Cloud Above Santa Maria degli Angeli, Assisi
Yes, this is an excuse for a post about elder and probate mediation. . . ! On Monday I gave a presentation to a Parkinson’s support group in Arvada. One of the major points I raise about disability planning (like health care powers of attorney, advance directives – a/k/a living wills – and general durable powers of attorney) is its value in the minimization of conflict. Conflict is a normal part of human existence and it is inevitable, but how we choose to deal with conflict, both individually and in a group like a family – can be complicated and sometimes destructive, particularly when a loved one faces a health crisis and we are left feeling powerless.
End-of-life care decisions are usually difficult under the best of circumstances, so when there is disagreement between a spouse, adult children or other family members, this can be a source of major problems which adds to the stress of the caregivers and the encroaching grief from the advance of the disease process.
Late stage care, like hospice and palliative care, can often provide turning points in the care of a person when family members may start to better come to grips with their loved one’s impending demise. This is not often the case however. Sometimes with neurodegenerative diseases such as Alzheimer’s or other forms of dementia, ALS or Parkinson’s, there is a steady and inevitable decline, but this can also be unpredictable and sudden. Here’s a link to the National Institutes of Health’s National Institute of Neurological Disorders and Stroke, which has an exhaustive list of many different types of neurological disorders.
We need support groups for raising awareness about these diseases and also because these groups can provide resources and mutual support for family caregivers. As I told the group I addressed today, one of the highlights of practicing law in this field is that I get to see and also help facilitate people taking care of their family members, providing them with love and care during times when that is what is needed. One of the reasons we need support groups is that we have never had so many people living with these diseases. While it may seem that these diseases might well be a side effect of our unprecedented longevity – here in the US as well as in many parts of the globe – it remains a mystery why these diseases are affecting larger numbers of people, particularly as there are more of us aging.
There are productive alternatives to court proceedings that can be considered when an elder’s decision to continue to drive is no longer a safe choice, or where a parent’s health care agent is perceived by siblings to be suffering from “compassion fatigue,” or when disagreements about the type of appropriate caregiving have overtaken the family members’ ability to effectively communicate regarding the elder’s care. This is where elder mediation can be particularly helpful.
It might be useful at this point to distinguish elder law from elder mediation. The practice area of elder law is defined by the legal problems of the elderly (which practically makes it a broad general practice area, which is why many of us focus on particular aspects of it) and the “consumer demands” of the elder population. Elder mediation, in contrast, often struggles to include the voice of the elder and to respect the dignity of their choices and preferences in circumstances of intense conflict which can often involve encroaching disability or increased frailty, slipping cognitive skills, other health challenges. Here’s a link to a recent article in Bifocal, a journal published by the ABA Commission on Law and Aging, which features research on the topic of health care decision-making authority.
The providing of care and sharing of care for an elder who has a neurodegenerative disease can be stressful to establish, particularly when sibling have different approaches to and comfort levels with conflict. This is why talking with an elder mediation professional can be helpful. But there are several useful articles available on the web about “self-help” for disputants, and I liked this one from Social Work Today. A particularly effective means of dealing productively with inevitable conflict is to make plans around it, particularly by having the conversation around end-of-life matters and also executing documents that name health care agents and express wishes and values. Here’s a link to the Life Quality Institute, where you can find helpful resources.
I will end this post on a happy note, about the Dementia Friendly America Initiative, which seeks to make our communities easier places of inclusion for people with dementia, so that they continue to be recognized as community members. Denver is one of the communities which has pledged to become “dementia friendly” as this press release from the Colorado AARP explains.
©Barbara Cashman 2015 www.DenverElderLaw.org