

Family CaregivingFamily Caregiving

Mom/dad takes care of itMom/dad takes care of it Sibling involvementSibling involvement

– JealousyJealousy– ResentmentResentment– FairnessFairness– Differential resourcesDifferential resources– Long distance/right hereLong distance/right here

Designated Primary Designated Primary CaregiverCaregiver

Spouse - expectedSpouse - expected Oldest (sister or brother)Oldest (sister or brother) Health professionalHealth professional Unmarried sibUnmarried sib Gay sibGay sib Unsuccessful, less separatedUnsuccessful, less separated Sib who takes care of others as Sib who takes care of others as

family rolefamily role

Family of CaregiverFamily of Caregiver

ResentmentResentment Loss of incomeLoss of income Loss of attentionLoss of attention Loss of family timeLoss of family time Loss of privacyLoss of privacy Growing up too fastGrowing up too fast ““Dance between guilt & resentment”Dance between guilt & resentment”

Caregiver Abuse

Excessive demands Inadequate sleep Basic needs not met Loss of self

Institutional CareInstitutional Care

AbandonmentAbandonment Guilt & conflictGuilt & conflict Adjustment difficultiesAdjustment difficulties Uncertain roleUncertain role Continuing needsContinuing needs Less control -> frustrationLess control -> frustration Staff challengesStaff challenges

End of Life

Who notifies, who is notified Keeping vigil Care decisions Funeral decisions Inheritance, disposition of property

Practitioner Attitude

Suspend conclusions– Observation– Questions– Hypotheses– Varying points of view– Open formulations– A picture that becomes larger and

sharper over time

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

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

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

Family Education

Normative events, experiences Course of illness Treatments Alternatives Resources Communication

Limits

Acknowledge and accept… Lack of internal resources Lack of material resources Lack of social support Lack of role models

Limits

Cannot compensate for a lifetime of poor choices

Cannot compensate for misfortunes of a life

Acknowledge the Elephant

Sibling rivalry Substance abuse Other abuse Exploitation Tragic loss Blame, guilt, shame “It’s common in these circumstances

for families to….”

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….”

Find Middle Ground

Use cultural/religious/personal values Use what they’ve described as

important Ask what model they want their

children to have

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

Negotiation

Hold a family meeting Suggest formal mediation

– Community Dispute Resolution Program– http://courts.michigan.gov/scao/

resources/other/cdrpcenters.pdf

Involve Respected Authorities

Religious leaders Cultural/community leaders Trusted professionals Friends of the family Fictive kin

Predictive Interpretations

Describe possible reactions “Frequently people test the limits

by….” Encourage to persevere in spite Helps prepare/plan

Substitute Decision Making

Informed consent Accountability expected Bonding, report to court Harder to back out

Mark the Transition

Written agreement Formal documents Web site Ritual or ceremony Family gathering Acknowledge the accomplishment

Follow Up

Reinforce agreements Support and encouragement Start over if not working

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?

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?

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.