Three times a month, Laurie Efron makes the two-plus-hour drive from Golden Valley to Winnebago, Minn., to see her dad in a nursing home and mom in an adjoining assisted-living facility. For the better part of two decades, Efron has used almost all her vacation time to help her parents.

Her brother, Bill Brush, and sister, Nancy Owen, live in Winnebago and are able to pitch in more. The three of them talk frequently about issues surrounding their parents. "And yes, we have fights," Efron said. "We disagree on a lot of things." As for how often she feels guilty about not doing enough? "Always!" she said.

Efron, 50, is caught up in what might be contemporary America's foremost midlife crisis: dealing with aging, ailing parents and their inherent physical, emotional and logistical difficulties. According to the Alzheimer's Association, 43.5 million Americans care for someone 50 or older and 14.9 million care for someone who has Alzheimer's disease or other dementia.

Who ends up taking care of Mom or Dad or both can depend on many factors, especially since boomers often are geographically removed from their elders. Not so long ago, multigeneration families tended to stay in the same area, perhaps the same house.

These days, said Janeen Massaros, mediator at Midwest Senior Solutions in Bloomington, the primary-caregiver role usually "is either based on proximity or perhaps on which sibling is doing the least well. Often the person taking care of Dad or Mom is the one who can't get independent."

In any event, Massaros added, there can be a lot of resentment among siblings, not to mention Monday morning quarterbacking. "They're fine to let somebody take on a role," Massaros said, "but then when a decision gets made, they're right there going, 'I don't know why you did X, Y and Z.'"

The sniping doesn't end there. "For a long time my brother accused me of not pulling my weight," Efron said. "I had to remind him that I have a full-time job and don't live there. He doesn't work and lives there."

When a parent becomes ill, mentally or physically, or just becomes dependent on help, family members face daunting decisions that might include medical care, finances, power of attorney and myriad logistical challenges.

Experts say communication among the siblings, early and often, is crucial. Talk about decisions before they're made and keep in mind it's all about the parents' well being.

All parties need to be pro-active rather than reactive, said Sue Diekmann, clinical director for Ecumen at Home, a company designed to help seniors live at home. "People have a good idea what they want to do, they just don't plan," she said. "It's important to have health care and power of attorney in place. Figure out what your options are early on. ... Instead, people end up in crisis mode before they look for help."

Too, too much

Jim and Bob Tift have averted crises, even though their 87-year-old mother had to move from assisted living to an independent facility in Minnetonka after her long-term health insurance ran out.

"We do grocery shopping and things like that, but she's maintaining her independence," Jim Tift said. "My sister is out in Arizona and she's actually a geriatric care worker. One of our issues is that when she has [physical problems], Mom calls her first. She has to tell Mom to either call 911 or one of us here."

Tift should know how to navigate this minefield, since his day job is as community services coordinator at ElderCare Rights Alliance. That organization serves elders and their caregivers, who often suffer from stress and lack of attention to their own physical problems.

"We often hear it said that 30 to 40 percent of caregivers die before the person they're caring for," Tift said. "The most common thing is they try to do too much and they get really stressed out. And they're not aware of the resources where they can help [see box]."

A recurring problem for primary caregivers is that "they don't realize the amount of time they're committing to," said Diekmann. "I often see the children take on responsibility that starts out to be small and tends to grow.

"I had a lady last week say she didn't realize the responsibility, and she's actually getting burned out because the parents won't let someone else come in and take care of them."

Does father know best?

Even when siblings manage to sort out responsibility-sharing amicably, problems can arise because of their parents' desire for independence. Carole Sayer of Excelsior said "everything has been really great" with her siblings in taking care of their father, who suffers from dementia.

"I am proud to say that we have not had that issue [others second-guessing, butting in]," she said. "It hasn't been difficult, but it has been frustrating because he insists on staying in his own home. We're trying to honor that even though we all believe he'd be a lot better off in a more social setting.

"But the one thing we're not on the same page about is his driving. He insists on it, and some of us think it's a bad idea."

Efron's father also weighs in on some matters from his Winnebago nursing home.

"We would have a big problem, and I'd say, 'Dad can make that decision.' Like there was a dispute with a neighbor and my brother wanted to take it to another level. We let Dad make that decision.

"As long as Dad can make the decisions, he's still in charge," she said, adding with a soft chuckle, "That's the one thing that has kept us from killing each other."

Bill Ward • 612-673-7643