Dealing with difficult relatives can be a common occupational hazard for aged care facility staff and management, but failures in communication, complaints handling and staff training can all lead to aggressive incidents and conflict.

Worst case scenarios can include stress claims from affected staff, complaints to the department, investigations, negative publicity and bad word of mouth from disgruntled relatives.

Yet according to Sue Field, Adjunct Fellow in Elder Law at the School of Law, University of Western Sydney, clear procedures and policies can resolve most situations before they escalate.

“There are always warning bells to start with, the problem is when facilities wait until there are full blown sirens before they respond,” said Ms Field, a former aged care nurse and solicitor who handled elder law cases.

Speaking to Australian Ageing Agenda ahead of her participation in a panel discussion on dealing with difficult relatives at the upcoming Aged and Community Services NSW & ACT state conference, Ms Field said a common issue was around residents and mental capacity, particularly where a facility had not clearly ascertained which relative was the ‘person responsible’ or tribunal-appointed guardian.

“No one thought to ask at the outset who was the family member we should be dealing with. So you have the situation where a daughter rings and wants to talk about her mum, and later the son rings and says he’s his mother’s guardian, and he wants to know why we are discussing things with his sister,” she said.

When management and staff were not clear on the arrangements in such cases it was easy to become defensive and “get on the back foot,” Ms Field said. From there it usually went “downhill pretty quickly,” she added.

Developing good relationships with relatives was crucial, she said. “Developing that rapport must start from day one. That also helps you understand the family dynamics, which is essential to ascertaining the relationships within the family, and how that might impact you.”

Further, she stressed the importance of education for staff and management. “Providers must know the parameters that guide their practice. If you know the law, the policies and procedures, the professional and industry guidelines, then it is easier to respond appropriately and professionally when someone is aggressive – because you are on sure ground.”

A core policy requirement – and one that was essential in how organisations prepared for the issue – was around having robust feedback and complaints procedures that relatives could have confidence in, she said. While every circumstance was different, it was important in all cases that the relative was listened to. “You can’t have a tick and flick approach; you must make them feel the grievance is being heard, acknowledging how they’re feeling and discussing what action will be taken, if any.”

Ms Field also stressed the need for “objective documentation” whenever issues arose. She warned against using emotional or judgement language when documenting grievances or incidents. “Think about who writes in the notes, when they write and why, and think about where the notes could end up. Remember, you cannot go back and change them.”

The ACS NSW & ACT state conference takes place 6-7 May at Rosehill Gardens, Sydney. AAA is the conference media partner.

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9 Comments

  1. There is quality service in one aged care facility, you can visit and wait up to an hour before you even see any staff at all, they are all on breaks. So sad, when a loved one is put into aged care, they do never tell you that your loved one will not receive the care that is paid for nor do they tell you that most of the days, there will hardly any staff, no they tell you all the “care” that your loved one will receive, staff will be there 24/7, meals and etc.

    They forget to tell you that they will miss feeding your loved one, bath them and even forget to give them medication. They will forget to tell your family that they will not always change your loved one and leave them all day in soiled pad underwear. They will forget to tell you, that your loved one is only allowed 3 pad changes per day. They will forget to tell your family that if you question them about any matters, you will be made to feel like crap for caring. They will forget to tell your family members that your loved one will fall out of bed, because staff members “forgot” to put up the bed rails, They will forget to tell you that most staff will have only been given a 20 minute induction prior to commencing a shift. They will forget to tell you that your loved one will be checked by a nurse each day and if you say anything, they just blame the morning shift or the afternoon shift.

    Just so sad.

  2. And what have you done to address the situation?

    Have you contacted your local member to voice your objection to the proposed reductions in Registered Nurse coverage? How about the lack of mandated staff to resident ratios?

    Have you considered the link between low wages and a low skilled workforce (the majority being sub-continental immigrants who, having discovered there’s no more acccounting jobs available, have miraculously found their true calliing as an unskilled personal carer)?

    Have you researched any of the readily available DSS information promotiong a restraint-free environment to understand that your relative shouldn’t even have bed rails fittted in the first place?

    Welcome to our broken system. The system that the AACQA keeps telling us is going really well (thanks to their diligence). Their incessant box-ticking has driven an industry-wide obsession on process, not results. According to the agency, everything’s fixed. (Never mind if something’s not done, we presented a plan that said it would be.)

    Sadly, there’s no need to ask the identity of the facility you describe; 90% of facilities fit the description.

    Consumers need to be the main drivers of change (its quite obvious that we cant rely on providers). Formalise your concerns; write to your provider and local member instead of abusing the easy target. What type of result do you expect from complaining to a worker-bee earning $19/hr ?

  3. Could not agree more Dave. And unfortuantely the smaller stand alone facility who is doing the right thing is constantly being told to become like the bigger corporations and should be able to make as much per bed as they can every year.
    Some of us trying to swim upstream and keep up the standards and choose staff carefully, invest in lots of quality training and also keeping RNs on every shift.
    It is just getting too hard to do it all.

  4. As a Lawyer and Mediator of some 20 plus years, I recently went to the USA for specialised training in Elder Mediation. This concept is new in Australia, but a growing industry in the USA as they are way ahead of us in aged care issues. The range of topics to be mediated is vast, but family mediations are common with the focus being on the elder person, and the roles the family can play in the care of a parent or close relative. These mediations conclude with a written Agreement documenting who will do what. Another aspect is a mediation between families and aged care providers to set an agenda as to communications between the facility and family members, and the general care of the elder, thus putting everyone on the “same page”. No doubt we would not have enough Elder Mediators as yet to service the obvious need, however I see this as a beneficial way of making the life of our elderly community safer and more comfortable, and improving the relationship between families and aged care facilities.

  5. Excellent piece of article that poses a great gap in care services across all health domains , but one that is essential in aged and long term care.

    At the A.C.C.L.M and Frontline Care Solutions we offer very comprehensive evidence based and practical skills training for clinical leaders to adapt to these difficult and complex scenarios in the workplace. The problem here also exists with these leaders, who when given the opportunity to engage with this type of training are either resistant, resilient , or not supported in the OPD.
    We study , develop and run these contemporary training courses because we understand the learning tools are needed to develop skills in holistic person centered care, reduce the stressors that sit around end stages and palliative care work.

    We also understand that once the skill is learnt , the leader will have to engage and manage, which means they will also be accountable. We understand in the research that the individual will also encounter much conflict when education and mentoring complex care scenarios. Will the expert leader build confidence in practice and then will they be supported by the organisation as a whole when the conflict is raised?

  6. As suggested by the previous writer, Lyn, elder mediation is a positive way of dealing with the many issues that older people and their families face as they require aged care, be it in residential facilities or at home. Elder mediation is a process which includes family members, service providers and the older person. It enables all parties to come to workable solutions for the care and support of the older person. Trained elder mediators are sensitive to the issues experienced by all parties during this difficult time of family transition.

    Elder mediation does not replace sound policy and good management, but it does go a long way towards providing important and speedy solutions to some of the care issues confronted by older people, their families and service providers.

  7. Yes, Dave

    I and other family members had spoken many times to local minister, even went higher then the so called Manager, went the head office, put in many formal concerns, but nothing was done.

    Our loved one passed away in April

  8. Dear Dave

    The aggressive tone of your email to Pearl underscores part of the problem: defensiveness when situations that are not acceptable are pointed out.

    It is remarkable that excuses are often made about staff to patient ratios, or blame shifting occurs – at the end of the day, care in many facilities is sub-standard, and if that is to be the ‘standard’, whatever the excuse, then perhaps these places should not overstate what they can provide. The facility provides a service – it is not the family members’ responsibility to double-check on staff practices, however, that sadly occurs, because of the shambolic way people are treated. Trust is a big issue, and not something that can be brushed off as not important.

    And your response, which was a putdown to Pearl, is why family members often feel their complaints go nowhere.

    Patricia

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