Elizabeth Newman


Many years ago, my husband used to visit one of our elderly neighbors during the neighbor’s frequent visits to the hospital. For a long time my husband visited more often than any of the man’s five children.

Granted, some of the children lived far away, but I remember shuddering at the sadness of the situation, especially when the man entered a nursing home: It seemed to me then, and still does, that giving life to someone should imply a contract that he or she will visit you in your dotage.

But as Tolstoy famously said, “Happy families are all alike; every unhappy family is unhappy in its own way.” A Pioneer Network webinar on Thursday was a good reminder of how easy it can be to judge absent families when caring for the elderly.

Carol Siem, MSN, RN-C, GNP, RAC-CT, gave good guidance on how FaceTime or other technology can keep family members in the loop for a resident’s care plan. But she also told listeners how important it is to keep an open mind when dealing with absentee family members.

“I have said to many a staff person that we see this sweet lady or gentleman and the family doesn’t come in or comes in with an attitude,” she said. “We don’t know what [the resident] was like before they came into our home. What [the family brings] is the memory of who that person was.”

It could be the resident was abusive to his family, or that he drank to excess, Siem said.

It also may be less clear-cut: A divorce that caused strain on the family, a mental illness, an accident or illness, a child who was considered a disappointment for whatever reason. All of those may have caused emotional damage that any care provider would be hard-pressed to address.

But there’s one big category that may have caused a wedge in a family that also directly impacts providers: Money. In the case of my neighbor, the closest we ever got to understanding the frisson in the family related to how the children didn’t think their family had enough.

“Having enough money” is of course incredibly subjective. So let’s unpack the professional and personal sides of finances.

At its most basic level, money allows long-term care providers to aid a loved one in their final years. We tend to put a value on money in how it relates to that care. We roll our eyes at those who seem to value their future inheritance more than a parent.

I’d urge us to take a step back and think about what money means to us personally, and what it might mean for others. A resident’s adult children may have grown up in a house where money meant control: Dad made the money, so he made the decisions about where the children went to school. Money could mean safety: Having enough of it meant not having to move or worry about having to sell the car. Money could mean love: Mom was nicer when she had a job.

For those who grew up poor and made it to a successful juncture, there can be intense judgement about those families or residents who have made less than stellar financial decisions. For those who grew up with a happy financially stable family, the conflict around money may seem foreign. It behooves us to remember that the absence of having to think about money is a privilege within itself. Those who say money doesn’t matter tend to have it.

Ultimately, as Siem says, it comes down to walking a mile in someone else’s shoes. When there is conflict, “We can’t hold that against the family. We can’t judge them,” she reminds.


Follow Elizabeth @TigerELN.