Question: Our mother (age76) and father (age 83) are failing, both physically and mentally. Although I live closest to our parents and see them regularly, my two brothers -- who live in other states -- and I can’t seem to agree on what is the best course of action to take. I believe that they need assisted living because they are leaving the stove on and not keeping clean, etc. My brothers want them to stay at home and think I should “be available” to handle things even though I am working. My husband believes that this is selfish because they don’t want our parents’ money spent so they can inherit it.

These conflicts are causing arguments and disruption in our family relationship while our parents continue to suffer. My brothers and I even met with a lawyer to try to come to an agreement. But after 30 minutes, the lawyer lost control of the meeting and asked all of us to leave. My parents are very wishy-washy and won’t sign a power of attorney or anything. Their neighbors are concerned about them and call me at least once a day when Dad gets out of the house and wanders through the neighborhood. I clean up on Sundays, but their home is a wreck by Tuesday. I am at my wit’s end and no one has any suggestions about how to break the logjam. Do you?

Answer: In working with elderly individuals and their families on a plan for long term care, it is important to understand that there are numerous unique concerns for the planner, some due to the intra-family dynamics like yours. To be effective, the issues should be assessed and addressed as early as possible in the planning process because all long term care planning is filled with conflicts.

The family must remember that providing the best care for the elderly person at the best price is the goal of the planning process. This unfortunately is not always clear and causes squabbles within the family which can be avoided if family members are educated and understand that someone must be in charge. Here, that duty has fallen to you based on the facts you give.

Assuming your parents are able to participate in the planning process, they should be allowed to do so. Some of these conflicts include whether to preserve assets for beneficiaries (such as disabled children or a community spouse) or to use all assets to fund long-term care. And, if they are capable, a determination needs to be made as to whether your are comfortable with giving up control of assets and, if so, to whom. If not, alternate planning ideas should be discussed.

Another area of conflict is "quality of care versus cost of care." Certainly, everyone wants the best care available for their family; however, as with any commodity, the more you get, the more it costs. Should your parents stay at home? Do they need residential care? Can a nurse and sitters come into the house to help? Can you continue to assist with their care? Do they need a nursing home?

Ideally, your parents and the children should determine what care can be afforded and still meet other financial needs based on their unique circumstances. But your situation does not allow for this type of negotiation.

Ideally, your parents and your siblings would be able to face the question of their needs versus their desires. Almost no one wants to moved from their home, but some people need to be in a facility. The perception of the elderly person's health and the ability of the family to care for him or her may be very different from the true facts.

Taking the NextStep: It would appear to us that your first order of business is to hire a lawyer with sufficient background in this area to take the bull by the horns and assure that an appropriate plan is implemented that is in your parents’ best interests. In our view, given the stances of you and your brothers, the first lawyer meeting was doomed from the start and should not have taken place. If necessary, and it may well be, guardianship and conservatorship actions could be in the offing. Your parents should be evaluated by a geriatric care manager, and you should hire a lawyer to attempt to resolve the issues with no more input from your siblings.