As parents grow older or if someone gets sick, families often must make decisions about residential aged care and end of life plans. These situations can flare up underlying family tensions that have been brewing for years. 

We talk to Violet Guide, Rose Dillon as well Violet Clinical Committee member and palliative care social worker, Jo Wood about common issues that arise as well as advice to help you manage tension – for the benefit of your loved one.

Why tensions often surface as end of life approaches:

Lack of communication

A common cause of tension, especially when someone is in the last stage of life, is a lack of open, honest communication, either within the family or between the family and the healthcare team, explains Jo. Uncertainty about a loved one’s illness often fuels anxiety, she explains.

Resurfacing of old conflicts

Jo adds that families have a “whole life and history that happened before their loved one became unwell, and often these issues surface when their parent is dying.” Estrangement between family members, for example, often causes conflict.

This was the case for Debbie, an Adelaide freelance writer whose mother died in September. As an only child, she got more involved when her mother became unwell in 2018, which reignited long-standing issues linked to her mother’s manipulative and combative personality style.

Lack of planning and different views about care

Tension can also result if there is no appointed Medical Treatment Decision Maker (MTDM), Jo explains. Patients with capacity can nominate a MTDM. “However, arguments may ensue if the patient has become confused or delirious,” Jo says.

Furthermore, family members may have different views about end-of-life care, Jo says, and “decisions are often made based on past promises and guilt.” She adds that COVID-19 has greatly influenced family member’s decisions about RAC.

Different coping styles

Jo notes that different grieving styles can also cause tension, mostly due to a lack of understanding about how different people cope with difficult situations. This issue arose for Rose whose five siblings had different expectations about their father’s illness. “Not everyone had the same acceptance that my father was actually dying, so it was hard to plan anything,” she says. 

Tips for working through tension in your family

Fortunately, these issues can be addressed. Here’s some tips to minimise tension and help you work harmoniously with each other. 

Keep your loved one’s best interests top of mind

Rose notes that moving a loved one into care or exploring end-of-life options involves much uncertainty and stress. Your loved one will likely notice tension in the family, she says, which will be very upsetting. “My strongest advice is to remember the most important person in the equation is the person going into RAC or facing the end of their life,” she says. “For their sake, put old wounds aside and try to avoid relationship breakdown.”

Work on positive communication

As Jo Wood points out, “Education, information, and supportive discussion will often ease the anxiety patients and family are feeling, even though the topics being discussed can sometimes be difficult and confronting.”

You don’t necessarily have to talk to communicate effectively, either. Rose instigated a group email with her siblings to ensure everyone received the same information. 

For Debbie, seeing her mother was easier when she took her husband. “Having somebody else there was like a buffer,” she explains. “Mum wanted to make a better impression and usually behaved better if there was another witness around.”

Organise a family meeting

Another way to facilitate good communication is to arrange a family meeting with your loved one’s healthcare team, Jo says. “They enable complex and supported discussions in a safe environment and can help to resolve miscommunications and misunderstandings. Most people report feeling more at ease after attending a family meeting because they are aware of what to expect moving forward. 

“It also enables the focus to shift towards spending quality time with their loved one. For example, sharing memories, photos, listening to music, creating legacy documents, and even just sitting in the garden together.”

Care for yourself

For Debbie, spending more time with her mother caused a raft of emotions and significant stress. She highlights the importance of looking after yourself for defusing tension. “You need to draw boundaries,” she says. “You can try to be as good a daughter as possible, but you also have to protect yourself.

“When I couldn’t deal with it any longer, I’d say, ‘I'm going now, see you later’ and walk out the door.”

Debbie’s self-care included yoga, nature walks and listening to podcasts. She also found it helpful to connect with people in similar circumstances on a Reddit forum. “It had a space to talk to people anonymously who won't judge,” she says. “They're not professionals, but they got where I was coming from and made me feel better.”

If you’d like to connect confidentially with someone who has supported a family member through the last stage of life, consider talking to a Violet Guide. Our Guides have supported callers through family conflict and offer a judgement-free space to talk about whatever's on your mind. Click here to learn more about arranging your free call with a Violet Guide.