As a geriatric care manager, I’m often called when a difficult family has created disruption and chaos with service providers and their staff. A geriatric care manager can help elder care and senior care providers cope and care for difficult families in an attempt to ensure that the older adult continues to receive the care they need. My role is to collaborate, strategize, problem solve and communicate in a way that bridges the gap between the difficult aging family and the organizations that care for them. All this naturally translates in to improved quality of life and care for the older adult.
Let’s not kid ourselves…
When you work with aging families, you have a long list of stories about families that pushed you to the limit and required more patience than the average family. Difficult aging families can create chaos in an organization and can even impact the care other clients, residents and patients receive. If left unchecked, they can bring an organization to its breaking point and create burn out with staff. Dealing with difficult aging families is especially challenging when there is a vulnerable older adult in the eye of the storm and we, as professionals, have to stay engaged with the process (i.e. the difficult family) in order to protect, provide care and advocate for our aging client, resident or patient.
Difficult aging families come in many forms and sizes…
Contentious: the family that right off the bat starts arguing over doctor’s orders, cold food and lack of response. They see an argument at every corner and everyone is the enemy. They may want to complain about old family grievances and family arguments break out in front of us. Arguments so intense we are sure the grievance occurred yesterday only to find out it was 30 years ago. They continue to complain about issues that have been resolved; over and over again. You find yourself always defending yourself and your care team’s actions. You hear that voice inside your head: “there is no pleasing this family”!
Time Consumers: the family that seems to think their mom or dad is the only person you have to care for. You give advice, educate, rearrange the covers, close the blind, straighten up the home, answer more questions but it’s never enough. They call you at all hours of the night and refuse to accept time constraints when you attempt to set a boundary. This family can be self-centered and unable to see that others around them also need help. They start taking valuable time away from other clients/residents/patients and you find yourself hustling to get your work done by the end of the day. We all know that charting and documentation doesn’t write itself.
Denial: the family that despite all the evidence that mom may be actively passing they want the doctor to order an MRI to uncover some disease that can be cured. You provide education and communicate but it falls on deaf ears; you start to doubt and question yourself. You find yourself feeling like you’re talking to a brick wall. The denial is making it impossible for your client/resident/patient to receive the care they so desperately need. It’s at this point that the denial has become problematic and needs to be addressed.
Volatile: the family that at one moment appears to be engaged, complimentary of care and part of the care plan process and the next minute they are accusing you of abuse and incompetency; Dr. Jekyll and Mr. Hide. You never know what to expect or how far their outburst will go. They can be confusing and rope you in with a false sense that everything is fine and then the light switch goes on (or off). Their anger is so scary that you take a step back and wonder if you should call in reinforcements. It’s difficult to know what to expect and you find yourself shying away from them when you go for a home visit or see them walking down the hall. I’ve been known to dodge in to an office to hide from this family!
Triangulates: the family that has a tendency to pick sides, pit people against one another and create chaos in relationships. They get along with people who see their side of things and if you don’t look out. They will do their best to create chaos within your team to take the attention away from their issues or problems. They are vindicated when you take their side and they thrive on tension between family members and staff members. They may even “stretch the truth” a little to pit people against one another. As a team, you start to disagree about the best course of action and tempers flare.
I’m sure as you read down this list various families and scenarios come to your mind…
I don’t have the time or expertise to go in to the underlying psychology involved with difficult and dysfunctional families. What I want is for you, as a professional, to be able to identify that you are indeed working with a difficult aging family, identify their pattern and create strategies that work for you and your team ultimately leading to better care for the older adult you care for.
Strategies for Working with Difficult Families
Compassion: as difficult, inappropriate and volatile as dysfunctional families can be and as much as you’d like to run away from them, they need your help. Have compassion for the fact that they are scared. Their aging parent may be the glue that has held their family together and without mom or dad they don’t know how to function. The family in denial may not be able to face the fact that they’re mother or father may be dying. Understand the sadness this difficult family is experiencing and express compassion towards them. Your compassion may be able to break through the denial and disarm the dysfunction. Compassion may be the bridge to better understanding.
Boundaries: you don’t have to “by in” to the dysfunction nor should you tolerate abuse from difficult families. Set a boundary and be very clear that you expect respect and cooperation from the aging families you work with. This does not mean that you should discourage a family from complaining or voicing about care or treatment but they must do it in an appropriate way. Also, learn to set a boundary with yourself and not “take on” the burden of providing perfect care or making all your difficult families happy. You may want to consider transferring someone off your case load to get a break and re-group.
Pro-active: be proactive in the way you communicate and care for their aging family member. If you notice something “not quite right” address it right away don’t wait for the difficult family to discover the problem and bring it to you. Educate in advance and provide service beyond what they expect. For me, this is the strategy I prefer as it’s simple and inexpensive. By being proactive, you take away some of the fuel for their dysfunction and you disarm them from the ability to triangulate or become argumentative.
Teamwork: if you give the difficult aging family mixed messages, you might as well throw gasoline on the fire. Your entire professional team needs to be aware of the difficult or dysfunctional family and work together to help them. If the family that triangulates is unable to pit you against one another, they will be forced to deal with the issue at hand or if you all communicate the same prognosis a family may be able to come out of their denial and start dealing with the issue at hand. I guarantee you that if you send mixed messages and confusing information, the difficult family will escalate. The key is for the entire clinical team to be communicating the same message and when the family attempts to triangulate or head back in to denial, go back to the message. Don’t underestimate the power of a high functioning team!
Expectations: don’t expect too much from a difficult family; they may never want to hear what you have to say and they will certainly not become emotionally healthy while you’re working with them. Also, be realistic in the expectations you communicate with them in regard to care and services. Don’t promise something you can’t deliver. This goes back to the concept of boundaries but realistic expectations can set the stage for the difficult family. When we communicate clear expectations and set the stage for a difficult family, this can be a huge relief for a struggling family in chaos.
If you or your elder care organization is coping with a difficult aging family before you start talking discharge, utilize community resources that can assist in helping your difficult family and care team cope. Consider working with a geriatric care manager, counselor, ombudsman or mediator to help you with difficult families. It can really pay off in the long run….