When a parent develops dementia, families often come together to provide care and support. Yet for many families, this period can also reopen long-standing sibling tensions. Old childhood rivalries, differences in personality, financial pressures, and unequal caregiving responsibilities can quickly turn caregiving into a source of conflict rather than cooperation.

Across the United States, the majority of long-term care for older adults is provided by unpaid family members. Studies estimate that most eldercare—more than 75 percent—is delivered informally by relatives or friends rather than professional caregivers. In many families, adult children must decide together how to care for a parent living with Alzheimer’s disease or another form of dementia. When siblings struggle to agree on decisions, stress levels increase for everyone involved—including the person living with dementia.

For families in New York City and across the neighboring boroughs, where multigenerational households and strong family ties are common, these conflicts can be particularly emotional. Understanding why sibling rivalry emerges, and how families can manage it, can help protect both relationships and the quality of care.

Why Sibling Conflict Happens During Dementia Care

Caring for a parent with dementia requires difficult decisions about medical treatment, living arrangements, finances, and long-term care planning. Siblings often approach these decisions with different beliefs and expectations.

Research shows that disagreements frequently arise over caregiving roles, communication styles, financial responsibilities, and perceptions of fairness. These tensions can be intensified when one sibling provides most of the daily care while others contribute less due to distance, work obligations, or personal circumstances.

Several factors commonly drive sibling rivalry during caregiving:

Unequal caregiving responsibilities. One adult child—often a daughter—frequently becomes the primary caregiver, which can lead to resentment if other siblings appear less involved.

Geographic distance. Siblings who live far away may struggle to participate in daily caregiving, leading to misunderstandings about the level of effort involved.

Financial disagreements. Decisions about paying for home care, medical treatments, or assisted living can create tension.

Parental favoritism. Long-standing perceptions that a parent favored one child over another can resurface during caregiving decisions and intensify sibling conflict.

Educational and financial ego. Differences in education, income, or professional status may lead some siblings to dominate decision-making while others feel dismissed or undervalued.

Old family dynamics. Childhood roles and unresolved conflicts often resurface during times of stress.

Emotional strain. Watching a parent decline cognitively brings grief, guilt, and anxiety, emotions that can spill over into family relationships.

Researchers studying sibling caregiving relationships have also found that gender roles, availability, and specific skills influence how caregiving tasks are divided among siblings. When expectations about fairness are not met, feelings of resentment or exclusion can develop.

Unfortunately, when sibling conflicts escalate, the person with dementia may suffer the most. Delayed decisions, poor communication, and family disputes can disrupt care and increase stress for the older adult.

A Strategic Action Plan for Families

Although sibling rivalry can feel overwhelming, families can take practical steps to work together more effectively.

1. Start the Conversation Early

Whenever possible, families should discuss caregiving plans before a crisis occurs. Early conversations allow siblings to clarify expectations, identify available resources, and plan for future care.

Parents themselves should participate in these discussions while they still have decision-making capacity.

2. Establish a Shared Goal

Every caregiving plan should begin with a clear shared mission: protecting the safety, dignity, and quality of life of the older adult.

Writing down these shared values can help guide difficult decisions and prevent conflicts from becoming personal.

3. Define Roles and Responsibilities

Caregiving works best when responsibilities are clearly defined. Families should identify who will manage specific tasks, such as:

• Medical appointments

• Financial management

• Medication oversight

• Daily care and supervision

• Communication with doctors and social workers

Dividing responsibilities according to each sibling’s strengths, availability, and proximity can reduce misunderstandings.

4. Recognize Different Forms of Contribution

Not every sibling can provide hands-on care. Some may contribute financially, coordinate services remotely, or handle legal and insurance matters. Recognizing these contributions helps reduce resentment.

5. Schedule Regular Family Meetings

Caregiving needs change as dementia progresses. Regular family meetings—either in person or via video—allow siblings to discuss new challenges, update care plans, and maintain open communication.

These meetings should focus on problem-solving rather than blame.

6. Use Professional Mediation if Needed

If family tensions escalate, neutral professionals such as social workers, geriatric care managers, or family mediators can help guide discussions and resolve conflicts.

Many Alzheimer’s support organizations offer counseling services for families experiencing caregiving disagreements.

7. Prioritize Caregiver Well-Being

Caregiving can lead to burnout, depression, and physical health problems. Family members should encourage one another to take breaks, access respite care, and seek emotional support when needed.

What Older Adults Can Do

Older adults themselves can reduce future family conflict by planning ahead. Important steps include:

• Creating advance directives and healthcare proxies
• Discussing financial plans with family members
• Naming a trusted decision-maker
• Communicating preferences for long-term care

When parents clearly express their wishes, siblings are less likely to argue about what the parent “would have wanted.”

Protecting Families and Communities

Dementia caregiving is not just a medical challenge—it is also a family and community issue. Harlem families often carry strong traditions of caregiving and intergenerational support, but even the strongest families can struggle under the weight of dementia.

By encouraging honest communication, fair caregiving arrangements, and early planning, families can transform potential rivalry into collaboration.

In the end, caregiving is not about winning old family battles. It is about honoring the parent who once cared for all of their children.

When siblings work together, they not only protect their parent’s well-being—they preserve the bonds that hold families together.

Sources

Family Caregiver Alliance. Caregiver Statistics: Demographics.

Kokorelias, K., et al. (2022). Brothers and sisters sharing in the care of a parent with dementia. Dementia.

Lillie, H. M. (2021). Parental Caregiving and Sibling Topic Avoidance. Purdue University.

St. John’s Living Dementia Resource Center. When Siblings Disagree on Care Decisions.

Ward-Griffin, C., et al. (2020). Daughters’ experiences of shared caregiving to a parent with dementia. Scandinavian Journal of Caring Sciences.