What is Elder Mediation?

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Georgia Daniels

Eldercare mediation is a growing field that will increase in prominence as the number of elders increases. As parents age, conflicts can erupt between parents and their children over living situations, driving, or the need for more help with daily activities. In addition, conflicts may spring up between siblings about their parents' aging, such as when it is time for more in-home care, assisted living, or which sibling is responsible for what aspects of a parent's care. Mediation can also address more complex issues, such as estate planning and inheritance or healthcare choices, and may be used to develop alternatives to conservatorship. Mediation offers an opportunity to explore options and develop the best plan possible for the elder and family.

Usually, the elder's adult children or friends are quite clear that "something needs to be done." How this "something" can be accomplished is less clear, and can generate heated disagreement among those concerned. In addition, the spouse of the elder may be committed to maintaining the appearance that nothing is wrong.

Family members who are locked in ongoing conflicts may be unaware of elder mediation and its benefits. An example may help:

Example—Without Mediation: Daughter Darcy files a petition to be appointed the conservator of her father Hank's person and property. Her stepmother, Monica, insists that everything is just fine in their home, and is extremely angry with Darcy for interfering. Monica feels that Darcy is publicly declaring that Monica's caregiving is inadequate. The rhetoric escalates, and bitter litigation ensues. The judge ultimately appoints a third party (non-relative) as conservator of Hank's person and property. The conservator moves Hank into an assisted living facility, and Monica moves with him. The litigation causes a permanent rupture between Darcy and her father.

Example—With Mediation: Darcy contacts a mediator, and then calls Hank, Monica, and her sister Bella, to explain that she has some concerns which she would like to discuss. The mediator meets with all parties in a joint session, and they agree on ground rules. Each party takes a turn to air his or her concerns. The mediator helps them to identify what they really need for a successful outcome. Monica is reassured that the daughters are not trying to separate her from her husband; she learns that the daughters are worried that the caregiving burden on Monica is overwhelming her. Monica admits that she is struggling to care for the two of them, and her own blood pressure is soaring. She starts crying. With the mediator's help, they agree that Bella will contact a home care agency, to request someone to help a few hours per day with cleaning, shopping, cooking, driving, and dispensing medication. They agree to meet in a month to see how the new plan is working. The parties all feel that their concerns have been heard, respected, and addressed. The parties have a plan to continue working together for additional solutions if it turns out that more than a few hours per day of assistance is required. Unnecessary litigation is avoided.

Convening the Elder Mediation

The first step, and sometimes the most challenging one, is convening the mediation. This means ensuring that all necessary parties are invited to participate and are informed about the nature and content of the mediation. Frequently, either the mediator or mediator's staff will contact the potential parties for an intake interview and to confirm attendance. When mild to moderate dementia may be an issue, the elder's capacity to mediate should be considered and handled with sensitivity. An elder may be more comfortable having a trusted representative present to give voice to his or her concerns. It is also important to establish that participation in mediation is truly voluntary.

Benefits of Elder Mediation

The benefits of elder mediation include improved communication among family members, avoidance of unnecessary litigation, respect for the elder's dignity, and imaginative problem-solving. The plans and agreements which form the end product of the mediation are made by those who are directly affected by the situation. Parties usually report greater satisfaction with the outcome of mediation than with decisions imposed by a court. Finally, practice with conflict resolution techniques during mediation may allow the parties to resolve future conflicts without assistance.

Stages of Elder Mediation

Elder mediation takes place in a variety of settings, from senior service agencies, to elders' homes, to offices of private mediators. Where mediation is available from senior service agencies, the scope of mediation may be limited to a defined range of issues. The potential scope of private mediations can include a broad range of complex, multi-party issues.

The number of mediation sessions required may vary considerably. Sometimes, one meeting of two or three hours with all parties present is sufficient. In other cases, there may be several meetings over a period of weeks. Occasionally, out-of-state parties may participate by telephone or video conference.

When the mediation begins, the mediator typically explains the process to be followed, seeks input on proposed ground rules, and confirms that participation is voluntary.

Next, each party tells his or her story without interruption. The mediator may ask clarifying questions and summarize what has been shared. Frequently, the speakers feel that their perspectives are finally being heard by others in the family. Feeling heard and having their concerns validated can be an empowering experience for the participants.

After summarizing the various perspectives, the mediator identifies the issues, and may sort them into positions (wants) and interests (needs). The mediator notes areas of agreement and disagreement, and may start building an agreement by working with one small issue at a time.

Once the issues are identified, the parties brainstorm possible solutions, ranging from fanciful to practical. The mediator encourages imaginative responses as well as tried-and-true options.

The next step is to evaluate the potential options to see which ones might actually work, by asking questions such as "Can you live with this?" or "Would this meet your need for ___?" The mediator assists by rephrasing options and offering reality checks. Probably, some areas of agreement will emerge. The mediator continues to refine responses to the disagreements, looking for ways to bridge the gaps.

Finally, the parties come to a mutually agreeable solution, or perhaps even a graded series of results—first A, then B, C, and finally D. Usually the mediator prepares a written agreement to be signed by all parties.

As with any process-oriented endeavor, no two elder mediations will proceed in exactly the same way. Whether the topic is an elder's independence and continued ability to drive, planning for end-of-life health-care decisions, or anything in between, each mediation is as unique as its participants.

Reprinted with permission of www.mediate.com.