Maryland Bar Bulletin
Publications : Bar Bulletin : May 2006

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 Bar Bulletin Focus

Alternative Dispute Resolution    

What to Do About Mom's Failing Health?

~Mediation and elder care~

Conflicts often arise because of misunderstandings or lack of information, particularly when older people are involved. The misunderstandings may be among family members, health care providers, care home administrators or staff, or even friends or patient roommates, as well as the older person herself or himself. Because such situations cannot always be dealt with practically in the course of daily life, the mediation setting offers a much better chance of reaching an effective resolution.

Since mediation focuses on quality decision-making, the participants have nothing to lose – and a lot to gain – by trying to thoughtfully, quickly, satisfactorily and inexpensively resolve a matter. Mediation is especially appropriate in situations where one or more of the participants is perceived as particularly dominant or one or more of the participants is less equipped to deal with conflict or articulate concerns. The latter can often be the case when one of the participants is elderly.

Older people sometimes become confused. They may appreciate that there is something wrong or that they are not happy but not fully understand either the problem or a prospective resolution. Families can help to clarify their thinking by talking things out, especially with a third-party neutral to make the conversation safe for all voices, experiences and ideas. In mediation, people of all ages benefit from speaking about a situation, and the mediator can help this process for older people and their family members, as well as their other caregivers, without losing neutrality. With reflecting, summarizing and asking thoughtful open questions, the mediator can invite each person to relax and grow more comfortable with the concept of speaking and explaining more of their views.

Even when there is no confusion, a person who is timid or otherwise has difficulty with self-expression often functions when one of the listening is a mediator who does not challenge or question everything that person is saying. Some (and particularly older) people often worry about offending anyone, especially a family member, and they may find it easier to direct some of their comments to the mediator, with the other people listening.

Older people are sometimes caught up in disagreements between loved ones over what care or other arrangements are seen as appropriate for them. Family members may have different ideas over the elderly parent's needs and desires, and this can make life uncomfortable for the parent as he or she tries to avoid siding with one person or the other. Moreover, the older person's views may not even be considered by family members caught up in either the role of parental caregiver or deference to those in that role; this is common. Mediation allows for the vetting of the views and preferences of the older person before others speak, thereby removing that person from the position of having to disagree with what others say. Then, the differences between siblings, in the presence of or outside the presence of the parent, can be discussed and better understood.

Because of the many options mediation offers, all participants are allowed room to agree on temporary or trial arrangements, such as where the parent shall live; who shall care for the parent; expectations of other family members and the variety of shared care-giving responsibilities; clarified expectations for compensation or thanks; benchmarks for how long the older person can remain at home; whether the person receives home care or care as a resident of an institution; what kind of facility will work best; hospice care at home or in a facility; what other financial arrangements or options are feasible; legal and other documents needed; and how future decisions will be made. Of course, not every option tried in the wake of mediation will prove successful. Face-saving is often involved in resolving family conflicts; for this reason, pursuing the suggestions of different people (or simply giving them serious consideration) can help bring the various participants together. (To be sure, participants can always return to the mediation process.)

Mediation gives everyone an opportunity to be heard and to be involved in the process. When this happens, ultimate decisions are better accepted by everyone. Again, this can be important where arrangements or other important decisions affecting an older loved one or family member are involved. It has been said that there is a larger grace bestowed on society when families demonstrate their respect for and acceptance of loved ones growing old and, together, thoughtfully make decisions about their care. A mediator can assist in the process of everyone being involved.

Louise Phipps Senft is founder of Louise Phipps Senft & Associates/Baltimore Mediation, which specializes in mediation, facilitation and training in conflict transformation skills.

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Publications : Bar Bulletin: May 2006

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