It’s Complicated: Caregiving in Blended Families


It-is-complicated-caregiving-in-blended-familiesby Elissa Lewin~
The tearful voice on the phone asked, “Can I come in and talk to you?” Mary (not her real name) had recently lost her husband. When she came in, it was evident the story was more complicated than just her husband’s death.

Blending families raises issues in all areas of family life. It becomes even more complicated when issues of aging, illness and caregiving are involved.

A recent study in the October issue of The Journal of Marriage and Family by Carey Wexler Sherman, PhD, of University of Michigan, called “Dementia Caregiving in the Context of Late-Life Remarriage: Support Networks, Relationship Quality, and Well-being” identifies positive support networks (providing hands-on care, allowing the caregiver to step out, or being willing to just listen), negative support networks (questioning decisions, meddling, unsolicited advice), and their impacts.

The 61 women interviewed were step-mothers; step-children were adults when the marriage took place. By definition, these are not step-children raised by the step-mother. All 61 women were caring for husbands with dementia. Dementia caregivers experience the most stress among all family caregivers.

Older adults often use their spouse as their main support. What happens when that spouse is ill and now the source of stress, and the adult step-children may not be close? Sherman found step-children made up a full third of the negative support group. Adult step-children were the largest single group identified. Although they could also be positive support, they were the most likely group to not come through with expected or offered support.

There are many possible reasons. The step-mother entered their lives after they were grown; therefore, there may not be the sense of reciprocity children often feel toward the parent who raised them. There may be residual anger or hurt from the original marriage families. Although these feelings can be overcome (Doing the Right Thing by Roberta Satow, PhD is useful reading on this), they also can have a negative impact on caring for or about an aging parent.

Adult step-children may have their own feelings and agendas that are not related to the caregiving situation, but are not helpful for it. The step-parent may not have the relationship necessary to ask for support. There may be conflicting emotional needs when difficult decisions have to be made.

What about Mary? She was married 30 years to a man who had a brief first marriage and a daughter by that marriage. He was the love of her life. They were shocked when he was suddenly diagnosed in the terminal stage of cancer.  Mary and her husband had advanced directives. He did not want chemo or any heroic measures. Yet, when it was evident that he was failing, his daughter wanted to do everything to try to save her father.

Mary was torn. She had the legal right to make treatment decisions. Should she honor her husband’s wishes or the daughter’s request?Despite their long marriage, her step-daughter was always her “husband’s daughter.” The daughter’s mother made sure it stayed that way. The role of step-mother in this family was always second place.

Mary decided to allow one chemo treatment at her step-daughter’s request. She felt this gave her the best chance at maintaining a positive relationship with her step-daughter.

The treatment triggered a cascade of negative events. At the funeral, Mary stood next to the casket. Her step-daughter stood beside her briefly. Further down the line stood the daughter’s mother, inserting herself further into the blended relationships, and the daughter eventually went to stand with her.

Mary felt guilt for any additional suffering her husband experienced and desperation to maintain whatever relationship she could with her step-daughter, all on top of the grief and fear she experienced as a caregiver and widow.

Blended families can complicate what is an already difficult situation. Torn loyalties, misplaced feelings of entitlement, and old hurts all come out in times of stress. Adult children, busy with their lives, may choose to believe that the step-parent is handling everything. What can caregivers do?

Several steps may help, but they require families to talk before there is a crisis.

  • Discuss long-term care and final directives. Families may be able to do this independently. Otherwise, use a family therapist or family mediator. Everyone needs to know the plan.
  • Estate planning helps. An estate attorney or elder law attorney is a good resource.
  • Find that network of positive support – among friends, in a support group, in a community or faith-based setting.
  • Identify that safe place to vent and get useful feedback.
  • Utilize available resources. Caregiving websites, like this one, and on-line communication sites like and keep people in the loop and let step-children know you cannot do it alone.

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About Elissa Lewin

Elissa Lewin is a Licensed Psychologist and a Licensed Marriage and Family Therapist. She has maintained a private practice outside of Philadelphia for 25 years. Her own experience as a caregiver led to her founding Nancy’s House, a comprehensive respite program for family caregivers. www.nancy'

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