Navigating Family Dynamics When Caring for Aging Parents: An Interview with Francine Russo

Francine Russo has an impressive history of expertise around relationships and family dynamics. An acclaimed journalist, she has authored pieces in The Atlantic, The New York Times Magazine and The Village Voice, among other publications. As Time magazine’s Boomer Expert, Francine answered questions about aging loved ones and other subjects from adults around the world in her “Ask Francine” column. 

Her writing on the impacts that increasing care needs can have on a family unit and her countless interview hours with experts in fields such as gerontology, social work and elder care law culminated in the highly acclaimed book, They’re Your Parents, Too! How Siblings Can Survive Their Parents’ Aging Without Driving Each Other Crazy (Random House, 2010). She describes:

I was not alone in needing help. Even the family experts I interviewed told me that this family transition was so difficult that even they, who managed relationships for a living, had trouble with it. In my years of research to learn more about all the different pieces of this transition, I interviewed Geriatric Care Managers, leading family therapists, gerontologists, elder law attorneys and many other professionals in the worlds of aging and family. I talked to researchers on caring for aging parents, sibling and parent relationships, end-of-life decisions, dementia, death, mourning, and more.

Hailed as “an indispensable book for anyone whose parents are aging,” the book addresses common questions such as:

• Who will make major medical decisions, manage finances, and enforce end-of-life choices if your parents cannot? And how will this be decided and carried out?
• How will you negotiate caregiving issues and deal with unequal contributions or power struggles?
• How can caring for your parents be an enriching experience rather than a thankless chore?
• How can you ensure the best care for your parents while lessening conflict, guilt, anger, and angst?

We had the great pleasure of speaking with Francine about her life and work and are thrilled to share her words with you:

Q. How did you make the transition from writing about relationships and family dynamics in a more broad sense to becoming the de facto baby boomer expert at Time magazine?

I am one of the oldest boomers, so I have a jump on trends. I get a sense of what my peers are dealing with or will be dealing with because I’m one of the first to whom it happens. I had left my family—when I say left, I got out of town and kept some distance – call on Sundays and visit once in a while. The dynamics of my family were pretty uncomfortable and I wasn’t eager to get more involved. My sister and I had a difficult relationship always. Since our mother wasn’t very loving I was looking for friends and teachers and people who would mother me and be my big sister and I didn’t really have it in me to be the kind of big sister she wanted. In addition, she’s convinced, and maybe she’s right, that I was my mother’s favorite and she was very, very angry about that and was tremendously resentful. Also the fact that I left town and she stayed meant she was there and I wasn’t, and this became especially pronounced when my mother started aging and it was my sister helping my dad through it. I want to stress, I think it’s really important, that nobody asked me to do anything. Instead the message I got was “You’re not around, you’re a bad person.” It was like guilt, guilt, guilt and anger and my response to guilt and anger was to keep my distance. When my mother died and I was at the funeral I saw my father and my sister holding each other up and sobbing and I got a sense for the first time of the horrible ordeal they’d been through without support from me and I felt terrible. I learned much later to forgive myself because as I studied other families, and I began to do that, I saw that what happened in my family was not at all unusual – that often family dynamics prevent the person who’s the caregiver from getting the help they say they want. There are many variations on this but as the boomer expert in Time magazine I began to see so many other siblings in trouble because nobody had really dealt with the fact that siblings get together – or don’t get together – but deal with each other over their aging parents in a very intense way and sometimes this interaction is the first in probably 30 or 40 years. I saw it in my own family, I saw it in every family I interviewed, and I interviewed many families, [that] everybody goes back to being who they were when they lived together so that if the older sister had the role of taking charge and being bossy, the older sister will take charge, or try to, even though other people in the family may be better qualified or emotionally more the right person. Those dynamics fascinated me and that’s what I wanted to find out about. 

Q. What ultimately spurred you to write They’re Your Parents, Too! How Siblings Can Survive Their Parents’ Aging Without Driving Each Other Crazy (Random House, 2010)?

It was a much bigger subject than just an article. Until my generation most people didn’t live to be old and needing care. But now, that’s just not the case. It was completely new and families just didn’t have a model for how to do it – they still don’t have a model. It all falls to the family and they kind of scramble around and they try to do it and all of the old history comes back to infect the process. There are things that people can do to make this better but they need insight. When the siblings get back together again over their aging parents, they’re dealing with mortality – their parents’ mortality and their own mortality – and it awakens some pretty scary feelings. So, people tend to react at a very profound emotional level and whatever feelings they had for each other when they were growing up come out in spades now as if the intervening 30 or 40 years didn’t matter. People need to be aware that this is coming from a childhood feeling that is not totally rational at the moment. One of the reasons I wrote the book was to give people insight into this emotional process. Then, people can deal with the actual decisions they have to make and not just be driven by emotion.

Q. What has the response been, both from readers and your family? Have any of the responses surprised you?

In general people are incredibly appreciative and they have also told me they found the book surprisingly easy to read—it’s incredibly readable. They fear that it will be a heavy book, but I remember one person who wrote to me said, “I just got the book and my husband made me put it away at midnight—I couldn’t stop reading it.” People’s responses are, “Oh my God, this is about my family.” I tell the stories of many, many families in the book but the basic story of coming back together with your siblings when you see time with your parent(s) running out and all that arouses—that’s kind of universal. 

Q. Did your sister react to the book at all?

Not very much. I did end up apologizing to my sister because I wasn’t there for her when my mom died and then I was much more there for my dad in his last years, but she remained very, very angry with me. After my dad died I did make her an apology, a heartfelt apology that I hadn’t been there for her the first time around and she accepted the apology. One of the things when I talk to audiences, which I do now – I go around the country giving talks, is that I stress that every sibling reaction is an interaction between two people at least and if one person in the interaction changes their attitude, what they do, what they say, even a little bit, that can change the whole tenor of the interaction. One of the most insidious forces in families at this time is guilt. Guilt is uncomfortable and people defend themselves from it. Siblings often go into what I call the “anger-guilt gridlock” where I try to make you feel guilty, you respond by not doing what I want and perhaps getting angry, I try to make you feel more guilty, you get even angrier, it goes round and round and round until one of the people realizes they can get out of the dynamic and does something different. One of the things everybody needs to recognize is each person has a role in what happens. I’m sure there are absolutely rotten sisters and brothers somewhere but most people are very complicated and they’ve had complicated relationships with their parents and it’s important to remember that each person has a completely different relationship with the parents and that will affect what they’re willing to do and how much they’re willing to do and everything about this.

Q. You often bring your own, rich history as a wife, widow, mother, sibling and friend into your writing. Is it difficult to do this, and what impact do you think this has on your readers?

It’s actually the easiest thing to do, although I have to be careful because I’m writing about other people who are close to me. I think it enables me to talk to other people and be able to share their experiences because I’m coming out of similar experiences of my own. 

Q. What was the hardest thing about writing They’re Your Parents, Too!? What was the most rewarding?

One of the most rewarding things about the book was the many, many conversations I had with siblings about their deepest feelings – about their parents, about their sisters and brothers. Also the most fascinating thing was that in many families, I was able to talk to more than one sibling and sometimes as many as five and you know, I heard five different stories. Those conversations were very rich, very intimate and I learned a tremendous amount. Those people were incredibly generous to share those things with me. I would say the hardest thing was writing about something that had not been written about in this way before and finding a way to organize it and deal with all the issues without repeating myself. Plus, I had never written a book before. It was a very difficult process.

Q. In your research, what have you found to be the best predictors of how well a family will handle transitions into parental or spousal care needs?

Well, I would say having a reasonable family history where there hasn’t been a lot of anger and guilt, where the family gets along relatively well, is the first. The second thing is if the siblings who are not doing the primary caregiving give emotional support at the very least to the person doing it – I would say that is the most critical factor because caregivers can feel very alone. I will say that there are some caregivers who make it very difficult. Also, caregivers often don’t know what they need – nobody will help me but then it turns out they really want to control it themselves and they really don’t so much want help – what they really want is appreciation and emotional support. It’s really helpful if the caregivers can figure out what they really want and if they expect help of some kind, even long distance, many things can be done using technology. They just need to be able to delegate and work cooperatively.

Q. You talked to experts in myriad aging-related fields – if you could assemble a “dream team” to help a family facing the care transition, who would be on it?

If they have the money and it’s not that expensive I recommend [families] hire a Geriatric Care Manager. This is a field that’s grown exponentially in the last 20 years and people belong to a professional organization. They tend to be either social workers or nurses and they check in on the parents, they are masters of every resource they might need whether it’s a certain kind of doctor or health care aides or assisted living, they also give reports on health – when they see the parents, they examine them and they can talk about mental condition and physical condition and make suggestions to the family. The other thing they can do, which is invaluable, is to hold family meetings. Having a professional person at this meeting short-circuits all the family dynamics that get in the way. I would also say, if you don’t have a Geriatric Care Manager or even if you do, it might be helpful to have a family therapist or a psychiatric social worker to deal with the family and have these family meetings. I would also say of course you need a physician who is trained in the diseases of older people. And I would say an elder law attorney. A lot of things will have to be legally put in place – power of attorney for health, power of attorney for finances, arrangements, will, end-of-life instructions – and many of these elder law attorneys have worked with many families and have also helped to make the peace. 

Q. What are the themes that most intrigue and inspire your writing today in the realm of aging (e.g., family relationships, brain health, retirement)?

I am interested in older people and retirement, family relationships always but really nowadays it’s often the people who are my readers being the oldest in their families and dealing with the younger generation – that interests me very much. The other thing is I’m very interested in romance and marriage after 60 because 45% of people over 65 are single – either divorced, widowed or single – and people are dating like never before and I’m especially interested in the new relationships they form – both the way they deal with them on a practical level and the emotional texture of these relationships and how they are the same or different from marriage and relationships at other periods in their lives and how they are different from people who are married, say 40 or 50 years. This is something I’m just starting to research. I hope to do a book on it. I actually believe that in some ways forming a relationship after 60 could be one of the best times in life to do it – there are fewer distractions and challenges like raising a family, struggling over money, being young and unformed and trying to figure out who you are and create your identity and deal with your partner as you each go through inevitable changes. Also older people not only have a huge amount of experience, but emotionally they tend to live more in the moment; they focus on the good things in life and they don’t sweat the small stuff. They know what they want, they know who they are. It’s about being together and enjoying life, it’s not about anything else.

Q. If you could offer one piece of advice to the baby boomer generation what would it be?

Do what you can to be healthy—exercise and enjoy life.

For more information on Francine or her book, visit www.yourparentstoo.com.