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Published on: June 4, 2018
by Barry J. Jacobs for AARP:
It’s not that she didn’t want to meet with her older sisters. At Christmas, Easter and birthdays every year, they got along just fine. But when I suggested to my 52-year-old client Sabrina to invite her siblings to a family caregiving meeting after hearing her complain that they weren’t helping her care for their aging father, she sounded very pessimistic. “I don’t think they’d come,” she said at first. Then later, she added: “If they do come, they won’t tell you the truth about what they’ll do. And they’ll just criticize me.”
Sabrina’s lack of trust in them was striking. Didn’t they all have their father’s and each other’s best interests at heart? I suggested she think about trying to meet anyway. After a few weeks, she reluctantly agreed.
The resulting gathering in my office was surprising. Though everyone acknowledged that Sabrina was the primary caregiver, she was unusually quiet, as if — in her sisters’ presence — she had reverted to being their helpless little sibling. But the sisters — older by four and five years — were neither critical nor bossy. They complimented Sabrina for how well she was caring for their father. They also said they had always planned to pitch in more but did not want to step on Sabrina’s toes, because it seemed so important to her to be in charge. I asked Sabrina if she would accept their aid now. She nodded yes. We then spent the rest of our time together coming up with ways the sisters could really help.
Not all family meetings are as revealing of interpersonal dynamics or as successful at devising pragmatic caregiving plans. Sometimes, heated arguments break out over a loved one’s diagnosis and needs, who should do which caregiving tasks, or even who’s been the most responsible relative since childhood. But more than any other event during the caregiving years, the family meeting has the potential to bring loved ones together as a strongly bonded team — during caregiving and afterward.
How can you hold family meetings that foster greater commitment (not dissension) and more coordinated (not divergent) plans? Here are some ideas.
Send out engraved invitations. Well, not literally. But family discussions about a loved one’s needs should not occur haphazardly at random get-togethers or through whisper-down-the-lane phone calls from one family member to another. There needs to be a formal, agreed-upon process of bringing all parties together — generally through a quarterly meeting in person, if possible — in order to create a heightened sense of urgency and a shared purpose for negotiating an effective plan.
Carefully set the stage. Family members who actually want to take part in caregiving generally will show up at the initial meeting. Those who don’t come may be missed — and resented — but shouldn’t be the focus of ensuing conversations. The meeting’s organizer should then underscore the seriousness of what’s at stake by making three pronouncements:
Build consensus — but tolerate honest disagreement. Some family members will have a tendency to minimize the extent of a loved one’s impairments and needs, while others might exaggerate these deficiencies. Standoffs can easily result over what’s happening. To create a shared understanding of the medical situation, scan and email the care recipient’s doctor-visit notes, physical therapy reports, hospital discharge summaries, etc., to all team members. Often, this is enough to align their perceptions and opinions. If not, be patient. More evidence of a loved one’s decline over time has a way of forcing a common vision of the growing crisis at hand.
Regularly revise action plans. Once the crisis is known, team members can devise coordinated plans — really, works in progress — to better support their loved one. At every meeting, each family member should be asked what he or she is willing and able to contribute to the cause at that time, then tasks should be divvied up accordingly. At every follow-up gathering, that process should be repeated and the previous plan should be revised — sometimes greatly — to account for the changing circumstances and needs of both the care receiver and individual family members. These meetings rarely run perfectly. But they can be investments of time, energy and mutual consideration that pay off in better caregiving — and more connected caregivers.
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