The aging dysfunctional family takes an expert to tackle because violence can break out at any time. In the film version of Tracy Letts August in Osage County. Julia Roberts (the eldest daughter) attacks Meryl Streep (the pill-popping aging mother) at a ritual family gathering- the elder Dad’s funeral after he commits suicide.
In the dysfunctional family, there have been symptoms of problems such as alcohol abuse, drug abuse, child abuse, or emotional abuse, like the demeaning mother the character Meryl Streep plays in August in Osage County. These dysfunctions usually create barriers to nurturing and this affects everyone in the family system.
The family system is also marked by ambivalence and all adults and children live in a love-hate relationship with other family members. (Julia Roberts character and all the daughter both love and revile their mother ).
As systems resist change, it is even more difficult for members of the dysfunctional family to move to make changes when their parent needs care, like Meryl Streep does in August in Osage County. Julia Roberts and none of the daughters will care for their despised mother.
The nearly normal system is shaken to its core by the parent being dependent. However, a care manager can guide the family members into reorganizing their family roles when the parent can no longer act as head of the family, while acknowledging the shift and changes they need to make both emotionally and practically.
The members of the dysfunctional family who may have experienced a lack of nurturing by their parent and have no role model of caring. They are angry and resentful at caring 
for the parent, and thus will find it difficult to provide the practical and emotional care that their aging parent needs. The challenge to the adult child of the dysfunctional family is how to meet the dependency needs of the here and now old-old parent when the parent did not meet them dependency needs as a child. That is why they need a highly experienced Geriatric Care Manager who can work with dysfunctional aging families.
The challenge to the care manager is to bring the adult child of the dysfunctional family into the here and now and see their parents for who they are- an aging dependent person, flawed and imperfect, but a human being who needs their love, support and nurturing.
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