Why Daughterhood?

I was trying to explain to a male colleague why I am naming my new website “daughterhood.org.” He’s both an expert on aging and shares responsibility with his sister for their mother’s care. So, I wanted his advice on creating a resource that helps families care for their parents.

But when he heard the name of the website, his first reaction was: “So this isn’t for me?” A couple of other men were confused too.

They seemed to think I was being impractical. Why would I go to the trouble and expense to build a business to help people manage their parents’ care and name the website in such an exclusive way – potentially losing a lot of subscribers who would benefit from the information and resources, not to mention a source of funding and revenue?

The Numbers

It’s a good question and it got me thinking about the differences between how men and women approach caring for their parents. The biggest difference starts with the numbers.

It’s an undisputed fact that, in caring for frail elderly parents, women are doing more unpaid work. Survey data analyzed by my colleagues, Rich Johnson and Josh Wiener, tell us that daughters account for about seven of every ten adult children who help their frail parents. And, five of every six assume primary responsibility for the day-to-day, in-the-trenches, labor-intensive duties that keep a parent dressed, fed, bathed and out of a nursing home bed.

But anecdotally, I know a lot of men who do heavy lifting too. They manage finances, haggle with doctors, hospitals and insurance companies. They research and make decisions about where, who and how paid care will be delivered. Some also do hands-on daily care.

And, while there may be fewer men providing and managing their parents’ care, they worry about their parents just as much as women. They are as deeply affected as women by the burden of responsibility and the experience of witnessing their parents’ loss of independence and dignity.

The Difference I Worry About

The relative contribution between men and women of money, time and stress are important – particularly the loss of earned income, career advancement and retirement savings that comes with the extra, unpaid work women do. But I also worry about how parental care aggravates a more subtle and insidious gender difference that plays out in all aspects of women’s lives.

This difference – the “not.good.enough.try.harder.please.everyone” – is expressed really well by Lisa Miller in the last paragraph of her essay posted in Nymag.com Dec 1. She says,

“Try harder. That’s the message that women hear all around. Try harder to be happy. Try harder to be skinny. Try harder to be a good employee, mother, wife, daughter, friend. Try harder to feed your family nutritious meals and to give your child every possible opportunity. Try harder to find “flow” at work. Try harder to succeed…… when there’s a whole lot of trying without commensurate succeeding, then you have to start to consider that the game is rigged.”

This is an important observation relative to our health and elder care systems because they are truly, truly rigged. As a family member caring for elderly parents, it’s almost impossible for you to feel good about the job you do. The complexities of the situation require professional skills. But, unfortunately, most of the professionals who get paid to assist in these areas; the doctors, hospitals, insurance companies, nursing homes, and assisted and independent living facilities … have an extremely NARROW view of their responsibilities.

What do I mean by “narrow?” I mean that our health care system, by and large, is great with technical problems but terrible at complex problems. And, frail elderly people have terribly complex lives. Their needs cross-cut basic tasks of living, medical care, and emotional and family issues. The professionals participating in the health and elder care systems are not trained to look across these domains.

So if your healthy, vigorous 70 year-old Dad needs a heart valve replaced, you are in luck. There’s a surgeon out there who is a great technician. However, if your confused 82-year-old mother ends up in the hospital because of stomach problems, she’ll get an endoscopy. NOT the nutrition counseling or meal preparation she needs at home to prevent her from eating spoiled food. Also, her physician will not attempt to understand the root cause of the confusion – is it her medications, are there too many? That will be up to you.

And, that leaves you performing professional duties without the requisite skills. If a boss gave you a job you weren’t qualified to perform without with any support and then told you your family’s well being depended on you succeeding, we’d say you were set up to fail to say the least. You’d certainly be set up for an ulcer.

A typical man responds — “this situation stinks.” A typical woman responds — “I failed.” What’s worse, the woman will perceive herself to have failed her parent. There should be a whole psychological therapeutic category for this.

It’s this toxic blend of self-reproach and dysfunctional elder care system that warrants a website dedicated to women. It’s called daughterhood.org because I want, first and foremost, to convince my girlfriends — women caregivers and managers — that they are up against a mighty wind, but that their efforts ARE good enough. That we can work together to do something about it and to create a sense of ease and control. If men want to be part of it, all the better – I definitely want them to be part of the conversation.


A Profile of Frail Older Americans and Their Caregivers, The Retirement Project, The Urban Institute, Occasional Paper Number 8, February 2006.