“When you comin’ home dad?”

 “I don’t know when

But we’ll get together then.

You know we’ll have a good time then…”

                         Cat’s in the Cradle, Harry Chapin

As care management professionals, my team and I have worked with hundreds of adult children grappling with the challenges of caring for an aging parent. Every family comes with its own personality, its own history, and its own family dynamic. But one situation is particularly complex, and more common than one may think: an adult child who grew up with an absent parent who now requires care in his or her old age.

The definition of an “absent parent” is, of course, subjective. For some, it is a parent who was not physically present during their childhood. For others, it is an uninvolved or even narcissistic parent. For others still, it is a parent who was neglectful, abusive, alcoholic, or mentally ill. No matter the definition, in each situation the now-adult child is faced with the impossible decision of how, or even if, to put aside old hurts and resentments and care for an aging parent who did not care for them.

 A moral, legal, and ethical responsibility

In most countries, there is a cultural expectation – a moral duty – to care for one’s aging parent that does not distinguish between “good” and “bad” parents. In the USA, 28 states have something called filial responsibility laws, legal rules that hold adult children financially responsible for their parents’ medical care if parents are unable to pay.  In Israel, the responsibility to care for aging parents is based on Judaism’s ethical commandment to honor one’s father and mother, and intricately woven into the fabric of Israeli society where family members are expected to provide hands-on care and even financial support.  

Duty aside, perhaps it is a biological love and compassion towards a less-than-stellar parent that enables an adult child to acknowledge that his or her parent is human and has likely incurred some trauma of their own, which in turn compels the adult child to take on the responsibility of caregiving.

At the end of the day, every person has a right to set their own boundaries. Some will find a way to sort through their injuries and feelings to care for their parents in old age. Others will limit their involvement. In a New York Times essay, Dr. Richard A. Friedman acknowledges that some parent-child relationships are so toxic that they must be severed, but adds, “Of course, relationships are rarely all good or bad; even the most abusive parents can sometimes be loving, which is why severing a bond should be a tough, and rare decision.”

For those struggling with caregiving decisions for a family member with whom you have a complicated relationship, you are not alone. Here are six steps to help guide you through the process:

  • Get support

First things first: talk to someone – a family member, a therapist, a friend.  Be honest with yourself so you can manage your own emotions. Don’t pretend everything is okay when it isn’t. Acknowledge and resolve your feelings of anger, guilt or failed expectations so you can genuinely move forward

  • Communicate with family

Caregiving affects everyone in the family. Communicate with siblings who may or may not have similar feeling about your parent, and talk to your spouse or partner and your own children. As difficult as it may be to say things aloud, this is the time to be honest about the situation and how it is affecting you. Make your family part of your support system and your caregiving plan.

  • Create a plan

Without the insight of an ongoing relationship, you probably have no idea about your parent’s care wishes. Research your options and present them to your parent. Do they wish to be cared for at home with a caregiver? Move to a nursing home? Hospice care?  An elderly parent who is sick will be focused on themselves and their current situation – dealing now with past history won’t help the situation at hand.

  • Delegate caregiving tasks

You can ensure an elderly parent’s well-being without being personally accountable. Consider hiring a professional care manager who can identify your parent’s needs, present all available options, and coordinate and monitor things ongoing. Here in Israel, a Care Manager will be able to coordinate medical care, hire caregivers, navigate bureaucracy, apply for benefits and more. Working with a care manager will ensure that your parent is being cared for and ease the burden and guilt of feeling that you should take on more than you can handle.

  • Appoint a legal guardian

If being even slightly involved in your parent’s care is just too painful, emotional, or traumatic, you may consider guardianship. This involves declaring that an elderly parent is no longer able to manage his/her affairs and is therefore legally incompetent. The court will appoint a legal guardian to be responsible for all care decisions.

  • Learn more

Ultimately, the decision for how much, if any, contact you have with your parent, or whether you should be involved in their care as they age, is a personal choice that takes into account your own emotional and physical wellbeing.  Here are a few books to help you cope and gain perspective as you make an informed decision.

Taking Care of Parents Who Didn’t Take Care of You: Making Peace with Aging Parents
Eleanor Cade

My Parent’s Keeper: The Guilt, Grief, Guesswork, and Unexpected Gifts of Caregiving  
Jody Gastfriend

Doing the Right Thing: Taking Care of Your Elderly Parents, Even If They Didn’t Take Care of You Roberta Satow, PhD

(This article originally appeared in the Times of Israel)