Senior Centers, church groups and anywhere seniors congregate find more and more conflict surfacing among seniors and well-meaning family members. Life expectancy in America has increased between 1900 and the year 2000 from 47 to 76 years (AARP, 2001). The increase in family/elder conflict that has resulted runs the gamut from estate squabbles, to living accommodations, to out-of-town sibs who blitz into town for a week and criticize the primary caregiver for the way the parent is being treated.

As seniors age, their concerns and complaints are many about well-intentioned family involvement:

“All my kids want is to take my car keys away,” said 82 year-old Catherine*. Meanwhile, Catherine’s eldest, Nancy, is tired of getting calls from the police because her mother drove over the street lines or got lost.

“My daughter wants to put me in a nursing home. I’d rather die first,” retorted 78 year-old Rose. Rose’s daughter, Melissa, who found her mother’s stove left on several times this last month and noticed smoke singes on the kitchen wallpaper, agonizes over Rose’s safety and dreads getting into another shouting match over the need for help.

“My family thinks I’m going to come live with them so they can control all my money,” fears John. “Ever since I turned 85, they think I don’t know what they’re up to.” And Jim worries that his father, John, will fall again with no one around to help him. With John’s diabetes, Jim can’t afford to let him be alone much longer.

Almost daily in our mediation and counseling practice, my coworker, Thomas O’Reilly, and I receive calls from caregivers with these and similar stories. Adult children with best intentions, try to balance careers, children and spouse duties and care for the growing list of needs of their aging parents. Somewhere in between, they are encouraged to exercise, practice yoga for stress relief and maintain healthy self-care.

Caregiving, meant to be an act of love and family dedication, can become stressful or, at the worst, a path to burnout and even elder abuse. Sadly, caregivers often remain unaware of conflict solutions that would reduce stress, provide extra services and help them juggle responsibilities.

One such solution is mediation, a process in which a neutral third party (the mediator) helps two or more parties participate in a respectful decision-making session, which can last a few hours or continue over several sessions. Mediation can be utilized for stepfamilies, business conflicts, divorce dissolution and neighborhood disputes. The process is often chosen because people are helped into communicating respectfully, saving time and avoiding costly court battles.

For decisions involving elders, a specialized type of mediation has emerged within the last decade known as Elder Mediation (EM). Some mediators simply use the term Family Mediation; EM distinguishes it as a specialty. Since 1994, EM projects and research studies have emerged internationally, including the U.S. One mediator, Margaret Dale, has begun teaching a course in Elder Mediation at Sonoma State University in Santa Rosa, CA.

The goal of EM is to allow seniors a voice in the decision-making process and to help families communicate with compassionate candor about situations which need to be addressed. Estate matters, end-of-life decisions, living arrangements, medical preferences and driving concerns are typical issues. Because all parties have a voice in the outcome, we see an 80% to 85% compliance success rate in most kinds of mediations including EM.

A recent mediation that we handled involved an aging mother and her daughter.

A frazzled Chris called Thomas near tears several months ago. Her mother, Barbara, just celebrated her 75th birthday, tries to stay active in her Fairlawn home of fifty years that she and her now-deceased husband built. Barbara knows all the neighbors, everything is just where she can find and reach it and she enjoys her garden of lavender and lovely spring perennials.

Chris (age 47) worried because her mother fell just before Christmas and was unable to get up until a neighbor friend came over and found her. “Mom repeats stories over and over and the house is not kept up [like it used to be]. She was meticulously clean. I can’t believe she lives like this!” said Chris. “I live a half hour away, and it’s getting harder and harder to support my husband’s new business, work full time and still take care of our three kids,” she added. “I’ve even been to counseling for this as my stress increases, but Mom refuses to come.”

Because many seniors were raised into thinking that counseling is taboo, they are often resistant to anything involving that profession. However, mediation is often more conducive to attempting a fair resolution.
Chris was desperate. The dynamics of their once loving mother-daughter relationship were quickly deteriorating and frequent arguments became the norm. Chris tried to discuss assisted living options with her mother, who always replied, “I will die in my own home. End of story.”

Chris, feeling strong layers of guilt for even having to consider moving her mother, believed that safety first was in mom’s best interest. And Barbara felt resentment and betrayal, threatening to hire an attorney and write Chris out of her will.
When they arrived at the first mediation session, Barbara’s close neighbor whom she trusted and who had befriended her came with.

Chris and her husband, Ray, came without the children. The atmosphere was cordial yet clearly guarded.

Most mediators follow a six-step process, which was also used with Barbara and Chris’s family.

Step 1 Following introductions, the mediator explained her background, prepared them for what to expect in the mediation process and articulated ground rules. Some of the rules included no name calling, no rehashing bad past experiences, one person can speak at a time and conversations should be future oriented.

Step 2 Both parties related his or her side of the conflict as each saw it. Barbara was adamant that she was not going to a nursing home; Ray and Chris spoke of their feelings of love and guilt and growing concern for Barbara’s safety. Each side was asked to repeat what the other said to make sure each was being represented clearly.

Step 3 The mediator asked for clarification on some points, reminded parties about needing to keep emotions in check and proceeded to ask for some alternatives to keep Barbara feeling independent and Chris knowing her mother was safe.

Step 4 Barbara, though resistant at first, at least agreed to hear some suggestions from Chris, though it was obvious she was holding her ground to stay alone at home. Chris threw several options on the table including a three-month trial at assisted living closer to where Chris lives, a live-in caregiver, living with the family on weekends and adult day care. The mediator also suggested options such as using the Meals-on-Wheels program, looking into a local senior center for social support and a parish nurse to help check in on her mom. Barbara was even able to disclose to Chris how afraid she was to lie on the floor for two hours until her neighbor came by.

Step 5 Chris, Ray and their mother began the negotiation phase of the mediation by taking a look at each option, tossing out unacceptable ones and keeping others. With this, another option surfaced: Barbara could go through a Geriatric Assessment (a comprehensive medical and psychosocial screening).

Step 6 All family members agreed to the Geriatric Assessment, to Meals-on-Wheels and to looking into the services of their church’s Parish Nurse Program. It is critical at this stage of mediation that all participants feel they are walking away with a comfortable resolution to their conflict. The mediator draws up a contract at the time or a few days later that all parties sign. Barbara, Ray and Chris also agreed to implement these decisions immediately and to re-evaluate the situation in two months.
Chris called a few weeks ago. She has relaxed a bit knowing that her mother’s geriatric assessment showed a very slight sign of early dementia that is being monitored and that many other elements are now in place that have taken some of the strain off their relationship.

“At least I know there’s a process to go through to help guide us in making these weighty decisions. I was such a wreck before, and my husband and kids were taking the brunt of it. I never heard of Elder Mediation, but now I’m beginning to feel like I’ve got my mother back. We don’t argue near as much, and I know if mom deteriorates, someone can help us sort it all out,” Chris said.
Elder Mediation is just one of many options caregivers have and can use to maintain healthy family balance, consider decision-making options about which they may be unaware and change their attitude from being grudgingly responsible to feeling a restored sense of empowerment, self-control, and freedom to love and care for family members.

Advantages of Elder Mediation Any mediation–whether for young step-families, business conflicts, divorce dissolution, neighborhood disputes or involving an aging parent—can effectively convert what once felt like a runaway train into at least a manageable ride. Effective mediators:

• Help people communicate respectfully
• Encourage disputants to think outside the box, considering options they couldn’t see when in the heat of the battle
• Keep the process simple, structured and fair
• Ensure that all parties feel a sense of accomplishment
• Creatively offer options that parties may not have considered
• Develop an atmosphere in which all parties see they are working together to attack the problem and not each other
• Help parties hammer out plans that are manageable and agreed upon by all
• Teach a process that conflicted parties can use at home (or elsewhere) when they face future conflict
• Work toward decreasing instances of elder abuse when caregiver stress gets beyond them