Ways to deal with the challenges of caring for an aging parent from abroad

I Feel So Guilty

by Phyllis Larkin, Psy.D
Geriatric and Family Psychologist

Many of those caring for a loved one from abroad feel guilty. Should we?

Let’s take a closer look at this powerful, and misunderstood, emotion in relation to our aging loved ones.

Guilt | Definition by Merriam-Webster
1: responsibility for having done something wrong and especially something against the law. He admitted his guilt.

2:  a feeling of shame or regret as a result of bad conduct. Other Words from guilt. guiltless \ -​ləs \ adjective.

According to Webster, one must have committed an offense. This results in guilt,  the appropriate reaction. Guilt generates feelings of regret for doing wrong. The guilt reaction calls us to change our behavior and make things right with those we have harmed.  

So what have we done wrong?

Most caregivers feel there is “always more” that they can or “should” be doing to make their loved ones lives nicer, easier or more pleasant. “Should” is the problem here. “Should” implies the expectation that you can do all the things others want, regardless of the impact on your life, health, finances or living conditions. Guilt often comes when we can’t meet an “expectation,” yet feel obligated to meet the expectation anyway. Guilt tells you that you “should” be able to meet the expectation even if the demands are unreasonable or unfeasible. But are you guilty? Or are you being harsh with yourself? Let's ask some basic questions about your expectations for yourself:

  • What can you do from abroad?  
  • What is reasonable?  
  • What is appropriate?  

I would encourage you to answer these questions as if you were judging a respected friend or family member.  

  • Would you expect anyone else to meet the obligation given the circumstances?
  • Are you being asked to sacrifice your financial security? Can you afford to contribute to your loved one’s expenses? If you can, how much?  
  • Are you capable of the tasks being requested? Driving to medical appointments is impossible. Reviewing household bills is possible if you are given access via websites or PDF files.  
  • Are resentment or anger preventing you from meeting responsibilities you are capable of? Then you may be feeling appropriate guilt that demands changes to your behavior.
  • Are you breaking laws? Then you are truly guilty and the feeling is congruent with your behavior.
  • Are you feeling irresponsible, even though you are meeting your commitments and doing the best you can? Then the feeling of guilt is unwarranted and needs to be examined. Replace the guilt with an appropriate feeling. You might feel sadness at your loved one's decline, anger that things haven’t gone as you would have liked or grief at the loss of connection due to living abroad.

Healthy guilt is warranted when we have acted immorally, unlawfully, or disrespectfully.

It calls us to change our behavior and results in self-improvement.

Unwarranted guilt is counterproductive. It generates feelings of worthlessness and remorse for responsibilities that are out of our control or our ability to meet them.  Unwarranted guilt does not improve anyone's lives. It just makes us feel bad about ourselves. We feel helpless to change our behavior and this prevents us from doing what we can for those we love.

This prayer can help us decide what we can do and what we can’t:

God, grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference.

— American theologian Reinhold Niebuhr (1892–1971)

Money Matters

by Phyllis Larkin, Psy.D
Geriatric and Family Psychologist

  • Mom says in a panic, “They turned off the electricity. I don’t know what happened?”
  • Unopened bills are piled on the counter.
  • There are unnecessary new windows and doors on dad’s house, and the replacements were financed through a second mortgage on the house.
  • Since the caregiver moved in, money is being taken out of the bank accounts.
  • Identity theft of mom’s credit.

Unfortunately, the senior population is at high risk for financial fraud and abuse. Isolation, cognitive decline, and physical impairment are exploited by criminals who target seniors. Having financial documents in order helps protect seniors and their families from fiduciary abuse. Below are links to helpful information regarding fraud.

Consumer advisories: Preventing fraud

Beware of scams targeting older adults during the holidays Read the blog
Work with your bank or credit union to protect older adults from financial exploitation Read the blog
How to avoid becoming a victim of an asset recovery scam Read the blog
Planning for diminished capacity and illness Read the blog

Planning is Key

Obtaining access to your loved ones’ bills, financial accounts and assets must be done before the onset of cognitive impairment to avoid costly and painful court proceedings. Procedures for Court Appointed Guardianship differs from state to state so be sure to get specific information about the state that your loved one lives in.

One of our support group members found this excellent guide that addresses the financial documents that you may need to help your loved one. The Consumer Financial Protection Bureau guides are tailored to the needs of people in four different fiduciary roles, and there is a helpful video discussing different situations. These documents should be created before hiring caregivers. All financial documents, bills, and personal identification should be removed from the home if outside caregivers are engaged. Unfortunately, seniors may need to be protected from unsavory family members and these documents help protect their financial security.

Power of attorney

Guides for those who have been named in a power of attorney to make decisions about money and property for someone else.

Court-appointed guardians

Guides for those who have been appointed by a court to be guardians of property or conservators, giving them the duty and the power to make financial decisions on someone’s behalf.


Guides for those who have been named as trustees under revocable living trusts.

Government fiduciaries

Guides for those who have been appointed by a government agency to manage another person's income benefits, such as Social Security or Veterans Affairs benefit checks.


Home for the Holidays!

by Phyllis Larkin, Psy.D
Geriatric and Family Psychologist

Scenes from a Rockwell painting rush to mind when we think about the holiday season: the family tableau, cookies baking, ”I’ll Be Home for Christmas” playing in the background…These idealized images, sounds and smells all give us a romanticized version of holidays full of bliss, joy, and harmony. In reality, “Home Alone” is closer to the truth for most families, who struggle to cope with a time of year that creates emotional, financial and travel expectations that are difficult, if not impossible, to meet. Now let’s throw in a parent who is in failing health or experiencing cognitive decline. No wonder some of us are filled with dread instead of hope at this time of year. Is it any wonder this is also the time of year when binge drinking increases, stress takes its toll on our bodies, and family discord spikes?

How to cope:

Prioritize your spending on things that will really create a sense of peace.

  1. Give the gift of time. Offer to take care of your aging loved one and give their primary caregiver a break. Taking mom or dad shopping for new clothes is a great way to show appreciation. Offer to do laundry, fill prescriptions, buy medication boxes and fill them (one month of meds is ideal), drive your loved one on errands, do the grocery shopping, make meals to freeze, install grab bars, put anti-slip mats under throw rugs to deter falls, find a handyman to help as things need to be done, etc….
  2. Don’t spend money you don’t have. The finances of living abroad can be staggering and adding airfare, presents, expensive food, hotels, dining out, and incidentals may be more than you or your family can manage.
  3. If you can afford it, offer to cover the co-pays for your loved one if they are living on a fixed income. This is a gift that will be remembered all year.

Tough talks:

  1. DO NOT have discussions about your loved one’s financial, physical, or cognitive status at family functions! This includes the kitchen or sidebar discussions. Your loved one will feel betrayed and so will the hostess. Keep it light! Save these talks for a private, dedicated time in a safe place.
  2. DO talk about your loved one’s needs and wants (see last month’s blog) in a calm and loving manner. This should take place after a meal, preferably at a time of day when they aren’t tired, and in a place THEY feel comfortable. Plant seeds. Don’t push or insist. “Mom, I live so far away and I need to know what you want. I want to be able to advocate for you if there was ever a time when you couldn’t advocate for yourself.” Then listen. Don’t judge. Don’t cajole. Don’t have an agenda. Ask: “Does Dr. Blank know what you want if you can’t speak for yourself?” More listening…
  3. Be honest about how hard these discussions are to have. “It makes me so sad that mom is having trouble remembering things. I don’t want her to get infirm and dependent, but she is. I can’t imagine how hard it is for you to see this every day.” “Becky, this is so hard on you. You handle all mom’s medical issues! How can I help out while I’m here? Would it help if I handle the insurance paperwork? I can do that from Amsterdam.” “John, can I go to Home Depot and buy the grab bars you want to install?”
  4. If you have siblings, you will want to discuss everyone's strengths, and how these can be used to help your loved one and the primary caregiver. “I can’t be on the ground in an emergency, but I can email, call and pay bills.” “John, you have been so good about helping keep mom’s house functioning. Do you need us to set up an account for these expenses?” “Becky, you have really shouldered the medical appointments and doctors' visits. Do you need help with mom’s insurance co-pays and banking?” “Becky, can I arrange my next visit around your vacation so you and Bill can get away?”
  5. NEVER keep secrets! Don’t band together against one member. Discussions should be open and honest. “John, I know your construction company is doing really well. Do you have the time to do all this stuff? Can we hire one of your workers to help out?” Sally has two kids in college and it’s expensive to hire outside help. Instead of asking for money, say, “Can you ask the kids to spend time with mom so Becky can have an afternoon off?” “Can Billy (Sally’s son) mow mom’s grass this summer? It would really save on yard expenses and she would love to see him when he’s home from school.” “Can Susan (Sally’s daughter) help mom with her marketing? The bags are getting heavy and they both love to shop.”
  6. Engage the next generation in help. This models intergenerational commitments and strengthens family ties. We all share the memory of mom bringing Billy a Coke while he’s mowing her lawn or Susan putting the groceries away while chatting with grandma. These moments last long after the expensive gifts are gone. Gifts of love and time are what we all want. These are the Rockwell moments!


This is a term given to those of us who live far away — we swoop in and then we leave. Often we can see things that those on the ground can’t. We then voice our concerns, tell people what to do or criticize how things are being done. Then we get on a plane and leave a wake of resentment behind. “My sister, who lives in Europe (eye roll) came in and told me how to manage my mother's care! Who does she think she is?” Criticism is never helpful and is never acted upon. Instead, follow this strategy:

  1. Open with a compliment. A real compliment. No sarcasm, no judgment. “Becky, you are doing a wonderful job with all mom’s medical appointments and insurance. Thank you.”
  2. Follow with a compassionate question. “How are you taking care of your arthritis when you’re so busy with mom? I’m concerned about your health. Taking care of mom is exhausting. How are you?” Listen — for a long time. No suggestions, no judgment.
  3. Offer practical help. “Can I order mom’s meds and have them delivered?” “Would it help if I called mom every day so you can have a break from the constant calls?” “Can I transfer money to mom’s account for the grab bars?”
  4. Be open to alternatives. “I need to keep track of the insurance. Could you arrange for her rides to the senior center online?” “Could you send $100/month for her co-pays instead?” “Can you set up a Skype account and show her how to use it?” “Can you set up her online banking and help her pay her bills?”
  5. Execute your commitment. It’s not help if it doesn’t get done. Instead, it leads to resentments and conflict. If you don’t execute the request, you are swooping.

Go bake those cookies, play some Bing Crosby and have a cup of tea with your loved one. Happy Holidays!

What Documents to Include in a “Medical Grab Bag”

by Phyllis Larkin, Psy.D
Geriatric and Family Psychologist

Last month we discussed ways to deal with a medical crisis from abroad. This month I will delve into the legal documents that should be established and/or reviewed to make caring from abroad easier on you and your loved one. This month we will focus on “Medical Grab Bag” documents. (Next month: financial documents.)

With an ill or aging loved one in your life, you will need a “Medical Grab Bag” that contains all the documents your loved one and their doctors will need to respond to medical needs and wishes for emergencies and end-of-life care. Each bag (or envelope) should have the completed documents. The Medical Grab Bags should be in the car, the home, and with loved ones when traveling.

Medical Grab Bag Documents:

  1. HIPAA Release forms for each doctor
  2. Medicare Card
  3. Supplemental Medicare Insurance Card
  4. Medication List with Provider and pharmacy contact information
  5. POLST
  6. DNR
  7. Durable Power of Attorney
  8. Living Will/Advanced Directive

You may feel overwhelmed at the list, however, your loved ones’ doctors are familiar with all these documents. We'll review a few of them here.

I suggest you let your loved one know you want to be their advocate in the case of accident, injury or illness, and that you need to know their wishes in order to advocate for them. By having this tough conversation, you can serve them as they have served you. (We have been discussing how to approach this topic in the Caring from Abroad Support Group. Come and join us!)

HIPAA Release Form (Medical information release)

The Health Insurance Portability and Accountability Act, also known as HIPAA, was created in 1996 by the U.S. Congress to protect the privacy of your health information. The act prohibits your health care providers from releasing your healthcare information unless you have provided them with a HIPAA release form. Unless you have provided a signed release form, health care providers are prohibited from discussing any aspect of your medical information with anyone who is not directly involved in your care. A HIPAA Release does not give you the authority to make medical decisions. You will need POLST, Medical Power of Attorney, or DNR.

A HIPAA Medical release form allows whomever on the release to talk to the physician. It’s wise to have a release form for each physician, insurance carrier, and financial obligations. The identified person will have full access to both medical and financial information so that they can speak and write to health care providers and billing personnel. This form does not give you power for medical decisions.

      • General practitioner or gerontologist
      • Any specialists involved in your loved one's care
      • Insurance companies
      • Hospitals/institutions/medical centers
      • Assisted living
      • Pharmacy (local and mail order)

What is a POLST form?

POLST stands for Physician Orders for Life-Sustaining Treatment. It’s a one-page form, usually on bright pink paper, that specifies the end-of-life treatments that someone does or doesn’t want. Copies are valid.

Why a POLST?
If your loved one stops breathing or their heart stops beating, EMTs and hospitals must follow the instructions on a POLST because it’s a medical order signed by a doctor. It’s legally recognized in many, but not all, U.S. states.

A POLST is usually recommended for terminally ill or very frail seniors who have made their end-of-life wishes clear.

Where to post your POLST?
A POLST is only honored if people know it exists. Make sure doctors, hospitals, and assisted living communities have the form on file and/or post it prominently in your senior’s room. Print copies on neon colored paper for your Medical Grab Bag and for family members.

At home, it is wise to have multiple copies:

  • On the fridge and/or bedside table for EMTs 
  • Glove compartment Medical Grab Bag (Medicare cards, Medicare supplemental Cards, Physicians’ names and contact info, family contact info, Advance Directive, POLST, Living Will)
  • All family members who may interact with medical personnel or EMTs

What is a DNR?

DNR stands for Do Not Resuscitate, and it is also a signed medical order written by a doctor. It tells health care providers and emergency medical personnel not to do CPR on your loved one if they stop breathing or if their heart stops beating.

The DNR is only a decision about CPR (cardiopulmonary resuscitation). It does not affect any other treatments, such as pain medicine, other medicines, or nutrition.

For doctor’s orders about other end-of-life treatments, your loved one may want a POLST instead.

POLST vs. DNR: The most important difference
The primary difference between POLST and DNR is that a POLST covers a variety of end-of-life treatments. A DNR only gives instructions about CPR. (DNR=CPR)

With a POLST, seniors can specify:

  • If they do or don’t want CPR
  • What type of life-prolonging medical interventions they’d want on top of comfort care, if any
  • Under what circumstances they would want to be moved to a hospital
  • If they would want a feeding tube, and if so, for how long

With only a DNR, during an emergency, decisions about other interventions or treatments beyond CPR would be left to EMTs or hospitals.

Why do seniors need a POLST or a DNR?
Without a DNR or POLST, hospitals and EMTs are required to do their best to resuscitate someone who is not breathing or doesn’t have a heartbeat. They cannot stop these efforts without a signed medical order.

How to get a POLST or DNR
After talking with your loved one, discuss their end-of-life preferences with their doctor. The doctor should have access to the appropriate forms for your senior’s state and must sign the official form. They can also make sure the form is filled out accurately and completely so it won’t be rejected during an emergency.

It’s essential to use a form that’s legally recognized in your loved one’s state. No matter which forms are legally recognized, it’s important to discuss end-of-life preferences with their doctor. They can advise you on how to ensure those wishes will be carried out.

How a living will and POLST work together
To make sure your loved one's wishes will be honored in any situation, they should have both a living will and POLST. Keep them in your Medical Grab Bag so you can show them to doctors, hospital staff, and EMTs.

POLST vs. living will

POLST Living Will
Age requirement For any age For age 18 and older
Who can use it? Only those who are seriously ill or frail Anyone regardless of current health
How is it used? To direct immediate medical treatment To direct future decisions about medical treatments
Tells EMTs & hospitals what medical treatments can be used in an emergency YES NO
Guides patient treatment when staying in a facility or hospital YES YES
Appoints someone to make health care decisions on your behalf NO YES


Durable Power of Attorney for Healthcare
A medical power of attorney (also known as a health care power of attorney or durable power of attorney for health care) is a legal document that authorizes someone you trust (called an agent, attorney-in-fact, or surrogate) to make medical decisions on your behalf. The agent only has this authority if it is determined by your doctor that you are incapable of making such decisions, or you are unable to communicate your wishes, if you’re in a coma, for example. -Edward A. Haman, Esq., October 2015

Advanced Directive
An advanced directive expresses your wishes regarding medical treatment in very specific situations. It is more limited than a health care power of attorney. A living will does not appoint anyone to make decisions for you, and only applies if you are in a terminal condition, or in a permanent unconscious condition. A few states also permit a living will to be effective when “the burdens of treatment outweigh the expected benefits.” Therefore, if you are temporarily incapacitated but are expected to recover from an illness or injury, a living will does not come into play and does not allow someone to make treatment decisions for you. Only a medical power of attorney would help in this situation.

A living will and a medical power of attorney may be incorporated into a single document or can be separate documents. -Edward A. Haman, Esq., October 2015

How a living will or advanced directive works
A living will / advanced directive is a legal document that contains your loved one's end-of-life preferences. When decisions need to be made about future treatments, a living will guides the health care agent to make choices that honor their wishes.

Because a living will isn’t a medical order, it can’t tell EMTs and hospitals what to do. Even if resuscitation or other end-of-life choices are specified, they can’t be honored. Standard emergency medical protocols must be followed unless a doctor’s orders say otherwise.

Living wills are more useful in non-emergency situations like when someone is in a hospital or skilled nursing facility.

What’s the difference between a Durable Power of Attorney for Healthcare and an Advance Directive?

Here is a quick comparison between the Durable Power of Attorney for Health and the Advance Directive:

 Medical Power of Attorney Advanced Directive
Must be created by an Attorney Yes No
Allows you to clearly state your health care wishes No Yes
Requires Notarized Signatures Yes No
Considered a Legal Document Yes Yes


The Call

by Phyllis Larkin, Psy.D
Geriatric and Family Psychologist


You’re going about your life, and then the call or text comes: Mom or Dad is in the hospital and you have to make decisions quickly.

Here is some practical advice that will help you determine what to do and when to do it.

Don’t rush to the airport yet. Give yourself time to gather information and digest the information you receive. Don’t expect logical thinking from yourself or others until the full scope of the situation is known. If you rush in and start making decisions, other family members may feel “swooped-in-on” and resentful: “Sure, now you come home from your glamorous European life. I have been here dealing with the day-to-day grind…..”

Assess the situation. Get as much medical information as possible to find out what your loved one’s status is: physically, cognitively, and emotionally. Are they in ICU, CCU, post-op? If you are not physically present, medical professionals won’t be able to speak with you without your loved one’s permission, usually in writing. Physicians are very busy and may not be available in your time zone. Contacting the hospital social worker can be very helpful. The social worker can be an advocate for your loved one and help you get the information you need. After the initial crisis, you will need to know your loved one's ability to perform Activities of Daily Living (ADLs) after discharge. (Examples of ADLs are cooking, eating, meds, bathing, dressing, shopping, bill-paying etc.) This will help you determine what type of care your loved one will need after their hospital stay and how long you may need to be available.

Figure out where you fit in. Identify your area of expertise. Finances? Running the household? Hands-on caregiving? Care coordination? Consider the possibility that you may be of more help in sending money, coordinating care, or paying bills online, etc. If you decide to go home, it may be better to wait and help out after Mom is released from skilled nursing and needs someone at home with her. This will give you a chance to get time off, coordinate schedules and be more effective on the ground once you’re stateside.

Ask for help. Hire or call in favors for areas that you can’t fulfill. “I can pay the bills online. Can Sally talk to the doctors?” “I can call/Skype every day at 8 a.m. to make sure Mom is taking her meds and out of bed. Can you check on her weekly?” “Can Dad’s neighbor across the street stop by and pick up the mail? Can she let me know if Dad is lonely, in pain, or needs anything?"

Critical information. Keep all data on a thumb drive or a secure cloud account so that it is easily accessible from anywhere. An old smartphone without internet access can be a great place to store passwords and financial data. Critical information includes doctors' contact information, hospital contact information, Medicare and SSI information, financial and legal documents, POLST (Physicians Orders for Life-Sustaining Treatment), Advanced Directives, medical files, friends and family contact information, banking information, and monthly bills.

Once you have the information, talk with a trusted friend or family member and discuss your options. Be honest about what you can and can’t do.

A ticket for the next plane out may not be the best solution. A flight the next day or even the next week might be better.


What is my role now?

by Phyllis Larkin, Psy.D.

What is my role now?

Moving abroad creates internal and external stressors that can’t be understood by those we love in the States. And those we love in the U.S. have stressors we cannot understand because we aren’t there. This lack of shared experience causes incredible emotional upheaval in most families. Add an aging parent with health or financial problems and things can get explosive. Old family dynamics will likely resurface with a vengeance. Siblings can revert to their 8-year-old selves and parents are likely to become emotionally childish also. If it’s like everyone is reading lines from a play, they are! Every family has its own script, and every member plays a role. In healthy families, everyone plays all the roles depending on life's circumstances. We all are human, we all make mistakes, we all feel lost, we all have humor, we all get hurt, we all need support.

Knowing your roles and strengths can help you be of service without feeling overwhelmed. Here is a list of typical family roles I have adapted from Sharon Wegscheider-Cruse.

Identified Patient: An aging parent living in a constant state of chaos, they feel overwhelmed and unable to cope with problems and difficult feelings. As a result, they become overly dependent, may burn bridges through angry outbursts, lie about their health and/or finances, and manipulate those around them in an attempt to get the help they need. They may isolate themselves and can become secretive to prevent their children or spouse from knowing the truth of the situation. They may blame others (scapegoat/caregiver) for their problems. This creates negative effects for the entire family. Their role is changing from one of power to one of dependency. All other roles in the family are changing as a result of the aging parents’ declining health.

Hero (Savior/Messiah); The family hero is your typical “Type A” personality: a hard-working, overachieving perfectionist. Through achievements, the hero tries to bring the family together and create a sense of predictability. This role is usually taken on because the hero fears failing or being controlled by others. They seek to give hope and stability to the rest of the family by being the “Rock of Gibraltar.” Unfortunately, the driving need to “do everything right” tends to put an extreme amount of pressure on the hero, leaving them highly anxious and susceptible to stress-related illnesses. Other family members will often resent this person for having too much power and control over decisions and finances. Heros and scapegoats often trade roles within the family as the hero becomes exhausted and needs help. Heros need to be taken seriously, but this prevents them from being fun. If they can learn to say no and accept imperfection, they can accept the help they need, relax and have fun.

Caregiver/Victim/Enabler/Secret-Keeper: The goal of this role is to provide care and safety for the identified patient. While most often a spouse, this role can also be taken on by an adult child. In order to “protect” the family, enablers convince themselves that there isn’t a problem, or that they alone can take care of it. In order to diminish the seriousness of the situation, they make excuses for others behavior. Warm, loving, compassionate and fiercely loyal, they have lots of information about the reality of the identified patient’s situation. This person feels overwhelmed by the identified patients secrets, but can’t tell anyone for fear of betraying someone they love. This can result in appearing clueless, apologetic, avoidant, indecisive, or controlling. They are often blamed for the problems of the identified patient, and then react with anger and control to protect themselves and the identified patient. Caregivers, they often sacrifice their own health to care for others. They are loyal, responsible, and fearful for the wellbeing of those they love. They are great problem solvers if they can accept the reality of the situation and accept help from others without controlling the process. They can be counted on to follow through and need to maintain firm boundaries so they don’t get exploited or exploit others.

Lost Child/Loner/AWOL: Shy, withdrawn, and sometimes thought of as “invisible” to the rest of the family, the loner can feel unable to express feelings and is often lonely. They don’t seek attention from other family members, especially when a crisis is present within the family. A typical perception is “At least we don’t have to worry about Harry.” Lost children put off making decisions, have trouble with forming intimate relationships, and choose to spend time on solitary activities as a way to cope with feeling judged and unimportant. Good listeners (because they don’t share their opinion) and often creative, they can come up with unique solutions to family problems. They are often resented for not “showing up;” however, they are also not asked to show up and are often kept “out of the loop.” They can be excellent negotiators and can feel needed at times of crisis if they are asked. If they can learn to speak up and share their opinion they can be a good resource for caregivers.

Mascot/Clown: In trying to deflect the stress of the situation by supplying humor, they aren’t taken seriously. Fragile, vulnerable, and needing the approval of others, mascots are hiding deep pain and fears of inadequacy. Providing comic relief is a defense against feeling pain and fear that is overwhelming. Mascots often grow up to self-medicate with alcohol, drugs, food or work. Mascots can also be helpful in bringing lightness and humor to difficult situations. Hard working and responsible, they can also help the family express difficult emotions, and become leaders in times of stress.

Scapegoat/Black Sheep: Blamed for the family’s problems because they act out the hurt, rejection, and shame of the family, the scapegoat offers the family a sense of purpose by providing someone else to blame. “If only Jack would get his act together!” Their behavior expresses the family’s collective frustration, anger, and failure through impulsivity and risk-taking while shielding the identified patient from blame and resentment. If the family is focused on the black sheep, they aren’t focused on the identified patient or the caregiver. When scapegoats get older, males tend to act out, while females may run away or participate in troubled relationships. Scapegoats can become truth-tellers, identifying the obvious problems and helping the family come to grips with the new reality of the identified patient’s failing health. If the black sheep can help the identified patient in concrete ways and be recognized for their positive contribution, they can relieve some of the burdens on the caregiver. This role has the most power to change if they can learn to speak the truth without anger or manipulation. They can finally feel good by being good and taking appropriate risks. They can become good leaders and be helpful to the hero if allowed.

It very important to realize roles tend to be rigid; however, if one person changes their lines, the other players have to change their responses. Roles in healthy families are flexible and interchangeable. Changes are most likely during times of crisis and stress. Your power resides in your truth when it is expressed with grace and dignity and when listening to the reality of your loved ones. You may be far away, but that doesn’t mean you’re not a resource for those you love.



Caring from Abroad: Emotions

by Phyllis Larkin, Psy.D

Geriatric and Family Psychologist


This is the first in a series of articles about ways to deal with the challenges of caring for an aging parent from abroad.

Often it’s a call in the middle of the night. Sometimes it’s a long-anticipated decline. Mom or Dad can no longer function independently — financially, cognitively or physically — and you live five to nine time zones away. The question is always: What am I going to do now?  

Helplessness and anxiety, with a heaping side of guilt, are just a few of the common feelings around caring for aging parents. Here are some tips on how to deal with those emotions.

Your feelings are normal.

It’s normal to feel overwhelmed. Shock does that to us. It’s normal to feel sad, fearful, panicky and even resentful. Dread is a common reaction: “I can’t just leave my_______ (job, family, spouse, life).” Grief often follows medical events, and it’s normal to find yourself re-experiencing loss and sadness. When the third act arrives, it reminds us all of our mortality and triggers feelings of loss.

What causes your emotions: internal or external?

If you can identify what is causing your emotions, you can better control your reactions. Warning: there is no black and white when it comes to emotions.

Internal emotions are driven by history, experiences, and relationships, whether they were good or bad. “I don’t want to care for Dad; he left us when we were little. Why should I give up my life to care for him now?” “I love mom and feel so bad about not caring for her now. She was always the rock when we were growing up. She cared for all of us, and now I’m letting her down. I feel so guilty.” Examples of internal emotions are: love, respect, longing, regret, resentment, loyalty, or ambivalence (for example, to feel relief with a diagnosis, but overwhelmed with the fallout.)

External emotions are driven by stimulus: living abroad, ICU sounds, medical terminology and procedures, family members, travel complications, work schedules, spousal reactions, legal issues etc. “I just need to get out of the hospital (skilled nursing facility, house.) I can’t stand seeing Mom so helpless and dependent. My brother is AWOL. I just flew eight hours and I haven’t slept in 48 hours. This is costing me a fortune. My husband is asking for a schedule and I can’t give him one. I don’t have any way to access her bank account to pay the bills at the house. I just want to scream!”

Interactive emotions are the combination of both internal and external emotions. It can all get a little overwhelming.

Getting control.

This is a good time to determine what is within your control and what isn’t. You can’t change the situation, but you can change how you react to it.

We can change our internal emotional state by being compassionate with ourselves, not judging our emotions and accepting our human condition. We can avoid catastrophic thinking.

What’s in your control:

  • Your thoughts
  • Your reactions
  • Your time
  • Your attitude

What’s not in your control:

  • Your loved one’s health
  • Other people's reactions, including family members
  • Outcomes of medical decisions
  • Other people's decisions
  • History

What you can do:

  • Eat well: Hunger complicates thinking and feelings.
  • Rest. Sleep as often as you can.  
  • Stay informed about medical issues.
  • Exercise.
  • Meditate.
  • Keep in contact with friends that you can trust who won’t judge your reality.
  • Hire caregivers to help with the burden. (Respite care can be used to get a break from caregiving. It is used by family caregivers to take vacations, recharge patience, catch up with medical needs, etc.)
  • Ask for help and then accept it.
  • Join the AWCA Aging Parents Support Group.


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