In every facility there is at least one family member who tries to take over the care and decision making for their loved one. The term is “Helicopter Children.”
Helicopter Children observe their parents aging and proceed to take over their lives and become overly controlling. Some Helicopter Children are genuinely concerned for their loved one’s well being, but some are not. Staff must make sure the Helicopter Child is not overstepping their boundaries.
First, staff need to determine if the resident has an advance directive/healthcare power of attorney that names the Helicopter Child as the healthcare agent. More importantly, staff need to see when the document goes into effect. Some documents have the agent’s decision-making go into effect as soon as the resident signs the document. Others state that the document goes into effect after the resident has been deemed incapable of decision making. Additionally, some documents include a phrase where the resident should still be consulted even if he or she has been deemed incapable. The social worker will be able to determine when the POA goes into effect.
If the resident does not have an advance directive, one should be completed as quickly as possible. Again, the social worker can coordinate this. If the clinical team documents the resident is incapable of completing an advance directive, the state’s surrogacy hierarchy will go into effect. Check your state’s Office of Attorney General for details.
Next, the Helicopter Child needs to be told that their loved one will be consulted in all decision-making. The family member may be asked for their input, but the ultimate choice will be the resident’s.
If the Helicopter Child steps over the line, i.e. speaks for the resident when the resident is not present, demands changes in medications, communicates with outside consultants without sharing with the healthcare team, describes behaviors in the resident that staff does not see, there could be serious issues. The relationship could be unhealthy to the point where the family member could be harming the resident.
This Helicopter Child could be suffering from factitious disorder imposed on another (FDIA) formally called Munchausen syndrome by proxy. FDIA is a mental health condition where the person lies about either their own medical conditions or those of someone they care for in order to earn praise and attention.
If you feel the family member is overstepping their boundaries here are some suggestions to address the situation:
- Don’t make healthcare decisions without the resident’s input. When possible, include the resident in conversations with the family member. If the family member says they are speaking for the resident and the resident is not present, speak to the resident later privately to confirm.
- Arrange a visiting schedule so the resident and family member have time away from each other.
- Consider using a contingency contract (behavioral contract) with the resident, family and care team.
- Consult your facility’s behavioral health partner.
- Consult your local ombudsman’s office.
It is a resident’s right to have their family members involved in their care. But if the family member is violating their loved one’s right to proper medical care, participating in care choices, and access to information, we must step in and protect these rights.
Teresa M. Geroulo, LCSW-C, CDP, CCTP, is the Director of Social Work at Broadmead, a lifecare community in Baltimore County, MD. She has been a social worker for nearly 30 years, and is a certified dementia practitioner and a certified clinical trauma professional.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
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