From time to time almost every single senior living community is forced to deal with family conflict
Yesterday we published Part One of this two-part article titled Stuck in the Middle – Thinking about the Silverado Sugarland, Texas Lawsuit. From time to time almost every single senior living community is forced to deal with family conflict. Only occasionally does it get so bad that someone files suit as is the case at Silverado Sugarland Texas. There are two additional important considerations:
- Dementia makes these conflicts more complex and delicate.
- Be very careful about picking sides.
Dementia residents add a great deal of complexity to the problem of resident rights and resident safety.
Joel Goldman, a prominent senior living attorney recently told me a story about a male resident with dementia who had a female friend that wanted to come visit. The family and the senior community had been able to document that this “friend” was physically and emotionally abusive to the resident and yet the resident wanted to continue the visits.
The female friend filed a complaint and licensing came out to investigate. The investigator asked just one question: “Do you want this person to continue to visit?” He answered “Yes” and the community was cited.
What the investigator never bothered to figure out was that this resident pretty much said yes to everything, meaning that if the investigator had asked if he wanted the senior community to ban his friend from coming to visit, he would have likely answered yes to that as well.
Most often what happens with dementia residents is that the family member(s) who are far away and have limited contact with the resident do not have a realistic picture of the level of confusion or disconnect with the real world the resident is experiencing. It is possible for residents to even “fake” normalcy for short periods of time. Even when a resident has dementia it does not mean they lose all of their rights to make decisions about how they live their lives . . . about who visits and who does not . . . about what care is delivered and how it is delivered.
The best advice is lots of communication with everyone and, as importantly, encouraging family members to have open honest conversations with each other.
Don’t Take Sides
When a resident moves into a community it is natural that one family member has most of the interaction with the senior living community. Particularly if that relationship is comfortable to the staff, there is an assumption that when other family members show up on the scene with guns blazing they must be the bad guy.
That assumption may not be correct. It could be that the one you like is the one who is raiding mom or dad’s bank account.
Most of the time there is no clear good guy/bad guy. It is simply a gut-wrenching time for family members as they watch their loved one decline. There needs to be lots of empathy and lots of discussion. Even if there is one apparent righteous party or side, you may not have all the facts.
Finally, many times when there is extreme family conflict it is the culmination of a lifetime of family conflict and dysfunction boiling over. Picking a side will likely cause you extreme grief and possible legal action.
How have you dealt with these issues?
This is why an in-house family therapist, generally an MSW, paid by the system, and trained in the nuances of elder family treatment is essential. Too many elders bring their family conflicts and mood disorders with them and require these services.
Alan, that is a great idea.
Steve – as a Dementia Solutions expert, I have been captivated by this particular series. And, actually forwarded Part 1 to a current client, to review as they re-vamp their current policy/procedures.
However, I need to nit-pik you for one second. You wrote: ‘It is possible for residents to even “fake” normalcy for short periods of time.’
As a Dementia advocate – this statement doesn’t sit well with me. When folks with Dementia have moments of clarity and lucidity – it is absolutely not a ‘fake normal’. That terminology implies that the rest of their life is not normal. And, glosses over the true facts of the Dementia disease journey.
The Dementia journey is very different for each individual. They type of Dementia impacts how the journey progresses as well, based on which part of the brain is impacted. It’s a disease of the brain that robs the persons ability to maintain and create new neuron conections. And, the moments of clarity are most certainly not Fake – they are merely moments where the neurons are finding ways to connect, for a brief moment.
There is already a significant social stigma pertaining to Dementia both in society and in our Senior Living industry. And, I realize my comments aren’t completely on-point with the actual article conversation..however, I felt compelled to squash this ‘descriptive line’ in the article.
Because, you are correct – as professional providers we must be the Experts. And, this becomes critical when dealing with family dynamics that are dicey. Which makes it that much more imperitive that we speak about the Dementia journey correctly as we guide/educate both staff and family.
Families already become frequently at ‘odds’ about Mom/Dad’s ‘decline’ – therefore…insinuating that something is a ‘fake normal’ – does imply that Mom/Dad may be able to control it…which, ultimately leads to even more frustration for the already-feuding family members.
Ellen that is a fair criticism and I should have written it differently.
I was in a Bible study yesterday and the group included a retired pastor and his wife. The pastor has fairly advanced dementia and mostly just sits quietly in the group. Something in the discussion triggered something deep within him and he talked for perhaps 5 minutes. What he said was perfectly on topic and relevant. When he was done, he somehow retreated into what we mostly see.
It was for everyone a really joyful moment.
Very thought provoking, and sadly, very common. I agree with the commend about “fake normal”. Though it is important to have an in-house counselor or social worker, in these types of high-conflict situations the community may need an objective outsider who is not affiliated with any of the parties involved, to provide recommendations. Professional Geriatric Care Managers such as myself are uniquely experienced to provide this type of evaluation and input. Mediation provided by a trained elder mediator might also be helpful.
You are right Brenda. Thanks for joining the conversation.
Steve, Let me focus on the in-house therapist idea…I have presented this idea and how to best use it for the resident and staff and found 4 systems reuse it outright. They cannot “afford” it and find that my reasoning is not something they can work with. The cost is so marginal and they seem much more interested in their facade to lure people into their place and that by coming there, all residents can find all their need met by their staff,,.,This is really denial ( we don’t have such problems) and rationalization ( if there were such problems, we could handle it.) I am about to give it up. A a senior myself, I tremble at the though that the profit motive and process they use puts seniors and their families at risk…
please forgive the typos…