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GuideOne Risk Resources for Health Care
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W. Des Moines, IA 50265-3538



Managing Difficult Family Relationships

By Paula Parker, GuideOne Senior Loss Control Consultant

Admitting new residents into an assisted living facility environment may occur on a daily basis, which means many tasks must be completed quickly. Among those tasks are the caregivers' initial discussions and plans that center on the resident's medical, dietary and physical care needs. The resident is expected to bring personal belongings; however, they sometimes bring unanticipated family discord.

Many factors can contribute to family discord or conflicts. Unfortunately, the admission process may trigger buried emotions from family members that, when brought to the surface, can negatively affect both the staff and resident. It is always a difficult challenge to deal with families who frequently complain, interfere with care and make unreasonable demands.

Sometimes the point of contact or Health Care Proxy for a resident may be part of the family discord when other family members feel excluded. That is why care conferences should include key members of the family as often as possible, unless the resident wants them excluded. Sometimes the simple act of inviting a difficult family member to the meeting can diffuse a potential adversarial situation, as it gives them a platform to be directly involved with the decision-making process of their loved one's plan of care.

Likewise, it is a serious omission when that family member is not notified that the plan of care has not been followed, resulting in a serious decline or change in the resident's condition. When such a situation arises, management must acknowledge and immediately remediate the problem by notifying the family and keeping them abreast of the situation, explaining what occurred and what is proactively being done to resolve it. Without that prompt conversation, the family member will assume the worst about the facility when they later discover the decline or change. Any perception of a cover-up leads to anger and a potential lawsuit.

Direct care staff should always foster family partnerships and remain neutral in order to avoid adversarial relationships. Management can end-up spending too much time dealing with staff and family conflicts. Even if a formal process is in place for dealing with complaints, family members may go directly to the Ombudsman and circumvent the facility staff.

A goal of every facility should be to improve relationships and decrease family complaints that can lead to costly investigations and lawsuits. The process to minimize conflict should be managed much like the process to reduce falls or medication errors. Family and resident grievances often can be disregarded or ignored, and yet they are a valuable way of identifying more general problems.

Improved interaction and communication between staff and family are necessary. To assist caregivers in these types of situations, a framework for improvement is outlined via the Quality Assurance and Performance Improvement (QAPI) process. Rather than being adversaries, working collaboratively with families is a legitimate and necessary part of the staff and management's role.

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