A new way to resolve ‘high-conflict family dynamics’ for elders
A new way to resolve ‘high-conflict family dynamics’ for
elders
Senior Editor
What happens when mama is sick and dying, but her two daughters can’t agree on how to care for her, and their rift explodes to the point it’s harmful to mama?
One daughter sends mom roses for Valentine’s Day; the other one throws them in the trash. One daughter wants to visit mom in the nursing home; the other one refuses to allow it and gets a no trespassing order.
It happens. Even much worse. At a stressful time when families should come together to do what’s best for their ailing elder, old grudges both petty and monumental can loom large.
There’s a groundbreaking new tool called “eldercaring coordination” now running as pilot projects in eight Florida circuits: the Fifth, Seventh, Ninth, 12th, 13th, 15th,17th, and 18th. Florida has joined Indiana, Idaho, Ohio, and Minnesota in leading the effort to help manage what social workers call “high-conflict family dynamics” so that the vulnerable elder and family members can resolve their differences without litigation. That not only makes matters easier for the families and allows the elder to die with dignity amongst the company of loved ones, it frees judges from micromanaging nonlegal decisions that should be made by family members.
The concept is the brainchild of Linda Fieldstone, supervisor of Family Court Services in the 11th Circuit, who has worked for 25 years with parents and their children. She was very familiar with statutes and administrative rules that created “parenting coordination” to help parents of young children in those high-conflict situations. Why not try the same concept with children and their elderly parents, especially as the number of baby boomers reaching 65 is projected to double from 2008 to 2030?
“I started thinking: There are a lot of grandparents taking care of children. What happens when these families get older and they need to take care of their parents? Old feelings come back, like, ‘I didn’t get the bicycle I wanted when I was 10.’ Can you imagine the stress on the elder whose needs are really not being met?” Fieldstone asked.
Fieldstone brought her idea to the Florida Chapter of the Association of Family and Conciliation Courts, when its president was Sandy Karlan, a retired 11th Circuit administrative family court judge, currently mediating.
“My first reaction was issues having to do with families are a continuum for our entire lives. Having been in the family court and having practiced family law, I knew issues continue,” Karlan said. “In some states, probate court is included in family court. In Florida, it’s separate. It makes sense that where there is conflict in families, it’s always better to try to resolve that conflict without litigation. So this made sense to take a tool working for families with children and see if it could be adapted to work with children and their parents.”
Karlan appointed Fieldstone (also a former FLAFCC president and its parent organization, the Association of Family & Conciliation Courts) and Fifth Circuit Judge Michelle Morley as co-chairs of a task force that led to the pilots. They convened a group of 20 statewide organizations including The Florida Bar Elder Law Section and Florida Legal Services. Working in tandem with the Association for Conflict Resolution, their mission was to create eldercaring coordination that focuses on reducing the level of conflict so family members are better able to focus on the pressing issues of their elder and work with others to provide health care, legal advice, advance directives, guidance, and planning.
Judge Morley described a case that resonates most with her:
A vibrant 83-year-old widow, who lived in the Villages, enjoyed an active retirement, including memberships in pickle ball and dance clubs. She went in for hip replacement surgery, coded on the operating table, was oxygen-deprived, and came out in an irreversible vegetative state. The only thing to do was make her comfortable.
But deciding how to best make her comfortable caused an uncomfortable chasm between her two daughters.
“They were two lovely daughters,” Judge Morley said. “Talk about heartbreaking. They were both registered nurses. One was more progressive and liked to try Chinese medication. The other one was more traditional. And both petitioned to be guardian.
“By the time I got to appointing a guardian, they were so polar opposite on what to do with Mom. I appointed the traditionalist and she placed their mother in a skilled nursing home.”
The progressive daughter wanted to try new treatments; the traditionalist daughter didn’t want to disrupt Mom.
One day, when a nurse walked in to change Mom’s bedpan, she witnessed the progressive daughter injecting something, perhaps something herbal, into Mom’s feeding tube.
The daughters’ philosophical differences on how best to care for their mother escalated to the point that the progressive daughter was not allowed to visit, and there was a trespass warning issued at the nursing home. There were pleas to move the mother, so the progressive daughter could visit.
“I said, ‘OK, she stays where she is.’ She is deteriorating and dying,” Judge Morley recalled.
The progressive daughter filed emergency motions to let her see her mother in her last dying days.
Judge Morley said she had to find time on her crowded calendar for decisions that are not legal.
“Their mom was so proud of them. They are both RNs, and they married well. Once they were close and they are not close anymore. All she would want is to have the two of them comfort each other,” Judge Morley said. “Imagine being with it enough to know your loved ones are fighting about you.
“The eldercaring coordinator brings everyone to the table to try to figure out: What’s really wrong? Let’s confront this problem and empower the elder who has the capacity to make their own decisions. And when the loved one can’t make the decisions, come to an agreement: Are we going to be co-guardians? So everything is in place and we can relax and focus on loving and supporting the elder who may have physical limitations and dementia. Let’s support each other while saying goodbye, and maybe eliminate probate disputes.”
Some families are “so enmeshed in conflict, they can’t utilize the resources around them. The driving force of that family is conflict,” Fieldstone said. “Coordinators are not therapists. We can help them by not judging their feelings and allowing them to have those feelings, but allowing them to put them aside to help the elder.
“We have all of these elders, all of these aging baby boomers coming into the system. How great it would be to help them with their families at the end of their lives.”
Ideally, the eldercaring coordinator can help clashing family members find something to agree on, Fieldstone said, “and perhaps the only thing they can agree to is that they want their parent to have a dignified time at the end.”
Fieldstone said she is excited to have Pamela Teaster, associate director for research at the Center for Gerontology and a professor in the Department of Human Development at Virginia Tech, on board for research.
“Instead of waiting until the cases have been completed years from now and looking back, she is starting from scratch. As things come up that could be done better, we can change them. That’s why this is a pilot project,” Fieldstone said.
Judge Morley hopes for statewide status.
“We hope that, ultimately, the process will be recognized by legislation just as parenting coordination was,” Morley said.
Fieldstone considers it “groundbreaking” that consensus was reached among 20 statewide and 20 national and Canadian organizations to see the need and endorse ethical guidelines for the coordinators.
While the Florida Chapter of the Association of Family and Conciliation Courts’ original mission is to help children and families, Fieldstone said, “They did not just accept these guidelines for eldercaring coordination. Their board of directors endorsed the guidelines, strengthening the definition of families to expand.
“Can you imagine a court system respectful to older families, with the same options as younger families? It will change the way people feel about the courts. This is the way to help resolve conflicts. At least, it’s a way to try.”
Currently in Florida, there are three trained coordinators at each pilot site, defined as a judge or magistrate in a circuit who will refer at least six cases to the coordinators. Or, it could be a group of attorneys that will refer six cases by agreed order. If a group of attorneys wants to start a pilot in their circuit, Fieldstone and Morley are ready to help. For more information, contact Fieldstone at [email protected]or Morley at [email protected].
