Family Conflict Series Episode 1: The Decision-Making Battle

When a loved one is diagnosed with Alzheimer’s disease or other forms of dementia, families must make numerous important decisions. They must make crucial decisions regarding finances, daily care, medical treatment, and long-term care. One of the most challenging issues families encounter is determining who has the authority to make these critical decisions.

Caring for a loved one with dementia and making decisions on their behalf is a significant yet important responsibility that should not be taken lightly. But what happens when families disagree about these decisions?

In this article, we’ll explore who has the legal authority to make decisions for a loved one with dementia, the common causes of family disagreements, and strategies for resolving conflicts.

Who Gets to Make Decisions?

Although many adult children assume they have the authority to make decisions for a parent with dementia, unless they are designated as the legal power of attorney, they do not have the legal right to make those decisions.

A power of attorney (POA) is a legal document that allows someone to act on another person’s behalf. The person appointed as the POA has the legal authority to decide for the individual. If no one has been appointed as POA, a court may appoint a guardian or conservator, which can lead to significant family disputes.

This is why it’s important to address legal matters for someone diagnosed with dementia before the disease progresses. Family members should consider having a discussion with their loved one about choosing a health care surrogate. A health care surrogate (aka health care proxy or medical power of attorney) makes health care decisions when the individual becomes incapacitated. This person has the legal authority to communicate with doctors, manage medical care, and make decisions on behalf of the individual.

An elder law attorney can assist individuals with dementia and their families with navigating medical, legal, and financial matters, including creating a will, power of attorney, and health care surrogate designation.

What Causes Family Conflicts?

Family dynamics can be complicated, and unfortunately, they often become even more complex during a crisis, such as a dementia diagnosis of a loved one. In addition to legal disputes, there are emotional aspects of family conflicts that can be even deeper and more difficult to navigate.

Varying Perspectives

Family members may have different perspectives depending on their relationship with the person diagnosed with dementia. For instance, a spouse responsible for day-to-day care will view the situation differently than a family member who lives out of town or has minimal contact with the person diagnosed. Similarly, adult children may struggle to accept these changes, as they cling to the parent they knew before dementia.

Trust Issues

One of the most common sources of family conflict is trust issues, especially when the parent with dementia has a new spouse. Adult children may feel like the spouse is making decisions for personal or financial interests, leading to legal and personal challenges.

Guilt and Denial

Guilt and resentment often go hand in hand in families facing a dementia diagnosis. In addition to struggling to accept a parent's decline, adult children who are unable to contribute due to work or distance may feel guilty about not being able to do more. This guilt can become resentment towards the spouse or siblings who are more involved or making important decisions.

Not Understanding the Disease

Alzheimer's disease and other forms of dementia are progressive conditions that affect a person's memory, thinking, and behavior. When families don’t understand the symptoms, progression, and how dementia will affect their loved ones, it can lead to conflicts and disagreements. That’s why education is so important. When families take the time to learn about dementia, they’re better equipped to work together to care for their loved ones.

4 Strategies for Solving Family Conflicts

Although family conflicts can be challenging, there are strategies to help navigate this difficult time.

1. Open Communication

These discussions are important. Avoid communicating over text, email, or rushed calls. Instead, schedule in-person meetings or Zoom calls to calmly discuss your loved one’s needs and care. Be respectful and avoid adversarial, accusatory, or inflammatory statements, such as "you don’t care" or " you haven’t." Stay positive and focus on your loved one by starting the conversation with, I know we all want what's best for mom or dad.

2. Clarify Roles & Responsibilities

There’s a lot to manage when caring for a loved one with dementia. Even with a designated POA, multiple family members can and should be involved in caregiving and decision-making. To ensure clarity, assign specific roles so everyone understands their responsibilities and knows what to expect. Roles can include handling doctors’ appointments, managing finances, shopping, check-ins, and preparing meals.

3. Consider Asking a Third Party for Help

Family disagreements can sometimes escalate to the point where they lead to legal battles, emotional abuse, or ineffective care.

If this happens, it may become necessary to consider hiring one of the following professionals to help resolve family disagreements:

• Dementia coach
• Family therapist
• Mediator
• Care manager

4. Support the Caregiver

Dementia caregiving is physically, mentally, and emotionally exhausting. It can be impossible for family members who aren’t local, or don’t experience the daily struggle of dealing with wandering, agitation, or hygiene battles, to understand and empathize with the difficulty of caregiving. Listen to the caregiver, don’t assume they’re overeacting, and volunteer to give breaks when needed.

5. Focus on What’s Best for the Person With Dementia

It’s common for family members to become frustrated by the daily struggles of caring for a loved one with dementia. In these moments, it’s important to remember that their care and well-being are the only things that matter. Let go of unresolved conflicts and petty disagreements and focus on finding resolutions that enhance your loved one’s quality of life.

Wrap-up

Emotional baggage, trust issues, and clouded judgment can make it difficult for families to come together and care for a loved one with dementia. By focusing on open communication, shared responsibilities, and the best interests of the person with dementia, families can navigate power struggles with less tension and more collaboration.