By Jeannette Franks, PhD
Businesses often approach tough issues by scheduling a meeting
of those most knowledgeable and concerned. Successful academic
departments at every prestigious university hold monthly meetings.
Governments can break through imponderable dilemmas via
well-planned and appropriately attended meetings.
Overcoming Barriers to Holding a Family Meeting
There are various barriers, real and imagined. Geography is a
big one-often families are widely dispersed across the country.
Lives are already busy and often overscheduled without adding yet
another commitment. Paid caregivers might not want to donate their
time to ponder the issues; families may feel it is too expensive to
pay them for meeting time. Also, it's easy to think, "My sister
would never agree to a meeting." But have you asked her? Families
can be so heavily burdened by the responsibilities of caregiving
that it might be surprising what people will readily agree to if it
might be an improvement on the status quo.
Bringing the family and support network together to discuss a
loved one's changing situation and available options is a crucial
step in elder care planning and making appropriate choices.
Why Hold a Meeting?
Whether or not there are specific problems to solve, sharing
information and airing thoughts will be productive. Often family
members may feel that they aren't doing enough, when in fact an
individual might be doing too much. It is also typical for siblings
or other caregivers to feel that individually they are doing more
than his or her share and someone else is not.
Often these roles are influenced by culture, gender, and birth
order. For example an adult son may be quite willing to mow mom's
lawn and totally turned off by the idea of bathing and toileting
her-that's woman's work! In fact it's easy for almost anyone to
handle yard care but it takes significant physical and emotional
strength to help a disabled person with personal care. It's also
more difficult for a man to help a woman and vice versa with
intimate tasks such as bathing.
Caring for a frail older person is never easy. Holding a
caregiver/care receiver meeting is almost always going to improve
the situation if it is well planned, well attended, and conducted
Who to Invite?
Invite at least three or four (confirmed attendees) and a
maximum of approximately ten. Of course an important person to
include is the loved one concerned, even if it means holding the
meeting in a hospital room or with a person with profound
Alzheimer's. Issues such as
dementia, or reluctance to acknowledge or discuss the problems
are special challenges.
Some families may consider it inappropriate to include the loved
one concerned, perhaps because the disabilities of that person make
it difficult to discuss the situation in front of him or her. In
addition, American culture has a tendency to leave out older
people, just as you might exclude a child from financial
discussions. Also, in some families cultural or traditional taboos,
such as discussing death in front of the dying person, preclude
inviting him or her.
However, I personally prefer to respect the choices, dignity,
and autonomy of individuals, regardless of age or frailty, and
believe that including the loved one concerned would produce the
most informed and beneficial outcome. Each family is different, so
you must decide what works within your family dynamic, but it's
important not to assume that a meeting about a person means that
that person should not be there.
Direct professional caregivers are sometimes overlooked or
excluded. It's possible that the housekeeper who cleans once a week
may know the most about relevant issues, such as incontinence,
which the family is totally unaware of.
Perhaps invite neighbors and old friends, as well as all
available family members. For geographically wide-spread friends
and family, you might consider setting a date near a holiday or
birthday, so folks have time to fly and also share a Thanksgiving
or 4th of July.
Depending on your family's spiritual beliefs, it can be helpful
to include a religious advisor such as a rabbi, priest, or
Every family is unique and while some may benefit from the
services of trained professionals such as a case manager or social
worker, it is not essential. The most important consideration is to
be as inclusive as possible and not overlook current or potential
resources to help your family.
What to Cover
Again, be as inclusive as possible with your agenda. Everyone
will have wildly divergent ideas of what is important and just
recognizing that one fact will be useful in itself. Be sure to give
the main character-your loved one needing care-a starring role.
For example, when you ask your mom, "What are your biggest
problems you're having right now?" you may expect her to say "My
failing health." Instead, she is more likely to say "You are all
trying to get me to move-that's my biggest problem!" You might
consider rephrasing the agenda item to say, "Pros and cons of mom
moving." This might lead to a discussion of "why we want you to
move." Be frank-"We are afraid you'll fall and not be able to get
up." This might lead to a discussion of all the possible solutions,
including personal alert systems, cell phones, a daily phone call
or visitor, as well as the benefits and potential drawbacks of an
Review the elder care planning agenda in advance with all
concerned. Use email, phone, mail, or whatever is convenient for
your group. Don't forget to set a date for the next meeting. It
could be in a week or a year-but setting a time to reconvene is
Prior to the Meeting
After your agenda is complete, be sure to assign a neutral
person to the role of facilitator. Another person might be
designated to be the note taker and yet another to be the time
keeper, both to limit the length of time of the meeting as well as
to try to make sure that people share "air time," that is, no one
gets to speak more frequently or longer than another.
Arrange a comfortable physical environment with food and
beverages and comfortable seating where everyone can make eye
An enormous obstacle to a successful family meeting is family
history, especially family conflicts. Even the most harmonious
family has had huge fights in the past, and multiple slights,
insults, and injuries-and most families arenot harmonious. Mothers
and daughters, sons and fathers, brothers and sisters are
traditionally at odds with each other. Now add in-laws, aunts, and
a grandparent and you have a recipe for a messy stew. Keep in mind
this is normal family dynamics. But this meeting is not about the
past,it is about the future. Say so.
Disparate viewpoints will emerge at this meeting. Assure
everyone that there is no perfect answer and no solution will
please everyone. Compromise, compromise, compromise.
Recognize that safety may not trump all other variables in elder
care planning. Most individuals desire a good quality of life,
which may trump quantity of life. For example, some older people
prefer the safety of living where they need not use stairs; others
find the risk (and healthy exercise) of stairs, especially in a
beloved and familiar environment, worth the risk of a
Distribute the notes to all concerned, even people who could not
attend but wanted to be there. Honor and follow up on what was
decided at the meeting. Be flexible in case the situation changes.
Your loved one may be fine at home now with the new support systems
set in place as a result of the meeting, but even without saying
so, families usually recognize that the situation will most likely
change and probably not for the better.
Elder care planning experts suggest having a list of potential
fall-back positions, for example three retirement communities where
mom might consider
moving. Plan a visit with mom to each and consider advising her
to put her name on the waiting lists. It doesn't mean she must move
when her name comes up. It is a "Plan B" in case the situation
Whatever the outcome of the family meeting, try to remember that
it may not solve every problem. Sometimes just being able to
mitigate some dilemmas and clear the air is a step in the right
Many families engage a social worker or case manager to be part
of the team. Where do you find such a person? One web site is the
Eldercare Locator at http://www.eldercare.gov;
This is part of the National Family Caregiver Support Program
and they may be able to refer you to free social workers or case
managers in your area. Often your county Area Agency on Aging (http://www.n4a.org/) will have
specially trained staff that may be available to consult with your
family at no charge.
Jeannette Franks, PhD,
is a passionate gerontologist who teaches at University of
Washington and Bastyr University. She is the author of a book on
assisted living and numerous articles.