This article provides insights and guidance on conducting productive and supportive family meetings in the context of caregiving. It emphasizes the importance of open communication, collaboration, and addressing conflicts to enhance care coordination and support for both the caregiver and the care recipient.
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When taking care of an elderly parent or another relative, family members need to work cooperatively. The more people participating in care, the less alone a caregiver feels in his/her role. Books and articles about caregiving commonly mention the family meeting as a way to facilitate this process. But how does one go about having such a meeting?
Each family is different. In some families, only a husband/wife and their children are considered "family." In other families, aunts, uncles, cousins, present and ex-in laws, and close friends might be included in the definition of family. When planning a family meeting, it is important to include everybody who is or will be part of the caregiving group, and this may include a family friend, neighbor, or paid caregiver.
It is also sometimes beneficial to involve the assistance of an outside facilitator, such as a social worker or minister, to help the family talk about difficult topics during the meeting. (This is covered in more detail below.).
A choice must also be made regarding whether to include the ill family member in the meeting. Family members typically do not wish to be excluded from family events, and their preferences for care must be considered. However, if someone has dementia or another condition where he/she may misconstrue the purpose of the meeting, it may be appropriate to hold at least the first meeting without him/her present. Also, other family members might need to share with each other thoughts or feelings that would hurt for the sick person to hear. Think about holding one meeting to focus on those matters, and holding a second meeting with the ill person present.
Communication is the key to working successfully with a group of individuals. 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 take part. A videotape or an audiotape of the meeting can also be sent to all family members who are not able to attend. With using email, even those who are not close by can also be kept up to date on how matters are going.
Prior to a meeting, you'll find it helpful to prepare an agenda. Somebody in the family will generally introduce the idea of a meeting and schedule the date and place. That individual can also make an agenda for the meeting and send it out to all the family members beforehand. Family members can then share their ideas and suggest other things to include.
An agenda could include subjects such as:
Fears:
Daily caregiving needs:
Financial concerns in caregiving:
It will most likely be challenging to cover all these concerns in one meeting, so extra meetings will be useful. Each occurring meeting needs to have a clear schedule and a definite beginning and ending time. Make sure to stay with the moment table; if meetings get to be too long, exhaustion embed in, minds will stray, as well as individuals might resist concerning future meetings.
Just like all high-level negotiations, choosing where to hold the meeting is as potentially debatable as the meeting itself. Whether you hold it in an office, a restaurant, or somebody's home, remember that you want an environment that most of the participants will find comfortable and convenient and that provides as few distractions as possible (e.g. noise, small children who need attention, etc.).
A productive family meeting gives everybody a chance to be heard. All feelings are appropriate and need to be shared and acknowledged. People will be more willing to talk about their feelings regarding the situation if they feel safe. For example, the brother who is never present may share that he is not able to stand seeing someone sick, and the sister who is doing all the work might not notice how she pushes others away when they offer to help. Another sibling may be having marital issues that he or she has not yet disclosed with the family, and yet another sibling might be worried about losing a job. Everyone needs to balance his/her own fears, concerns, love, and desire to help with available time, strengths, weaknesses, and hopes.
Until the depth and breadth of the issues involving the sick family member are explored, it is important to not try to solve the problems. Recording the problems in a list as they are shared, however, will be useful during the problem-solving part of the meeting.
It is important for every family member to learn to use "I" messages, as well to say "I need ..." instead of "You should ..." Even when disagreeing, try to find the part of what is said that you can agree with. The objective of the meeting is to work as a team in caring for the individual who is sick, even if there is disagreement among family members in other areas.
At the conclusion of the meeting, make sure everyone has a clear understanding of the issues and considerations discussed. When the answers to problems have been established, be sure that each person knows what he/she has agreed to do.
The most crucial thing for family members to keep in mind is that the meeting is not a single event. Family meetings need to take place regularly. It is helpful to schedule them at a given time, possibly at the same time every 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. Holding regular meetings puts less pressure on family members to get everything resolved in just one meeting, and allows more time for processing of information and decision-making. When a family member is unable to join a meeting, correspond with them by phone, mail, or email.
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 individual who is sick, and a history of how each person manages illness and hardship. And in each family there are rules about what can and can not 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, unique abilities, etc. The individual who is the caregiver might be different from the one who manages the money, who might 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 may play multiple roles. Also, typically someone is the "blamer," and someone else the "blamed." One person might attempt to make peace, and another might attempt to sabotage the process. There will be secrets, old family rivalries, guilt, unequal burdens, differing investments, values, and interests. Some will worry about past promises and about someone else not pulling his/her own weight. Everybody will require attention, power, love, control, and appreciation. It can help to recognize that there is most likely no fair distribution of work and trying to make it even will fail.
A narrow focus for every meeting can help alleviate some of the pitfalls. Still, you will need to handle some of the challenging issues when they get in the way of cooperation. Remember that you can't resolve long-lasting family issues with one such meeting. The job is not to "fix" the family, but rather to have everyone on the same team, as much as possible, in caring for somebody who is sick.
If alcohol will detract from the main focus of the meeting or will cause conflict, it is better not to provide it. However, each family has different methods of communicating, and in some families a drink might make everybody more comfortable and more able to talk. In any case, overconsumption should be avoided.
Consensus: Not all the issues inherent in caregiving and decision-making can be resolved; sometimes it is important to accept approximations of a good solution. Try to work toward consensus building. Change takes place gradually, but when families meet on a regular basis, the seeds that are planted can grow into more effective 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 assess these trials and modify them as needed.
Appreciating everyone's uniqueness and circumstance helps to create an environment of acceptance and allows for creative solutions to problems. For instance, Carol finds it hard to be around sick people, so when her brother got lung cancer, she knew she couldn't care for him. However, she was more than willing to make the pastas of their native Italy and take them to him to comfort him during his sickness. Jesse lives a thousand miles away, but can receive time off from work to be with her mother while her brother and his family take a vacation. When Ed's mom had surgery, Ed arranged to look after his dad with Alzheimer's, while his sister worked full time and helped with the costs. Gina takes her parents to medical appointments while her sister ensures they get their medicines properly every night.
Compromise: In order for these solutions to work, people need to learn to compromise. By being open to alternatives, you might get part-- although perhaps not all-- of what you want or need. We often hold out for only one solution to a problem, we do not consider other options 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 caretaker. Being appreciative is the best gift you can give somebody who is trying to help you, even if the type of help he/she is giving isn't exactly what you wanted. When you make somebody feel good about helping, he/she will want to help more. "Thank you" will take you a long way in working together. In building the caregiving team, think of how each person should be addressed.
Put it in writing: A written agreement recording the decisions and agreements made at the end of the meeting can be a handy pointer for family members. Distributing a calendar with different days marked with duties and commitments can also help everyone honor the agreements made.
Although family meetings can be powerful and effective ways to connect and work with family members, they can not magically solve all the problems of taking care of an ill family member. When families have trouble working together or coming to agreements or when the family is split on a major issue, it usually helps to ask a neutral outside facilitator to join. Sometimes a crisis precipitates the need for a meeting-- perhaps somebody is in the hospital and big life and death decisions need to be made. Time can be of the essence. Whatever work you have done with each other earlier will help you at these times of high stress.
Social workers from local caretaker organizations (like Caregiver Resource Centers in California), as well as ministers, private case managers, social workers in home health or hospice, physicians, and discharge coordinators in hospitals and nursing homes can help facilitate a family meeting or refer you to somebody who can. Psychotherapists in private practice are trained in family counseling. If you find yourself in a difficult position, you may also want to see a psychotherapist privately. Do not forget the support you can get with friends, colleagues, and support groups. Sharing experiences with other caretakers can help reduce the feelings and frustrations commonly associated with being a caregiver.
Family Caregiver Alliance, Holding a Family Meeting By Family Caregiver Alliance and reviewed by John Neville, MD. https://www.caregiver.org/research-policy/research-and-reports/
Yale New Haven Hospital, Support Groups and Social Work https://www.ynhh.org/services/support-services/support-groups-social-work
CT.gov: Connecticut’s Official State Website, Older Adult Services, https://portal.ct.gov/Services/Health-and-Human-Services/Children-Family-and-Older-Adults/Older-Adult-Services
Home Health Care provides skilled health care services wherever you call home. Our HomeHealth team works collaboratively with you, your family, and your doctor to help you recover from illness, surgery, or injury, regain your independence, and become as self-sufficient as possible.
• Improve your outcome;
• Regain your independence;
• Become as self-sufficient as possible;
• Maintain or improve your current condition or level of function;
• Slow any decline in your health status.
You’ll receive the services you need based on an individual plan of care developed by your doctor with our clinical team. Some of the home health care services we offer include:
• Skilled nursing care
• Home health aides
• Physical therapy
• Occupational therapy
• Speech therapy
• Medical social work
• Pain management
• Medication management
• Wound care
• Infusion therapy
• Diabetes monitoring
• Ostomy care
• Continence Nursing
You or a loved one may benefit from home health care if you:
• Have a chronic illness such as heart disease, diabetes, kidney disease or COPD
• Are recovering from surgery, hospitalization or illness
• Need help to get out of the house
• Frequently visit your doctor or the hospital
• Need education to manage your condition effectively
• Are at risk of severe illness due to COVID-19 (age 65+ or any age with an underlying condition)
You may be eligible to receive home health care under the Medicare benefit if:
• Your doctor prescribes and orders home health care for you.
• You need either skilled nursing care or therapy (physical/occupational/speech therapy) onan intermittent basis.
• Your condition limits your ability to leave home, rendering you “homebound.”
Absolutely, and we’d be honored to care for you or your loved one. Federal law gives patients the freedom to choose their health care provider.
A nurse or therapist will contact you by phone to schedule the first visit. If you’re coming from a hospital or nursing facility, the initial visit will usually happen within 24 hours after you’re discharged to make the transition easier.
On the first visit, a nurse or therapist will conduct a thorough interview and professional assessment. Our assessment identifies areas where you may benefit from education and tools to manage your health.
We partner with your doctor, as well as family and caregivers to determine the best services for your needs. This team approach actively engages you and your caregivers in your health care and, if applicable, helps to make the transition from a hospital or nursing facility to your home much easier.
The frequency and type of home health visits are based on your personal plan of care. Your doctor may change your plan of care as necessary, increasing or decreasing the number of visits or services provided, in order to provide you with the best home health care for your needs.
During each visit, home health care staff will:
• Ask about your pain and work to help you manage it
• Ask you about your health and symptoms
• Check your vital signs
• Coordinate your care and communicate with you, your provider and any other care provider
• Help with your medications and teach you and your family more about them
• Provide skilled nursing, therapy and home health aide services, as needed
• Teach you how to safely take care of yourself to remain in your home.
Medicare pays 100% of the cost of home health care services for eligible patients. Your state’s Medicaid program or your private insurance may also cover home health care.
Home health care is usually less expensive and as effective as care in a hospital or skilled nursing facility. Medicare pays 100% of the cost of home health care services for eligible patients. Your state’s Medicaid program, the VA, private pay, private insurance pay or waiver programs may also cover qualified home health care. Our team will work with you to determine your eligibility and level of coverage.
After we receive a referral, a skilled clinician will come to your home and determine, based on your insurance, whether you qualify. Some, but not all, insurance requires that you are homebound to receive home care services.
Homebound means your condition is such that:
• You’re normally unable to safely leave your home without help from others and the aid of assistive devices (such as crutches, canes, walkers or wheelchairs).
• Leaving home would require considerable and taxing effort. You can generally leave home as often as you need for medical treatment that cannot be provided in the home and still be considered homebound.
• You’re also allowed brief absences from the home for some non-medical reasons, such as an occasional trip to the barber or beauty shop, to attend church, or for unique family events (like a graduation or wedding). Such trips must be infrequent and require a considerable and taxing effort.
You can receive services wherever you call home.
Your residence is wherever you call home. This may be your house, an apartment, a relative’s home, a senior community, or some other type of residence. However, hospitals, skilled nursing facilities and intermediate care facilities may not be considered a “home,” which would mean we cannot provide home health services in those settings.
Based on your needs and insurance coverage, your doctor and home health clinician will determine how often your home health care staff will visit you.
Your doctor will determine the number of visits you receive, how often the visits should occur and how long they should last, based on your needs and health status.
No. Hospitalization is not a requirement to receive home health care. Many patients are referred by their doctor.
• Home health care staff in the home 24 hours per day
• Cleaning or personal care if these are the only care you need
• Household services such as shopping, cleaning and laundry when they are not related to your care plan.
We thoroughly screen and train our home health team members. Patient care staff have professional licenses and certifications that are applicable to their role. We also perform background checks and require several personal and professional references. Once hired, Careco Medical employees continue honing their skills through an extensive orientation process and ongoing training programs.
Home health care provides skilled clinical treatment for an illness or injury, with the goal of helping you recover and regain your independence. Home health care can also help you manage a chronic condition like heart disease, COPD or diabetes. Additionally, home health care can sometimes include certain personal care services, like help bathing and dressing, as part of the plan of care ordered by your doctor.
Personal home care services include help with bathing, dressing, meal preparation or your normal activities of daily living to remain independent within your home.
Hospice care provides compassionate, supportive care and comfort for those who are facing a terminal illness. It offers medical, social, psychological, bereavement and spiritual services that support a patient and their loved ones.
Yes. Our home health care center is Medicare-certified. This is a requirement for Medicare to cover the cost of home health services.
CareCo Medial covers New London County and many towns in Windhman and Middlesex Counties.