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Caregiving
By Paul Wynn

4 Tips for Only-Child Caregivers

Ideas for enhancing the positives and easing the negatives of caring for aging parents as an only child.

Roz Chast, a cartoonist for The New Yorker, hated being an only child. "It was lonely," she says. "I was very isolated and awkward with other children. The things that kids with siblings learn from their siblings, I had to learn from other kids."

Illustration of only child pulling boat that her parents are sitting in
Illustration by Wesley Bedrosian

She had mixed feelings about being an only child later in her life when she had to care for her elderly parents, an experience she chronicled in the award-winning graphic memoir Can't We Talk About Something More Pleasant? (Bloomsbury, 2014). On the one hand, her relationship with her parents was "fraught and complicated," she says, and caring for them on her own was challenging. On the other hand, she didn't have to field questions from siblings or deal with rivalries or second-guessing about care choices. "There was no fighting over stupid stuff. In some ways it was easier," she says. "There's no one to argue with about how to do this or that: 'Mommy hates pineapple juice!' 'No, she doesn't! She loves it!'"

Although Suzie Thead wasn't lonely as an only child—her father had 10 brothers and sisters so she had plenty of cousins to play with—she did feel different. "I didn't know any other only children in my town," she says. And she always longed for siblings, a desire that became more acute when her father was diagnosed with lung cancer that had metastasized to his brain and she became involved in his care.

Thead, a 4-H program educator in Sevierville, TN, found her situation particularly difficult because her mother was unable to accept her husband's diagnosis and pretended nothing was wrong. In the days before her father died in 2006, Thead found herself stuck in the middle between her dad, who wanted to die at home, and her mom, who wanted him to remain in the hospital. In the end, Thead's father died in the hospital. A sibling, Thead often thought, might have supported her trying to bring her dad home.

She continues to long for a sibling's help as she cares for her mom, who is 84 and has Alzheimer's disease. "My husband and adult children help me, but the main responsibility falls on me," says Thead.

Suzanne Modigliani, a social worker in Brookline, MA, says being an only child prepared her to step up and make most of the decisions for her father when her mother, who had several chronic conditions, was in denial about his dementia. "As an only child, I was used to being efficient," she says. "I was comfortable making decisions about assisted living, nursing home placement, selling their house, and dealing with possessions."

While there is no published research on the prevalence of only-child caregivers, psychologist Susan Newman, PhD, author of The Case for the Only Child: Your Essential Guide (Health Communications, 2011), has interviewed many and noted the advantages and disadvantages. "In most cases, the only child has no choice because no one else is willing to take on such a major responsibility," says Dr. Newman, who is the mother of an only child, a demographic that is growing. According to a 2015 report by the Pew Research Center, the percentage of women who have only one child has doubled since 1976, while the percentage of those having three or more has decreased. As the population ages, only-child caregivers are becoming more common.

To help them, Dr. Newman and other experts offer some advice.

Find Others to Help

"Don't try to go it alone. Ask doctors and other caregivers for advice and resources," says Dr. Newman. "Many caregivers try to do everything themselves and get sick. No one can afford that, especially an only child."

Thead relies on her husband and adult children as well as friends, and she has hired an aide to tend to her mother's personal hygiene. "With this help, I can spend time reminiscing with Mom and being her daughter."

Chast not only had to care for her parents mostly by herself, she also had to travel between her home in Connecticut and their apartment in Brooklyn until they went into assisted living closer to where she lived. "My husband was supportive and helped me move them, but they weren't his parents, and my children were too young." While her parents were living in Brooklyn, their neighbors helped out, and when her mom later needed constant care in a nursing home, Chast hired a health aide. Friends offered to help, says Chast, but weren't always available when she needed them.

For people who don't live near their parents, Carol Bradley Bursack, author of Minding Our Elders: Caregivers Share Their Personal Stories (McCleery & Sons, 2005), recommends hiring a geriatric case manager, also known as an Aging Life Care Professional, who can coordinate local services and support. "They can hire home-health aides, arrange Meals on Wheels, and organize transportation," says Bursack. "Meals on Wheels is particularly helpful because the person delivering the meals can check in on the parent and alert the case manager or child of any problems."

If cost is a concern, Bursack suggests Senior Corps, a national network of volunteers ages 55 and older who can care for the elderly.

Step Away Periodically

The stress of caregiving may be more pronounced for only-child caregivers, who can't bounce ideas off siblings or rely on them for a break, says Angela Gentile, a clinical social worker in Winnipeg, Canada, who specializes in aging issues and often works with only-child caregivers. She recommends finding ways to reenergize, such as exercising, meditating, or planning a vacation. Consider joining a support group or seeing a therapist or psychiatrist, especially if the stress starts to affect your mental or physical heath.

If you need a longer break, consider respite care, says Amy Goyer, a caregiving expert with AARP. Some faith-based organizations offer low-cost or volunteer respite care, she says. Or you can hire a professional directly or through a home-health agency. You can also take your parents to a local adult day care center, where there are activities and services.

Get Organized

Make sure to talk with your parents about their finances and end-of-life decisions such as resuscitation directives and a living will.

An elder-law attorney can help sort through legal issues that are certain to arise, says Chast. This type of lawyer can help set up power of attorney and other paperwork, so affairs are in order when parents face critical health challenges.

"Keep a little notebook where you have important information jotted down," Chast advises. "It should have things you will be asked again and again, such as your parents' social security numbers and what medications they're on and how much." Chast's notebook also included phone numbers for doctors, neighbors, social services, caregivers, and Meals on Wheels, among others.

Thead uses a book to keep track of her mother's doctor's appointments and stores important paperwork like her mother's living will, health care proxy, and power of attorney in a folder.

Inquire About Time Off

Juggling the demands of caregiving while working is challenging, says Jane Wolf Frances, an only child and psychotherapist in Los Angeles whose parents both developed dementia. For three years, she had to take time off from her practice for trips to New York City, where her parents lived.

Some people use a combination of vacation, sick time, and even unpaid personal leave, says Goyer, who is a former long-distance caregiver herself. Others ask their employers for more work flexibility. Or take advantage of the Family and Medical Leave Act, which requires employers (with some exemptions) to give unpaid time off for certain family reasons, including caring for sick parents. People who have been employed a full year and worked at least 1,250 hours in a prior 12-month period are eligible.

Resources for Caregivers