A 2020 AARP survey found that among Americans with siblings who share caregiving duties for a parent, 40% said the work was not divided fairly. In most of those cases, one adult child handled the bulk of medical coordination, finances and daily logistics while another stayed vocal from a distance. For the sibling doing the heavy lifting, the question is not always whether to ask for help. Sometimes it is whether to tell the other sibling anything at all.
Family therapists say that impulse is more common than most people realize, and it is not born from spite. It grows out of years of pattern recognition: one sibling escalates, the other absorbs the fallout. When a parent’s health declines, those roles do not disappear. They intensify.
Why one sibling shows up and the other performs
Research published in The Gerontologist has consistently shown that caregiving among adult siblings is rarely equal. A 2014 study found that the sibling who lives closest, who has fewer competing demands, or who has the strongest emotional bond with the parent typically becomes the primary caregiver, often without a formal conversation about the arrangement. The other siblings may contribute opinions, money or occasional visits, but the daily weight falls on one person.
That imbalance becomes volatile when the less-involved sibling is also the one who dominates the family narrative. Dr. Joshua Coleman, a psychologist and senior fellow with the Council on Contemporary Families, has written extensively about how favoritism and sibling rivalry persist into adulthood. In his book Rules of Estrangement, Coleman describes families where one child was historically protected or excused while the other was held to a stricter standard. When caregiving enters the picture, the “responsible” child may feel they have no safe way to involve the favored sibling without inviting chaos.
Clinical psychologist Dr. Ramani Durvasula, whose work on narcissistic family dynamics has reached millions through her YouTube channel and books, describes a recognizable pattern: the high-conflict sibling treats a parent’s illness as a stage. They broadcast updates on social media, rally sympathy from extended family and position themselves as the devoted child, all while doing little of the actual work. For the sibling managing pill schedules and insurance calls, watching that performance can feel like a second full-time job they did not sign up for.
Old wounds reopen at the hospital bed
Caregiving does not create sibling conflict. It excavates it. A 2015 study in the Journal of Family Issues found that adult siblings who reported unresolved childhood grievances, particularly around favoritism, experienced significantly more conflict when a parent needed care. The researchers noted that perceived inequity in the parent-child relationship during childhood was a stronger predictor of caregiving disputes than the actual division of labor.
That finding helps explain why some caregiving siblings go quiet rather than collaborative. If your childhood taught you that speaking up meant being dismissed, overruled or punished, you may carry that lesson straight into your father’s hospital room. The instinct is not to hide. It is to protect the work from being derailed by someone whose involvement historically made things worse.
Therapist and author Nedra Glover Tawwab, whose book Set Boundaries, Find Peace became a bestseller in 2021, has described this dynamic in interviews: the caregiver sibling is not just managing a parent’s decline. They are also managing their own trauma response. Tawwab stresses that boundaries in these situations are not acts of cruelty. They are acts of clarity about what you can and cannot control.
The cost of constant crisis
The toll on the primary caregiver is well documented. The Family Caregiver Alliance reports that family caregivers experience higher rates of depression, anxiety and physical illness than non-caregivers. When sibling conflict is layered on top of those stressors, the risk of burnout climbs sharply.
Dr. Karl Pillemer, a gerontologist at Cornell University and author of Fault Lines: Fractured Families and How to Mend Them, has studied sibling estrangement for decades. His research, based on interviews with more than 1,300 people, found that roughly one in three Americans are currently estranged from a sibling or have been at some point. Pillemer notes that caregiving is one of the most common triggers, not because siblings disagree about what Dad needs, but because the crisis strips away the polite distance that kept the relationship functional.
For the sibling who decides to keep a visit secret, the calculation is blunt: telling my sister I am here will not improve Dad’s care. It will create a second emergency I do not have the bandwidth to manage. That reasoning may look cold from the outside, but clinicians who work with family caregivers say it often reflects hard-won self-knowledge, not malice.
When secrecy becomes a boundary, and when it becomes a problem
There is a meaningful difference between privacy and deception, and family therapists urge caregivers to be honest with themselves about which one they are practicing. Tawwab has written that a boundary protects your well-being without requiring you to control someone else’s behavior. Secrecy, by contrast, can become its own form of control, especially if it affects decisions the other sibling has a legitimate stake in, such as medical directives, financial arrangements or end-of-life planning.
Legal considerations matter here too. If a parent lacks capacity and no durable power of attorney is in place, one sibling making unilateral decisions, even well-intentioned ones, can create serious legal exposure. Elder law attorneys recommend that siblings document caregiving roles and responsibilities early, ideally before a health crisis forces the conversation. The California Department of Aging and similar state agencies offer mediation services specifically designed for families in caregiving disputes.
The quiet daughter in this scenario may be right that her sister’s involvement would do more harm than good in the short term. But therapists caution against letting short-term relief harden into a permanent pattern. At some point, the father’s wishes, his legal rights and the reality that he has two children all have to be reckoned with, even if that reckoning is painful.
What actually helps
Pillemer’s research points to a few strategies that reduce sibling conflict during caregiving:
- Define roles early. Even a brief, written agreement about who handles what can prevent the resentment that builds when one sibling feels invisible.
- Use a neutral third party. A family mediator, social worker or geriatric care manager can facilitate conversations that siblings cannot have productively on their own.
- Separate the caregiving from the childhood. Easier said than done, but Pillemer emphasizes that the goal is not to resolve decades of hurt. It is to get through the current crisis without making it worse.
- Protect your own health. The Al-Anon Family Groups and the National Alliance on Mental Illness (NAMI) both offer support groups for family members dealing with a loved one’s addiction or mental health challenges, which often overlap with caregiving strain.
None of these steps require a sibling to forgive behavior that was genuinely harmful. They do require acknowledging that secrecy, while sometimes necessary in the moment, is not a long-term caregiving plan.
If you are managing a parent’s care and struggling with sibling conflict, the Family Caregiver Alliance’s support line (800-445-8106) connects callers with local resources at no cost. Updated March 2026.
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