Family mediation for elderly care

Dec 14, 2010

Crystal Thorpe, a founder of Elder Decisions, will take your questions about how families and seniors can deal with elderly care issues.

My family is very concerned about my grandfather, but aren't sure what to do. He lives far away (retired to Florida), and is alone after his second wife passed a few years ago. We aren't able to visit frequently, but I know he is a very dangerous driver, that he has a very poor memory, and he often complains about being lonely, but is unwilling to participate in any of his retirement-community activities where he might meet people or at least have some company. He has outlived both his children, who might have been able to talk to him, and my mother feels uncomfortable doing it. I worry about him being alone, driving, forgetting to do important things, and even little things like eating right and not drinking too much. He is difficult to talk to because he is always putting us on guilt trips about how we don't come to visit, and seems to have forgotten about things like limited vacation time at work and traveling long distances with an infant. Plus, a long time ago he did choose to move far away from any family, and part of me thinks he should have been expecting limited visits. I don't really know if there is anything I could/should be doing to help him, and I'm pretty sure he would never listen to me if I said "you shouldn't drive any more" or something similar.

Thank you for sharing your concern about your grandfather.  While it may seem difficult to bring up the subject, a conversation together can be a good place to start.  Asking him some open-ended questions like “how are things going for you?” and really listening to his answers can give you information about what’s going on for him and start to show him you care.  Let him know you are concerned for his well-being and safety, and ask him what ideas he has and if there are ways he’d like your help.  He may also be concerned about his own driving, for instance, but be worried about giving up his independence, so together, you may be able to come up with some options that can maintain both his safety and his independence.  For information about services that are available in his area, you may find the website to be helpful.  

Would a mediator be appropriate in a case where an elderly father with dementia insists on staying in his house and all of his children and his doctors can see the dementia and frailty in him? In this case, it is my father who has dementia, refuses to move (even though he can't live without one of his kids staying to cook and care for him). He has caused fires cooking and forgets to pay bills or take meds. I have taken him to see a very nice assisted living facility (looked more like a posh hotel to me), but he thinks he is fine and wants to stay put. How do people manage a move in this case ? Is it possible, or do we have to wait until he gets so sick, that there is no option. I have been caring for him in and now my health has become worse (cardiac issues). Any advice would be helpful.

Yes, mediation can be appropriate here, as a way to talk with him about your concerns and hear his own, and come up with options that can work for all of you.  A Geriatric Care Manager may also be a helpful resource; a GCM can assess your father's ability to live at home, suggest modifications in the environment, as well as suggest and provide supports in whatever environment you all agree on.  See

Gramps is a sturdy and solid 88-year-old small business owner who continues to work 6 days a week. His wife, who has always worked by his side, is unfortunately, of declining health due to cancer. She is often uncomfortable in the office now, but no one wants to leave her home alone while Gramps is at work. There are no family members nearby who are suitable or available to spend the day with her at home. To force Gramps to stop working would be horrible for his well-being. Gram can still go to work sometimes.

Is it realistic for her to get a nurse once or twice a week with little notice, on the days she wakes up not feeling up to it? They were considering assisted living, but I fear the physical and mental burden of moving will be very hard on them right now. Ideas on what's best?

As far as what is realistic for resources in your area, you may want to consult some local organizations near where they live. can help you locate appropriate care nearby.  Regarding "what's best" - this varies from family to family.  Consider having a conversation with your grandparents to hear their concerns and their wants, and then to express your own.  If this conversation sounds challenging, a mediator can help.

How can employers support their employees who have become the caretakers of their aging parents?

Providing flexibility to the extent you are able can go a long way toward reducing the stress that caretakers are under.  Be clear with your employees around what flexibility you can allow and how you wish to be communicated with (regarding schedule changes, etc.).  Offering "brown bag" programs about issues related to caregiving, and even an employee caregiver support group, can be helpful to provide information about resources available and give needed support to caregivers.

My grandmother is generally able to live on her own, but requires daily help in things like taking prescriptions (forgetting to take it all or taking too much), household chores (including food preparation, taking out the trash, etc), among other things (she doesn't drive).

My mom had hired an assistant to help with the household chores but my grandmother eventually "let her go" because she claimed she didn't need the help. Now my mom takes care of everything, while still working full time.

An assisted living community is out of the question because (1) we cannot afford it and (2) my grandmother would refuse to move. So, I have two questions.

One, are there other options for assisting my grandmother that are low or no cost? And two, how can I support my mom when I don't live in their area (they are in New England)?

Yes, there are other resources available.  Check with her local area service on aging (in Massachusetts called Aging Services Access Points - see for information on what is available there.  (Nationally, try There are also medication boxes that have alarms and timed releases to help people remember when to take medications.  Regarding supporting your mom, while it may not sound like much, a good listening ear can go a long way.  Check-in with your mom regularly and give her the chance to talk with you about her experiences (both joys and frustrations).  Asking her how you might help provide her with some respite can also help.

How can I help my elderly father manage his house and such without insulting him? He's fairly perky for 88, but I do worry. I live in the same town, so distance isn't an issue. He does the "ADLs" with zero problems so far.

Start by asking him if he'd like some help -- acknowledging that he seems to be doing really well but that you want him to know you are there and willing to help out if there's any way he'd like you to.  Remind him that you care about him and love him, and want to help if he'd find it to be helpful, but that you also don't want to "step on his toes."

Sometimes an elderly person experiences hearing loss without being aware of it. Family and friends should make sure he or she gets periodic checks. I've known several people confuse hearing loss symptoms with dementia - and look for nursing homes too soon!

Great point.  Thanks for sharing! 

Regular medical workups are also helpful.  Some physical issues (like urinary tract infections) can produce symptoms that are misleading and similar to dementia.

After being the main person [to care for] my frail and declining mother relied on for more than 10 years, I seem to be unable to re-energize and move on after her passing two years ago. I don't think it is depression, but more of a general emotional fatigue. I suppose it is different from, yet related to, real-time care-taker burnout(?). Do you know of any resources that might help me with this? Thank you for the chat.

You may find some of the groups and forums at the Family Caregiver Alliance website ( to be helpful.  Local aging service centers may also have in-person groups that would be helpful.  Finally, consider talking with a local counselor, clergy, or therapist.  Therapy need not be long-term, but can be very helpful to deal with the grief and exhaustion following your long-term caregiving, and can be a way to give back to yourself and identify how you would like to reinvest in your own life so that your future can be fulfilling.  Best wishes to you.  You gave a tremendous gift to your mother.  Take the time now to treat yourself with loving care -- you deserve it!

Do you have any suggestions on how grandchildren in their 20s can help? My friends and I discuss how we all live/work pretty far from our grandparents and therefore cannot provide much physical help, and in this economy we can't provide much financial help either. My parents are visiting, doing paperwork, contributing money... I feel terrible. I've been acting as a source of emotional support to my parents and do what I can when I go home for the holidays, but I feel that I should be doing more. Do you have any suggestions? Thanks!

The emotional support can be very helpful, so it's great that you recognize and give that.  You may want to ask if there is some respite you can provide when you do visit -- for example, providing extra visits to your grandparents, cooking meals for the freezer, or helping with appointments while you are there.   And, while distance may prohibit you from helping your own grandparents as much as you would like, consider volunteering locally to help other people's grandparents nearby -- delivering Meals On Wheels, visiting at a local senior center or facility, etc.  Thanks for your caring.

How do you help an elderly parent make decisions about the proper care needed for her spouse, who has dementia? My mother is very stubborn, needs to get VA benefit application done, needs to take care of banking issues, needs to place husband on a nursing home waiting list (which means getting a doctor to fill out a portion of the forms), etc. etc. but keeps letting other things get in the way. I have stopped making suggestions and just help out, no longer say anything. We could possibly be left having to make decisions on our own if she were to become incapacitated (not likely at the moment but one never knows). Thank you.

It sounds like all these steps may seem overwhelming for her.  Acknowledge that all these decisions and steps can seem difficult and overwhelming, and give her the chance to talk about it if she wants to, just listening to what she's going through.  Ask her if there is any piece of this that she'd like your help with.  Let her know that you are worried about what might happen in the future, and want to be of help to her now if you can. 
If this conversation seems too difficult to have on your own, a local mediator can help you talk together and hear each other.

Should the child who provided all the support for a parent in an assisted living home be entitled to more of an inheritance share if the will stipulated equal division?

Your question has two parts – a legal question (and for that I would direct you to a website resource for elder law issues: and a question of fairness.  What feels fair can be different for each family member, and as a result, fairness is an issue that is often discussed in mediation.  Sometimes, when people have a conversation about fairness and hear each other’s points of view, they can craft solutions that feel fair to everyone.

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