Common challenges

Family conflicts during aging, caregiving, and end-of-life transitions are common. Research shows that disagreements among family members about care decisions, roles, and responsibilities are frequent and can significantly impact both the well-being of the older adult and the caregivers themselves (National Academies of Sciences, Engineering, and Medicine, 2016; Bangerter et al., 2020). Below are key sources of conflict and how structured facilitation can foster unity:

1. Differing Perceptions of Needs
   Family members often disagree on the severity of a loved one’s decline, appropriate care levels, or safety risks, especially in conditions like dementia where needs can be complex and change over time (Eggenberger et al., 2022). Structured processes help align perspectives by grounding discussions in objective assessments and shared goals.
2. Uneven Caregiving Responsibilities
   One sibling or family member often becomes the primary caregiver, leading to burnout and resentment over unequal contributions. This dynamic is well-documented and is associated with increased psychological strain and negative health effects for the primary caregiver (National Academies of Sciences, Engineering, and Medicine, 2016; Tang et al., 2025).
3. Unresolved Past Conflicts
   Old rivalries, parental favoritism, or financial disputes often resurface during crises, complicating decisions and increasing stress within the family system. Mediation and structured communication can address these tensions directly, fostering healing and collaboration (Bangerter et al., 2020).
4. Communication Breakdowns
   Miscommunication or avoidance of tough conversations—such as end-of-life wishes or advance care planning—can escalate misunderstandings and hinder effective decision-making. Structured sessions create safe spaces for open, respectful dialogue (Eggenberger et al., 2022).
5. Financial Strain
   Disputes over care costs, inheritance, or who should pay are common, especially without prior planning. Financial stress can have ethical and health implications for both the patient and family caregivers (McAndrew et al., 2022).
6. Value or Belief Clashes
   Generational, cultural, or ethical differences (for example, hospice versus aggressive treatment) can create rifts within families. Facilitated discussions help honor diverse viewpoints while focusing on the loved one’s wishes (Ornstein et al., 2020).
7. Decision-Making Power Struggles
   Conflicts over who holds legal authority (such as power of attorney) or whose voice matters most are frequent and can delay or derail important decisions (National Academies of Sciences, Engineering, and Medicine, 2016).
8. Caregiver Burnout and Stress
   Emotional exhaustion from caregiving duties amplifies frustration and conflict, especially when caregivers feel unsupported or overwhelmed (Tang et al., 2025; Lillo-Crespo et al., 2020).
9. Denial of Decline
   Some family members may dismiss cognitive changes or safety risks, delaying critical decisions and increasing the risk of crisis (Eggenberger et al., 2022).

Why Structured Facilitation Strengthens Families

Aging adults often wish for family unity, yet stress and unresolved dynamics can fracture relationships. Structured facilitation addresses this by:

• Creating Equality: Ensuring all voices are heard, reducing power imbalances.
• Building Consensus: Transforming conflict into collaboration through guided problem-solving.
• Honoring Autonomy: Centering the aging loved one’s preferences while balancing practical realities.
• Preventing Crises: Proactive planning reduces reactive, emotion-driven decisions during emergencies.

By navigating these challenges together, families not only make better decisions but also deepen trust and connection—fulfilling a common wish among aging parents to see their loved ones united.

References

Bangerter, L. R., Griffin, J. M., & Rose, J. H. (2020). Conflicts experienced by caregivers of older adults with the health care system. Journal of Patient Experience, 7(6), 1028–1036. https://doi.org/10.1177/2374373520925274

Eggenberger, E., Heimerl, K., & Bennett, M. I. (2022). Determining evidence for family caregiver communication strategies in dementia care. Journal of Communication in Healthcare, 15(4), 247–257. https://doi.org/10.1080/17538068.2022.2157459

Lillo-Crespo, M., Riquelme-Galindo, J., Macrae, R., & Riquelme-Galindo, J. (2020). Impact of the caregiver burden on the effectiveness of a home-based palliative care program. Palliative & Supportive Care, 18(3), 316–322. https://doi.org/10.1017/S1478951519000964

McAndrew, N. S., Leske, J. S., & Schroeter, K. (2022). Ethical and policy implications of financial burden in family caregiving. Journal of Hospice & Palliative Nursing, 24(3), 183–190. https://doi.org/10.1097/NJH.0000000000000832

National Academies of Sciences, Engineering, and Medicine. (2016). Families caring for an aging America. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK396398/

Ornstein, K. A., Kelley, A. S., Bollens-Lund, E., Wolff, J. L., & Szanton, S. L. (2020). Family caregiving at the end of life and hospice use: A national study. Journal of the American Geriatrics Society, 68(6), 1250–1256. https://doi.org/10.1111/jgs.16485

Tang, S. K., Lai, D. W. L., & Cheng, S. T. (2025). An ecological approach to caregiver burnout: Interplay of self-stigma, family resilience, and unmet needs. Frontiers in Psychology, 16, 1518136. https://doi.org/10.3389/fpsyg.2025.1518136