ElderCare Online
Using Family Meetings to Resolve Eldercare Issues

By Mary Waggoner
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A crisis can bring a family closer together and illustrate strength and love; or it can drive a wedge of resentment between members. Whenever a loved one’s heath, safety or wellbeing becomes a concern, it is important to be proactive and address your loved one’s issues. If the issues come to a point of crisis, families – often spread out across several states – need to call themselves together to discuss the changes which are occurring and will occur in the future.

Stephen Covey, author of The 7 Habits Of Highly Effective People, states: "Most families are managed on the basis of crisis, moods, quick fixes, and instant gratification – not on sound principles. Symptoms surface whenever stress and pressure mount: people become cynical, critical, or silent or they start yelling and overreacting." If this is how you perceive a family meeting may progress, it is important to understand that it doesn’t have to. You can have family meetings that are under control and structured. Understand that you will never be able to please everyone all of the time, but that you are not meeting to meet your individual needs but those of your aging loved one.

Your first two family meetings should be small – only siblings or close family members who are in direct contact with your aging loved one. You definitely don't want it to have alcohol rehab or substance abuse clinic feel to it or for it to feel textbook like an online MBA healthcare class. Regardless of how you feel about your extended family members, it is imperative that everyone be involved in the meetings. If meeting all together in person is not possible due to separation by miles, arrange for a conference call through three-way or conference calling. This service is available through your local phone company for a nominal monthly fee. Whether you choose to have an informal meeting or a structured meeting depends on your family style and how your family best works together.

The first meeting should take place without your loved one present, as topics may be discussed which could cause him/her to become upset. During the meeting, you need to take a hard look at the situation at hand. It is best if you all have prepared three or four concerns (and even possible solutions) to discuss beforehand. Together, you will need to begin planning for the future and, if needed, take responsibility for specific duties. You will not need a masters in computer science to delegate duties, or perform tasks. The goal of the first meeting is to create a plan of action to work together as a team, or if nothing else, call a temporary truce to a family feud.

Don’t be discouraged if your first meeting doesn’t run smoothly. Everyone involved views the situation from a different perspective. Human nature is rather egocentric, so do not be alarmed if most are concerned with how the changes will effect them. It is easier to be defensive than admit fear.

If you will be discussing a topic that is going to be heated, it is best to hold that subject until another meeting where a neutral moderator can be present. The moderator should not be related to the family. It could be a family friend, a member of the clergy, a social worker or geriatric care manager, for example. For topics that will cause irrational responses, it is best to have all parties prepare, in private, why they feel so strongly. Many times, putting something in writing can make the "it" feel less abstract and frightening. You may find you all have a similar fear and are simply reacting in different ways.

You may ask your loved one’s legal or religious advisor(s) the be present at a family meeting of the serve as facilitator or moderator. Geriatric care managers are usually skilled facilitators or social workers who can lend experience and balance to difficult family dynamics. Consult the National Association of Professional Geriatric Care Managers at http://www.caremanager.org for a directory of local care managers. It may be a good idea for the family members to chip in for the care manager’s fees, rather than one member managing the relationship to avoid perceptions of "bringing in hired guns."

Planning a Meeting

We don’t always have the luxury of meticulously planning family meetings due to sudden illness, medical emergencies or family squabbles. But we can maximize scarce time by sticking to a few rules of thumb.

  • Establish a "goal" for every meeting that is agreed upon ahead of time by all (or almost all) participants;
  • Plan to move incrementally, rather than address ALL issues in one marathon session;
  • Select a comfortable and "neutral" location;
  • Most meetings function smoothest with no more than seven participants;
  • Invite close relatives only;
  • Collect and share background information. For example, bring fact sheets on Alzheimer’s Disease if your loved one is recently diagnosed, or legal documents if the topic relates to estate planning;
  • Prepare – and stick to – a short agenda that includes adequate time for each member to participate;
  • Allow the agenda to be slightly adjusted only at the beginning of the meeting;
  • E-mail or snail mail all materials to all participants ahead of time. Bring helpful brochures to show give people additional information if you can.

Conducting the Meeting

All participants must remember that they are in a meeting. Every meeting should have rules and guidelines. Unfortunately, when it comes to family meetings, many do not recall this fact. In the beginning of each meeting, gently remind all parties to have respect for one another and follow some rules that you have all agreed upon. If your family works smoothly and in unison, then focus on exploring your loved ones concerns rather than your own. Here are some rules that you may want to include:

  • No one is allowed to dominate the meeting. If you need to, use a timer and give each family member 10 minutes to state concerns and points of view;
  • Create a list of all concerns and then as a group number them 1 through 5. 1 being the most urgent, 5 being the least urgent. Tackle each one in the order of urgency, not in the order of preference;
  • When someone is talking, other must not interrupt. You wouldn’t interrupt another co-worker in a board meeting. Give your family members the same respect. If you have a comment, write it down and discuss it either at the end of their turn, or the beginning of yours;
  • The facilitator or leader should be fair, but firm, to ensure that the meeting follows the agenda and doesn’t take too much time;
  • Use only "I" statements. Avoid finger-pointing accusations that begin with "You..." This one is difficult to master;
  • Remember that your loved one still has the right and responsibility to make his/her own decisions (unless incompetence or dementia is the issue);
  • Stick to the topic. It is easy to get off topic and revisit old family arguments. Keep the topic of the meeting posted where all can see it, whether on a central board or on the top of everyone’s note sheet. This is also difficult to master, but possible;
  • Reach a sense of closure on each item of the agenda, or at least set an action item or next step. You may need to address issues that arise during the meeting and put them in a "Parking Lot" to be addressed at a later time;
  • Agree on what to discuss at the next meeting and schedule a time and date before concluding to avoid confusion.

Following Up on Meetings

After your first one or two meetings, your family will have found a style that works best for those involved. It is now time to begin discussing possible solutions. Include your loved one in the meetings if they are able to comprehend what is happening. Make sure to listen to your loved one first. Allow your loved one the time s/he needs to express their concerns, wants, and desires. Do not degrade their concerns. Although their priorities may be different than yours, unless doing as they wish will put them in physical harm, do your best to accommodate their wishes.

For example, the family might feel that it is best for Mom or Dad to move into a residential facility because there they will have meals provided, laundry done, and opportunities for socialization. Mom or Dad may wish to stay in their home for now because that is where they feel safe. Hiring in home care assistance for a few months may be the compromise for both sides. Your loved one has usually lost much control over their own life and even their body by the time you are holding a family meeting. Be gentle with them. It is upsetting for them to watch their world slip away and not have a say in what is happening, or to see discord in their family.

Roles and Responsibilities

Once solutions and duties have been agreed upon, you should discuss the possibility of having a family spokesperson. This is especially helpful for those families who are located in different areas of the country or world. It is less complicated when there is a single point of contact for information. Having a family spokesperson is also a way to encourage effective communication, avoiding the "operator game." The "operator game" is when one person passes an original message on to another and this person now sends what they heard onto the third person, etc. By the time the last person is reached, the original message is completely distorted. This can cause major problems within a family.

The spokesperson will represent the family if your loved one is unable to confer with professionals. S/he will keep in touch with the doctors and relay the information to the other family members. Additionally, the spokesperson may have responsibility – or share responsibility – for health care and legal decision-making.

Care management duties should also be divided up. Even if some live far away, they can contribute by calling your loved one, sending them cards, handling some paperwork, or even paying the bills. If someone else has small children and lives nearby, they could cook an extra serving of dinner and bring it by for a visit. Another family member could be responsible for coordinating the services needed while your loved one remains at home.

It is inevitable that one person will shoulder the majority of the duties, but if all are participating as a team, the chance of resentment building are decreased. Talk to your family members and see about coordinating respite and vacation times so that you are not overburdened. When necessary, bring in the appropriate professionals, such as geriatric care managers, elder lawyers, financial planners, counselors or religious advisors and insurance or paperwork professionals. Consider having family members contribute to a fund to pay for in home care assistance and respite workers.

Making It Work

By conscientiously planning, conducting and following up on family meetings, members can assure themselves that they are working in the best interests of their loved one and minimizing unhealthy family dynamics. Remember that you are all working in the best interests of your loved one who has lost some capacity to handle their own affairs. Be a positive participant and rise to the occasion.

Organizing a family meeting is a complex task. It involves coordinating the schedules of many to discuss a topic close to their heart. Having a predetermined time and date to meet will help all members be able to plan accordingly. You may find that it is convenient to keep in touch via the Internet. MyFamily.Com (http://www.myfamily.com) offers families the ability to coordinate schedules through a calendar of events, post updates, and even post pictures on the site! For each topic included on the calendar, those listed in your database will be notified via email. This is excellent when coordinating multiple doctor appointments, family schedules, and keeping everyone updated. It is also a fun place to show off the grandkids new art work and to remind everyone that they are a family as a whole, not only during a crisis.

Resources and Reading

ElderCare Online (http://www.ec-online.net) offers comprehensive and practical articles and tools on the range of caregiving issues. Family caregivers are welcome to print off a limited number of copies to share with family members in family meetings. Professionals should contact us for reprinting and copyright instructions.

Take the time to read documents that specifically deal with the issue you are facing, such as Alzheimer’s Disease, estate planning or residential options. The following resources belong in the arsenal of every caregiver:

The Caregiver Education Series includes booklets, workbooks and multimedia tools to help you maintain quality of life. The Prism Personal Organizer helps you collect, store and quickly access your loved one’s personal and financial records. This reduces time spent looking for information during emergencies and helps improve legal and financial decision-making. The Prism Medical Manager is an essential workbook to manage complicated care plans and busy schedules. This improves your ability to talk with your loved one’s doctor, manage complicated medical regimens and avoid complications and medical errors.

Financial Caregiving Article: Easy-to-follow checklist of issues to consider.

ElderLaw Basics: Concise explanations of the different legal instruments that all adults should have – Durable Power of Attorney, Health Care Proxy, Will and Living Will.

The Complete ElderCare Planner: Joy Loverde’s acclaimed book is great tool for managing aloved one’s affairs. It has recently been updated for 2000.

Talking With Your Aging Parents: Mark Edinberg’s comprehensive guide to talking with your loved one’s about legal, financial, housing and health issues.(Out of print, but available in many libraries)

Available from ElderCare Online™               www.ec-online.net               1999 Prism Innovations, Inc.