Step Family Relations Can Complicate Caregiving

Caregiving is complicated as we've discussed many times. And "sandwich generation" adult children have additional concerns and family issues that add another layer. But then sometimes we have to add in children--adult children--from previous relationships and it's quite a dance and very complicated.

Medical crises like  cancer do not--as in the made-for-TV-movie--make everyone behave better or rise to a higher level of functioning. Rather cancer and fear and worry instead aggravate whatever tension is underlying and can bring a focus to old battles--but with new focus. "Mom always liked you best" gets replayed, and "Who do you think you are?" gets a spin and in stepfamilies the painful, "She shouldn't be with you" and  "He's your husband not my father" might get said or played out with out words.  Just a painful layer of complications.

With our Boomer demographic having such a high level of remarriage and therefore blended families we have to factor step children and step parents into the caregiving equation.

Here's an article from PsychCentral that reminds us of this serious concern:

http://psychcentral.com/news/2013/09/28/stepfamilies-can-add-to-caregiver-burden/60046.html

Stepfamilies and Caregiving Facing Facts

Earlier this week I wrote about the situation our family faced with step kids and stepparents faced with cancer care. I’ve heard from many people who faced the double dilemma of cancer caregiving when one of the adults has children from a previous marriage. These are tough situations.

But hard as it is we are not alone.

Here are the facts:

–Between 52% and 62% of all first marriages will eventually end in divorce.

–About 75% of divorced persons eventually remarry.

–About 43% of all marriages are remarriages for at least one of the adults.

–About 65% of marriages involve children from the prior marriage and, thus, from stepfamilies.

–60% of all remarriages eventually end in divorce.

–One of three Americans is now a stepparent, a stepchild, a stepsibling, or some other member of a stepfamily.

If you then consider those stats next to the increasing incidence of cancer and the increasing reality of cancer as a chronic or terminal illness and you have a lot of people who are struggling with how to manage caregiving in a stepfamily.

There are lots of issues: Who is in charge? What does the patient want? If the patient can’t speak who gets to make healthcare decisions? They can be big decisions like approving a treatment or stopping treatment, and smaller ones like accepting discharge plan. When the spouse says, “Let’s take him home” but the kids say, “I can’t help out” there are bad feelings and serious issues.

There is also the money. Who decides how to spend down an account or to travel for a second opinion? Who pays for home health aides? As our healthcare system changes we will all be asked to pay more out-of-pocket—but out of whose pocket? And with money-as-power such a strong cultural value—does the adult stepchild with more money out vote the stepparent?

It can get hard and ugly and painful for everyone.

Prevention is best. If you are in a stepfamily—as the parent or the child—make sure there are a will, a living will, a healthcare proxy, a medical power-of-attorney and a durable power of attorney in place. You don’t always need an attorney to create these for you but it’s smart to have a professional make these documents because they could be challenged when feelings are on fire. And cancer and death are flammable.

The most critical part of this planning though is that it forces conversation between the married partners. The adults have to carefully consider all of the what-if’s and state their preferences. You don’t want to leave an unhappy stepchild and stunned stepparent to share critical medical decision-making. It’s not only ineffective it’s just too painful. And the patient is most likely to suffer.