Planning for Elder Care

Diane Carbo

Handling family dynamics can be as important as handling health issues.

By Diane Carbo

Having family meetings to plan elder care permits families to communicate issues and concerns on a regular basis. It also keeps everyone in the family informed, so they can make educated and appropriate choices.

It’s important to have formal elder care planning meetings. This is a way for a family to show support, and become aware of all the options and alternatives available. It’s also a time to calmly discuss differences and solutions to any problems.

There is usually one family member who becomes the primary caregiver. Family dynamics often dictate who will step into that role, based on such factors as cultural expectations, birth order, and gender. All of these factors will determine who will become the primary caregiver.

More often than not, the other family members take the primary caregiver for granted. This is something that is played out over and over again. And more often that not, the primary caregiver becomes resentful, bitter, and angry with the rest of the family for not acknowledging the amount of work involved, or offering to assist in the care.

An elder care planning meeting can help the primary caregiver educate the family on the needs of the aging senior, and the amount of care involved and the importance of everyone participating. Having regular meetings can open the lines of communications and keep the whole family educated on the future needs of their aging loved one.

To prevent a family meeting evolving into a situation of crisis and emotions, it’s important to approach it in a planned and structured manner—in fact, as if you were going to run a business meeting. At your first meeting you should introduce the goals and rules for everyone involved. This may be uncomfortable for you, but setting rules is very important when you are dealing with family dynamics. The conversation can become heated at times; it can be frustrating for all involved; but while rules and goals may not alleviate these emotional moments, they sure can dramatically reduce the chances of them occurring.

I suggest that the first family meeting be held with just a few close and involved family members. You may or may not want to have the first meeting with the aging senior family member present. That decision will be based on how you think they may react to the topic of discussion—their future needs. Some aging seniors want to be in control of their future and be involved in everything; others are in denial and become upset at the mere mention that they are even growing old, let alone that their needs may be changing.

The first meeting is to develop a family “team” approach. If the family dynamics are difficult, or family interactions are uncomfortable at times, this is the time to request that everyone put aside their personal issues for the sake of the aging family member.

It’s important that the primary caregiver determine an agenda for the first family meeting. The agenda should encompass no more than three or four topics. One topic on the agenda would be for each family member to identify what they feel is a concern or issue.

Another item on the agenda would be to ask everyone to take responsibility for a task. Each family member has something they do well or they like or have the ability to do. For example, the well-organized family member may be the one to take notes and send them out to everyone else. There are plenty of responsibilities such as yardwork, lawn care, and research for resources available. When individuals agree to do a project, a time frame should be assigned for completion.

If you have an extremely difficult family or a very uncomfortable or emotional topic that needs to be discussed, you may consider having a third party moderate that meeting for you. You could consider a pastor of your church or a trusted friend. I like to recommend a geriatric case manager or an elder care consultant, since they are experienced with the aging process, have knowledge of the medical delivery system and community resources, and have worked with families in a variety of settings.

To run a successful elder care planning meeting:

• Create the agenda and provide it to all attendees prior to each meeting.
• Ask all family members to have potential solutions to the topics on the agenda, if at all possible.
• Schedule both a starting and ending time for the meeting.
• Allow no one to speak longer than 10 minutes on a topic. This prevents any one person taking over or controlling the meeting. Keep a timer on hand and use it to keep everyone held to that time frame.
• Consider using a speakerphone, three-way calling, or a web cam to include those family members who live far away.
• Always schedule the next family meeting before you end the present meeting. Make sure everyone has their calendars available.

Here are some ground rules you may want to include for your meeting:

• No one is to interrupt someone when talking.
• No leaving in the middle of a meeting
• All discussions about “elder care issues” will be discussed as a group. Discussions without all involved are not acceptable.
• There is to be no blaming, finger pointing, or criticizing of others.
• The goal of this team is to assist the aging family member to remain at home, safely and independently, for as long as possible. There is no room for old family dynamics of hurt, anger, or resentment.
• It should be stated at the beginning of each meeting that this team must be flexible, as the needs of the aging senior family member will change. As the needs change, so too will the potential solutions.

Elder care meetings will not solve every situation every time. And the meeting will not always go smoothly. These meetings should remind each family member that this is about the aging family member and what is necessary to provide the best solutions to the problems they face.

Care giving is not an easy journey. Everyone experiences different problems and health issues. There are rarely clear-cut solutions to a problem. But elder care meetings can reduce the unhealthy family dynamics every family faces, especially under stress. By having a family meeting, you give everyone an opportunity to be involved in ways they may not have considered before. It gives generations a chance to bond and develop relationships at a new level.

Diane Carbo, RN has over 35 years’ experience in a variety of nursing settings, including orthopedics/rehabilitation nursing, home care, discharge planning, case management, oncology, hospice, senior behavior health, assisted living, and long term care.