Preventing difficult family situations

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Eleanor Feldman Barbera, Ph.D.
Eleanor Feldman Barbera, Ph.D.

I listened with great interest last week to McKnight'sFall Expo talk on Pain relief: Dealing with difficult family and resident situations. Attorney Matthew J. Murer provided excellent information on how to work with families to prevent conflicts over treatment and other care issues.

Here, from a psychological perspective, are some additional ideas to prevent or reduce disagreements over care, thereby decreasing the likelihood that the situation will result in legal action.

1. Create systems that easily allow family members to be part of the treatment team.

We collect initial data from families upon admission, but there's often more family members can and want to add to care.

Staff members may have difficulty adequately involving families because it's not a fluid part of their workflow. Family members tend to visit in the evenings and weekends when the administrative and day shift workers are no longer in the facility, for example, and care plan meetings are held during working hours when many family members aren't available.

Inviting relatives to meetings via secure video chat, establishing weekend or evening hours for key personnel such as social workers, and implementing a comprehensive communication system that transmits family information between shifts and departments can help.

In addition, staff members should be trained so that they're genuinely receptive to information provided by loved ones rather than creating the impression that the family is a nuisance. (I've seen this!)  

2. Educate families about the illnesses of their loved ones. 

Many residents are given diagnoses just prior to or upon admission, but receive little information about their conditions. Similarly, family members often struggle to come to terms with new diagnoses and have many time-consuming questions to ask of staff.

They also may look for health information from less-than-reputable resources. Set up a magazine rack in the lobby with information and resources about common illnesses such as diabetes or stroke and/or add a page to your website with helpful links for families. This meets a genuine need, generates more knowledgeable conversations between families and staff, and helps to create more realistic expectations on the part of families regarding treatment and prognosis.

In addition, we can create opportunities for residents and families to be of service to others and make meaning out of challenging experiences. For instance, perhaps there's a level-headed resident who's been living for years with Parkinson's who wouldn't mind sharing his experiences with an anxious new family, or a family member who used to bake sugary cookies for her loved one with diabetes and is now willing to talk to families about ways to adapt to special diets.

3. Support family members who are stressed and grieving over their loved one's decline in health and/or behavior. 

Many, if not most, admissions to long-term care are precipitated by a health crisis. People are frequently caught off guard and adjusting to a new order within their families.

Old roles are changing, patterns established over decades need to be reworked. We can ignore this aspect of the situation or we can offer families a haven in the storm. Facilities don't necessarily have to provide mental healthcare for families, but they can have a list of support groups and community clinicians to offer those in distress.

Organizations can engage their consulting psychologists to provide monthly family meetings to address concerns. New families can be given contact information of experienced family members who can show them the ropes regarding what it means to become part of the community.

4. Offer ways for families to be useful in the treatment. 

We've all dealt with the family member who comes in twice yearly from out of town and makes a fuss about their mother's care, only to disappear for the next six months. Perhaps this is that family member's misguided attempt to make up for six months of inattentiveness in one weekend.

Sometimes family members want to help but just don't know how. Other times, based on the generally bad press we get, family members might assume their best role is to fight us. If we give them other roles, they may be diverted from the fight.

As part of our admissions packet, we can offer families a list of suggested ways to help such as participating in care plan meetings, decorating their relative's room, joining in recreational activities with loved ones, and facilitating friendships with peers. We can offer suggestions for how to divide tasks when family members are far away or when certain family members have more financial resources than others.

We can help them negotiate this difficult emotional terrain because we know what works and what doesn't and they're in this for the first time.

5. Recognize that sometimes they're right to fight. 

We can learn a lot from what families tell us even when they don't say it in a way that's easy to hear. They might shout, misuse medical terms, speak in a condescending manner, etc., but they're involved and communicating with us.

As my old family therapy supervisor used to say, “This family's got a lot of juice.” Juice was good because it gave us something to work with, compared to a withdrawn or absent family.

Refer angry family members to a calm, knowledgeable staff person who can get past the presentation to the root of the problem. We might find that it stems from a lack of information on either side. The family member might not understand the necessity of a particular treatment, for example, or we might not be aware of a past reaction to a particular medication.

We might also hear the fear and pain of the family member that underlies their agitation or anxiety and be able to calm them and/or refer them for additional support.

In theory, an individual resident is admitted to long-term care, but in reality we're caring for the entire family. If we accept and embrace this reality, there are many ways we can improve the quality of our care for our residents and for the family members who love them and reduce the likelihood of conflict.

Eleanor Feldman Barbera, PhD, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.

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