Aging Life Care Manager Carolynn Nagao-Marco.

By Carolynn Nagao-Marcotte

Differences of opinion often come with the territory when dealing with relatives. But family disagreements about care can be a huge problem when there’s a crisis and a loved one’s best interests are at stake.

Unfortunately, this is a fairly common situation. But a bit of preparation and a collaborative approach can make a world of difference.

I recently worked with a woman in her early 90s, who was living at home and maintaining an active social life. However, her husband had died a few years before and her children worried about her living alone.

Some of the children wanted her to move into assisted living. Others wanted her to receive in-home services. They couldn’t agree on what was best. Meanwhile the mother was happy living at home and didn’t feel that she needed any help.

It was a complicated situation that was starting to take a toll on their relationships. But, working together, we eventually reached consensus on a plan that addressed the most pressing needs – and everyone is much happier.

It wasn’t quick or easy, but here are a few strategies for navigating this kind of family disagreement about care:

Start with what the elder wants. Overlooking this is a common mistake, especially when there’s a crisis. It’s natural to have strong feelings about the health and well-being of a loved one, but it’s also vital to respect that person’s autonomy and wishes.

Asking for help isn’t easy and it’s fairly common for people to initially refuse in-home assistance, even if they need it. Talk about it, and really listen. Remember that you’re both on the same side, and that trying to force somebody into a situation they don’t want often creates more problems than it solves.

Plan ahead. Discussing the elder’s wishes in advance is crucial, and it’s just as important to record those wishes and designate a trusted Power of Attorney and Health Care Proxy to ensure those decisions are carried out. Programs such as Honoring Choices or tools such as 5 Wishes can be very helpful here.

People often procrastinate, but a bit of preparation here can make all the difference. Instead of being divided by perceptions of what the elder may have wanted, the family can unite to carry out that person’s wishes.

Respect all opinions. Say there’s a crisis, where it’s not clear what the elder wants and there are conflicting ideas on what to do next. This can create a potentially explosive situation.

Talking things out is a good way to defuse things, but only if there’s trust that everyone’s opinions will be respected. Identifying the concerns and goals of each family member is often a crucial first step toward finding consensus. And keeping everyone in the loop can go a long way toward warding off resentment.

Identify shared goals. Every family has history, and it’s easy for that to bubble up during crises. Focusing on shared goals can help keep the conversation positive and minimize the chance of revisiting old conflicts.

Keep an open mind. Family members often disagree on the best course of action and become attached to just one solution, when it’s possible that alternative measures could deliver better outcomes. It’s best to keep an open mind while exploring options.

Hire a professional. An Aging Life Care Manager (ALCM) can help families reach consensus on health decisions in several ways. A good ALCM should be deft at facilitating family discussions, while also providing expertise on assessing the elder’s needs, delineating their options, and recording advance directives.

Whatever course of action you take, it’s important to have realistic expectations, and understand it’s entirely possible your loved one isn’t going to want drastic changes over the short term. A more productive tack is to identify the highest priority needs and try to address those first, with the hope of opening up an ongoing discussion about what’s best for future.

In the case of the family I discussed earlier, it turns out they weren’t really aware of the services that could help their mother stay at home safely. Once they learned about that, they regrouped and decided to work together on a plan that would address their concerns and keep their mother happy.

And at the end of the day, isn’t that what it’s all about?

Carolynn Nagao-Marcotte is a dementia certified Aging Life Care Manager for the CLO program at Somerville-Cambridge Elder Services, a non-profit elder services agency dedicated to supporting the independence and well-being of older adults. For more ways on handling family health disagreements, call CLO 617-756-1026.