Q. I am a home care nurse supervising a 90-year-old woman who is housebound and needs help to manage her daily activities.
This lady has two daughters, but they are quite different. The older one keeps in frequent touch, visits often and provides whatever is needed, but she is also quite strict with her mother because she doesn’t want her to start hoarding again.
The younger daughter, however, hasn’t contacted her mother for years or told her what caused the riff. This estrangement makes her mother sob and beg to see her daughter before she dies.
The older daughter has made several attempts to let her sister know that their mother isn’t well, but they are also estranged and the younger one has even taken legal steps to make sure that her mother and sister never contact her again.
I haven’t told the mother that her daughter has blocked our attempts to reach her, and I don’t know how to comfort her. How can she find some peace?
A. An estrangement between a parent and her child is always a heartbreak, and it is even worse if the cause is unknown.
You shouldn’t tell the mother that her child refuses to hear from her, but you could say that her daughter has moved; that you don’t have her new address and that you will mail any letters that she writes to this daughter as soon as you find it. This response turns the truth into a little gray lie, but it might help her get through the day.
Then give her a pen and some paper and suggest that she write about the happy memories she shared with this daughter, like the cake she made for her 10th birthday; the pretty dress she bought for her to wear to the prom and the many hugs that she’s saving up to give her.
If the mother is too infirm to write — or her handwriting is too poor to read — then turn on a tape recorder so you can transcribe those memories, if only for posterity.
And when a letter isn’t enough to calm her down, then go through the family photographs and ask her to identify nameless pictures and to pick out the best pictures of her two children. You wouldn’t want the older one to think that she wasn’t worth as much as the estranged daughter.
Once you know the mother’s favorite pictures, you can put them in a book so she can look through it every day. You can also get a picture of the two girls made into a poster and then hang it on her bedroom wall. This will give her the chance to say “good morning” to her girls and to relive that glorious, hectic time when they were so young and so adorable. These are every mother’s halcyon days.
But makeshift measures won’t always keep her tears away, so you, or someone whose name isn’t blocked, should write this daughter to say that her mother is really ill and include a picture of her as she is today. If she isn’t too angry and too full of grudges, this letter might persuade her to write or Skype or even to visit her mother, especially if you tell her that she isn’t a hoarder anymore. This is an important fact to include, because hoarding might well have caused the breakup between them.
The mother might not have thought that her hoarding was a problem and her older daughter might have endured it fairly well, but it could have traumatized her little sister. Many people can’t bear to be around clutter or to be around someone who gathers objects — or animals — randomly and compulsively.
The research about hoarding is still scant, but psychologists now know that it affects 2 to 5 percent of the population; that it is often inherited; that it often follows a loss, such as a death, a divorce, a fire or an eviction; that it is usually connected to obsessive compulsive disorder, depression, anxiety or ADHD; and that half of the hoarders have a history of alcoholism.
They also know that treatment is neither quick nor easy, so you can be grateful that this mother is housebound and that her older daughter is so capable and runs such a tight ship.
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Read a transcript of a recent live Q&A hosted by Kelly at washingtonpost.com/advice , where you can also find past Family Almanac columns. Her next chat is scheduled for Aug. 16.