As parents age and require more care, it’s not uncommon for the responsibility of caregiving to be shouldered by a single family member, rather than spread equitably.
Faith Hamilton-Trent knows this all too well. As the oldest of five siblings, she faced mounting responsibilities surrounding her parents’ Alzheimer’s disease diagnoses. Her story is one of unspoken (and spoken) family expectations and caregiver overwhelm.
Hamilton-Trent’s journey started in 2013 when she and her husband moved to St. Simons Island, Georgia. She was a retired music teacher, and the couple decided to embark on a new life journey. Before long, however, her siblings felt it best for their parents to live closer to one of the children — specifically, near Hamilton-Trent.
[READ: Common Caregiving Tasks to Do for Your Older Loved One]
Eldest Daughter Syndrome
While Hamilton-Trent loves her parents dearly, the nudge from her family to take on the role of caregiver felt more like a push, steeped in presumptions.
“It seemed like Eldest Daughter Syndrome,” she says. “Others in my family were still working, and one of my siblings felt strongly about moving our parents closer to one of the children.”
Anecdotally, Eldest Daughter Syndrome, while not a diagnosis in the DSM-5, the Diagnostic and Statistical Manual of Mental Disorders, is common among adult children of aging parents.
“It’s about unspoken family expectations that the oldest daughter will become the default caregiver, causing logistic, emotional and physical strain,” says Stephanie Moulton Sarkis, a Tampa, Florida-based psychotherapist.
This phenomenon tends to be more pronounced during major transitions, like moving a parent into a senior living community or making end-of-life decisions.
“In families with Alzheimer’s or other chronic illnesses, the eldest daughter may be seen as the one who ‘can handle it,’ even if that role was never discussed,” Sarkis adds.
[READ: Moving a Parent With Dementia to Assisted Living: 12 Tips to Ease the Transition]
Changing Care Needs
Shortly after Hamilton-Trent’s parents, Carol and Alexander Hamilton, moved to St. Simons Island, Carol’s health began to fail. She and Alexander had both received a diagnosis of Alzheimer’s disease, which precipitated a move to a senior living community. The couple initially lived in an independent living unit, with the option to move to assisted living as needed.
Then, like dominoes, a series of event upended their routine. Carol fell and broke her hip, and she moved to a senior rehab center. With COVID-19 in full swing at the time, Hamilton-Trent was unable to visit her mom for six months. Sadly, the rehab facility never fully recovered post-pandemic in terms of staffing and providing quality care experiences for patients.
“My mom passed away in that facility,” Hamilton-Trent recalls. “Those six months were very hard on her, and she died there in 2021. The isolation affected her terribly.”
Around this same time, Hamilton-Trent observed a shift in her father’s Alzheimer’s progression. Alexander’s move to assisted living helped but for only so long; the community did not have a memory care unit, and it was clear that living in one would be more suitable for his quality of life.
[Read: What to Expect From a Memory Care Facility]
Finding the Right Senior Living Community
Hamilton-Trent found the right senior care facility for her dad not far from St. Simons Island: Addington Place of Brunswick, Georgia.
“It’s bright and clean, and there are lots of activities to do,” she says, adding that her father is an avid trombone player, a hobby that staff fully embrace. “He was a high school band director and has a doctorate in music. It’s his raison d’etre. His two favorite things to do are practice trombone and take long walks.”
Other benefits include:
— Safety. Addington Place is a single-level facility with an enclosed outdoor space and picnic tables, and “it’s very accommodating,” Hamilton-Trent says.
— Socialization. Alexander engages with other residents in the communal dining space and participates in social events, such as a recent “Prom Nite.”
— Emergency preparedness. Addington Place has a charter bus, and in the event of a hurricane evacuation, staff drive residents to a sister location in the middle of the state. Hamilton-Trent adds, however, that because they’re far enough inland, evacuation is less likely to occur, giving her and her father significantly more peace of mind. Addington Place also has sufficient generators in place, she notes.
“We have found the best of all worlds in this facility,” Hamilton-Trent says. “The people we’ve gotten to know there are lovely and helpful.”
[READ: Taking Over Affairs for an Aging Parent in Mental Decline.]
Caregiver Support Groups
In the midst of all of these life transitions, Hamilton-Trent’s husband passed away. Between that and monitoring her father’s new move, she recalls feeling overwhelmed handling it all alone.
“I joined support groups and forums for caregivers of Alzheimer’s patients,” she says, adding, “It was easy to sit with people and ask if how I was handling things was normal: ‘Am I overly sensitive, or is this real?'”
Some of the caregiver support group suggestions included:
— Getting power of attorney for health care and financial decisions
— Not letting a person with compromised thinking make decisions about their own care
— Taking responsibility for situations that may impact a loved ones’ safety
— Couching terms with family members in a friendly but frank manner: “We are moving, and here is what you need to bring” rather than “Do you think we should move?”
Coping With Eldest Daughter Syndrome
In addition to the tips above, there are specific ways you can deal with Eldest Daughter Syndrome.
Sarkis suggests:
— Naming the pattern. Just being able to say, “I feel like the Eldest Daughter Syndrome is playing out here” and explaining what it is can start conversations with family members, especially siblings.
— Redistributing the load. Care doesn’t just mean physical or financial support. Care includes emotional labor, phone check-ins, managing paperwork or even making rotating visits. Have an honest talk about what each person can offer realistically. Keep in mind that what you think your sibling or other family member can offer and what they are willing to offer may differ.
— Setting boundaries without guilt. Boundaries are a kind of long-term care for yourself and your parent. Over-functioning can lead to burnout, which ultimately helps no one. You must take care of yourself first, whether that means respite care, days off or attending therapy.
— Letting go of the fantasy of fairness. In some families, the weight will never be equal. But it can still be sustainable and supportable if you are able to accept imperfection, focus on your well-being and even bring in outside help, such as a geriatric care manager or a home health aide.
— Saying no when needed: You are not obligated to care for your parent, as much as society and other family members may tell you otherwise. If caregiving is not possible, whether due to location, finances, family responsibilities or a difficult relationship with a parent, it is OK to say no. If you want to help out in another capacity, you can let that be known to family members.
— Using “I” statements when resentment creeps in: “I feel overwhelmed and alone in this” is less likely to cause defensiveness than “You’re not helping.” When you use “I feel” statements, you are more likely to have a productive conversation.
Avoiding Caregiver Burnout
Advocating for your needs, particularly if you’re the primary caregiver, is key to both preserving mental health and providing support to aging parents.
“Above all, eldest daughters deserve care too,” Sarkis says. “The pressure to remain constantly available and on your game can take a deep toll. It’s okay to ask, ‘What do I need to stay OK in all of this?’ and ‘What is in my best interest?’ Those answers matter just as much as anyone else’s.”
Hamilton recalls her burnout after 10 years of responsibility. With siblings scatted throughout the United States, from Washington, D.C., to Dallas and San Diego, she says that the “hardest part has been the toll it’s taken on my relationship with siblings.”
“It’s important that people know that the shift in family dynamics during times like this is a very real experience,” Hamilton-Trent explains. “I read multiple books, watched several YouTube videos and podcasts, but I’d often be at my wit’s end feeling alone in the process.”
Hamilton-Trent is happy that her father’s health has now stabilized to a point where she can travel for about a week. For many years prior, she was afraid to leave town because every time she tried, a need arose requiring her attention.
“It’s very real,” Hamilton-Trent says. “But right now, I just have so much gratitude to have both this break and this time together.”
Note: The editor of this story is the daughter of Faith Hamilton-Trent .
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