Working with Challenging Families

One of my favorite topics to present live is “Working with Challenging Families” and for many reasons. First, most healthcare professionals have had to deal with a difficult family member or two. Second, it is one of their least favorite things to do. And, third, this topic is ripe for humor and a little stress management. While working with families can be challenging or difficult, the truth of the matter is this – no one looks forward to their loved one being sick, hospitalized or admitted to a long term care facility. No one looks forward to falls, physical decline or dementia. I usually say to my audiences that we as healthcare professionals can also be challenging families when the shoe is on the other foot, and our loved ones are receiving care.

Working with Challenging Families: How Are They Challenging?

In how many ways can a family member be difficult or challenging? Oh, there are many! But, I have found a Top 10 list of the ways that families can be a bit troublesome. Coming in at number 1 is Resistance. Some families may not take our advice, believe that we are telling the truth or may simply be in denial of whatever is happening to their loved one receiving care. Next, we have the Neglectful family, or those who are inattentive to their loved one’s needs. And then, we have one of my favorites – the Dependent family member (aka “High Maintenance”), who asks, ”Do you have 5 minutes?” and then takes an hour of your time. Controlling family members are no fun. They want to control the treatments, medications, staff and plan of care. They can be very difficult and a legal liability. Intrusive family members are walking, talking HIPAA violations waiting to happen. They want access to things they have no legal permission to have access to.

Moving along, we next have my least favorite of any type of family – the Abusive family. All I have to say about them is we should all have a Zero Tolerance Policy regarding any abusive, inappropriate, neglectful or exploitive behaviors from anyone towards residents. The Pathological family can also be a handful. By “pathological”, I mean a family member who is not mentally well, who sexually harasses our staff, who is violent or threatening, one who visits under the influence of alcohol or drugs, has a criminal background, engages in risky behaviors, or is a major legal liability. Dysfunctional families (aka the “Too Much Information” families) can make healthcare professionals uncomfortable by their use of inappropriate language or providing too much personal information that we don’t need to know.

The next family member is me and you – the Stressful family member. We work long hours, deal with a multitude of issues all day long, go home, take the kids to piano lessons or football practice, cook, clean and start all over again tomorrow. In between, our parents are aging and become frail, ill or have an accident. Our kid breaks a leg. The dog needs groomed. I understand the stressful family, because they are hardworking people living their lives the same way we all do.

And lastly, the Colluding family, are those who plot, plan and try to get our staff to work against each other. They are very smart and manipulative people and I give them a lot of credit. But, they can be very difficult and we need to be a step or two ahead of them. They may use collusion to protect their loved one or they may believe they know more about care than we do. Either way, we need to work effectively and professionally with them.

Final Thoughts

You already have or will one day encounter a challenging or difficult family. It is best that you know a little about them and try to figure out what kind of behavioral tactics they are employing. All difficult families are not bad, but they are in need. One common thread that runs through all of these types of families is a lack of coping mechanisms or skills. Did you notice that? If one cannot cope effectively, then controlling the situation may be the next best thing. Becoming dependent on the healthcare professional may work better for me because I cannot cope with the situation. So, what can we do? Help to find ways for families to cope in healthier ways. Communicate openly and honestly with them. Let them know that they are not much different than us when it comes to the illness of a loved one.

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