Long-term care (LTC) facilities are rife with conflict. They are especially susceptible to the social dynamics that are associated with intertwined relationships at the level of family and workplace. Add to that the immediacy of the medical environment and the emotions felt by families who act as advocates for their service-dependent loved ones, and it’s easy to see why all LTC employees need to be well-versed in mitigating conflict.
Crisis intervention is a skill taught to LTC professionals across the disciplines. But, social workers often serve as interventionists because they are most engaged with both residents’ families and coordination of care with LTC employees.
Identifying key players is essential to navigating a conflict conversation within the facility. If you see family members who are disquieted by their perception of inadequate care and/or lack of communication, analyze that family constellation according to their relatedness to the resident. Identify the family members who are most active and involved, the legal representative(s) and those who have strong bonds with the resident. Along with the residents, these individuals are your constituency, as they are the most closely associated with promoting the well-being of the resident.
Consider the following scenario: A resident’s spouse has durable power of attorney and healthcare for his wife. He has been supportive of the resident every day since her admission. They have children who visit intermittently. Their daughter has been present, but their son has not visited until very recently. You walk into the resident’s room. The son is visibly angry and is red in the face. He looks at you as you arrive and says furiously, “Would you treat your mother like this? Would you put her in a nursing home?”
The son is neither very active nor a legal representative. You cannot contest outright his bond with his mother is not strong, but you can sense the issue is private in nature and not associated with the family as a whole. As the interventionist, you should seek to validate his feelings while reflecting the wishes of the resident and the constituency: quality care. “Yes, I understand your feelings. But, we are working diligently towards serving your mother’s needs, and I hope that you can see that getting angry like this is not supportive of her well-being. Again, I understand.”
Most times, the scene is not so straightforward and navigating the constituency takes a bit more effort. In this scenario, the son may not listen to the reasoning behind your statement. When you try to redirect his behavior, he gets even more furious. The rest of the family is becoming upset over his actions. What do you do?
Focus on your constituency. Make eye contact with the spouse and gesture that you would like to speak to him in private. Stepping out into the hall, you explain the son’s behavior is directly impacting the resident. You remind the spouse that, as the legal authority, he has the right to ask the son to leave.
In short, a family not interested in pursuing positive outcomes is not behaving in support of the resident. LTC professionals should remind family they reserve the right to dismiss a problematic meeting. While this runs counter to our customer service orientation, among all clients the resident’s needs must come first.
Where’s the fire?
Cognizance of the physical environment where a conflict is brewing is especially important for providing effective resolution. Residents’ rooms are an especially sensitive place that deserves respect of all visitors. Issues that arise inside residents’ rooms should be corralled under the same proviso of resident-centered care. If family members are upset and displaying their frustrations while visiting in a room, you are required to ask them to join you in a more appropriate setting. Other areas that should be respected include the halls, nursing stations, dining rooms and any and all locations residents can easily navigate as part of their daily living.
Sometimes, conflicts form during family meetings with caregivers. From my experience, family meetings are often met with the expectation this is where arguments are fostered and permitted to become heated. That is certainly not the case. Long-term care is driven by resident well-being and a focus on better resident outcomes. Practicing professionals should not permit the overuse of anger, aggression or assaults of any kind. The dismissal of a family meeting because of inappropriate behavior is always an option.
Why is there conflict?
Asking yourself why there is a conflict in the first place may feel like a waste of your time. But, identifying whether or not a conflict is subjective (based on personal feelings) or objective (based on facts and issues) will ultimately determine the dialogue toward a solution. In the above scenario, the son was experiencing a subjective reaction to what he felt was an objective observation. Negative family dynamics can be the most insidious catalyst for conflict, but remember those dynamics probably existed before their loved one was admitted. Family dynamics have little to do with your active role in promoting resident well-being—unless, of course, you are forced to navigate them.
On the flip side, you must maintain a vigilant eye for conflict resulting from a concrete observation of a decrease in resident well-being. The LTC industry isn’t perfect, and sometimes mistakes are made. Whenever an objective issue arises, you should do your best to include available staff associated with the issue and focus on hearing the complaint. Exercising forcefulness during a conversation about a legitimate issue is not advised unless the involved parties are not behaving on behalf of the resident.