When taking care of an elderly parent or another relative, family members often need to work cooperatively.
The more people participating in care, the less alone a caregiver feels in his or her role.
Books and articles about caregiving often mention the family meeting as a way to facilitate this process.
But how does one go about having such a meeting?
Who should attend?
Each family is different. In some families, only a husband or wife and their children are considered “family.” In other families, aunts, uncles, cousins, current and ex-in laws and close friends may be included in the definition of family. When planning a family meeting, it is important to include everyone who is or will be part of the caregiving team, and this may include a family friend, neighbor or paid caregiver.
It is also sometimes helpful to engage the help of an outside facilitator, such as a social worker or minister to help the family communicate about difficult subjects during the meeting.
A decision must also be made about whether or not to include the ill family member in the meeting. Family members usually do not want to be excluded from family events and their preferences for care must be considered. However, if someone has dementia or another condition where he or she might misunderstand the purpose of the meeting, it might be appropriate to hold at least the first meeting without him or her present.
How should we begin?
Communication is the key to working successfully with a group of people. If it's difficult for some family members to travel to the location of the meeting, technology can help: a conference call or the use of a speaker phone can make it easier for them to participate. A videotape or an audiotape of the meeting can also be sent out to all family members who are unable to attend. With the use of email, even those who are not nearby can also be kept up to date on how things are going.
Prior to a meeting, you'll find it helpful to prepare an agenda. Someone in the family will generally introduce the idea of a meeting and arrange the date and location. That person can also create an agenda for the meeting and send it out to all the family members ahead of time. Family members can then share their ideas and suggest other items to include.
An agenda might include topics such as:
- The latest report from the physician
- Sharing of feelings about the illness/caregiving
- Daily caregiving needs
- Financial concerns in caregiving
- Who will make decisions and how will they be made?
- What support role does each person want to play?
- What sort of support does the primary caregiver need?
- How will caregiving and support needs change as the illness progresses?
- Solving other problems
- Summary of meeting and schedule for next meeting
Holding the first meeting
As with all high-level negotiations, deciding where to hold the meeting is as potentially controversial as the meeting itself. Whether you hold it in an office, a restaurant or someone's home, keep in mind that you want a setting that the majority of the participants will find comfortable and convenient and that presents as few distractions as possible (e.g. noise, small children who need attention, etc.).
At the conclusion of the meeting, make sure everyone has a clear understanding of the issues and considerations discussed. When the solutions to issues have been established, make sure that each person understands what he/she has agreed to do.
The most important thing for family members to remember is that the meeting is not a one-time event. Family meetings need to take place regularly. It is helpful to schedule them at a given time, perhaps at the same time each month. However, if this is not possible, they at least need to take place when the caregiving situation or other situations in family members lives change.
Dealing with family dynamics
Families come with history: a history of how each person relates to the others, a history of what role each person has played and currently plays within the family, a history of how each person feels toward the person who is sick, and a history of how each person deals with illness and adversity. And in each family there are rules about what can and cannot be said, what emotions are okay and not okay to express. These factors can make family meetings difficult. This is why a third party facilitator can be helpful.
Family members play roles based on position in the family, relationship to the person who is ill, special talents, etc. The person who is the caregiver may be different from the one who handles the money, who may be different from the person who is the information gatherer, who is different from the one who is the decision maker or the one who has some medical background. One person might play several roles. Also, often someone is the “blamer,” and someone else the “blamed.” One person may try to make peace, and another may try to sabotage the process.
Finding consensus and reaching compromise
Try to work toward consensus building. Change happens slowly, but when families meet regularly, the seeds that are planted can grow into more productive solutions. Often things do not change until there is a crisis, but the work that has been done during the family meeting will make decision-making easier when the crisis does come. Agreements can be made on a time-limited basis to see if the agreed-upon action will work. Future meetings can be used to evaluate these trials and revise them as necessary.
In order for these solutions to work, people have to learn to compromise. By being open to alternatives, you might get part—although maybe not all—of what you want or need. We often hold out for only one solution to a problem, we don't consider other possibilities that could assist us. Asking for help is one of the hardest things to do. Learning to graciously receive help offered can also be a struggle, not only for the person who is sick, but also for the person who is the primary caregiver.
A written agreement capturing the decisions and agreements made at the end of the meeting can be a helpful reminder for family members. Distributing a calendar with different days marked with responsibilities and commitments can also help each person honor the agreements made.
Outside help may be needed
Although family meetings can be powerful and effective ways to connect and work with family members, they cannot magically solve all the problems of caring for an ill family member. When families have trouble working together or coming to agreements or when the family is divided on a big issue, it often helps to invite a neutral outside facilitator to attend.
Sometimes a crisis precipitates the need for a meeting—perhaps someone is in the hospital and major life and death decisions need to be made. Time can be of the essence. Whatever work you have done together earlier will help you at these times of extreme stress.
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