Eldercare Facilitated Dialogue and Shared Decision Making


Families today are assuming responsibility for the informal care of over 75% of elderly family members, and are often faced with difficult decisions from a bewildering array of choices including alternative living arrangements, financial issues, and multidisciplinary care. In the best of circumstances, this can be a stressful process, and sometimes leads to disagreements, confusion, and conflict at a time when the best intentions of the family are to work together for the needs of a loved and respected aging family member. Often families do not want to admit or acknowledge they have a family dispute, but they all know their interactions are strained and not as comfortable as they may once have been, to whatever degree.

What is Eldercare Facilitated Dialogue & Shared Decision Making?

Eldercare mediation (see above) is about dialogue and decision-making; it can also be referred to as Facilitated Shared Decision-Making. Facilitated Dialogue and Shared Decision Making is an alternative to help families work together meaningfully and productively. With the help of a trained professional mediator facilitator, family members engage in meaningful conversation, share information and perspectives, obtain outside medical and emotional and social evaluations as requested, explore and evaluate options, and develop workable solutions through a process that promotes open and positive communication.

The facilitator is a trained mediator and neutral that does not offer advice, but instead offers structure for a productive conversation. The facilitator believes that each family is unique and knows best what solutions will work for their family as a whole. For families in conflict or simply wanting help through a transition, eldercare facilitated dialogue and shared decision-making offers a process that can reduce stress for a family, including the elderly parent, and prevent a crisis. It can also reduce stress and conflict between the family and other care providers such as hospitals, nursing homes, and assisted living facility staff.

The process is flexible yet durable. Not only might the outcomes include decisions about living location, personal and medical care responsibilities, property and asset management, appropriate compensation for care, emergency communication plans for families, and plans for ongoing communication of family members, but they may also include decisions and plans for quality of living such as how to stay in contact with friends, church members, pets, hobbies, children, and even a spouse living in a separate facility.

For example, Ms. S. found herself in a difficult situation. Her 74 year old mother, living out of state, was recovering from a broken hip, but was not yet able to return to her own home. Ms. S. was working split shifts as a nurse and living in a rather small second floor apartment. She and her sister talked occasionally but had not been close for years. Her brother, recently divorced, was struggling himself and did not think he could offer much help. They had decisions to make, but discussion began to escalate into arguments. The family agreed to try mediation with a mediator of Louise Phipps Senft & Associates/Baltimore Mediation and came together to create a plan that would provide the needed care for their mother with the resources and time each of them could offer. As is often the case in mediation, they became quite creative in their approaches and developed a solution that not only achieved their goal of providing the best care they could for their mother, with resources provided as each was able, but also brought them closer together as a family in the process.

Who Can Be Involved in Eldercare Facilitated Dialogue and Shared Decision Making?

Anyone who has an important stake in the decisions being made – the older person, a spouse, sisters, brothers, sons and daughters, care facilities, physicians, mental health providers, or just the family. If there is a problem because of geographical distance, teleconferencing can be arranged so that the process is truly shared decision-making. For families who make the commitment to work collaboratively, the road that seems paved with stones is often found to be smoother.

Family Facilitators of Louise Phipps Senft & Associates/Baltimore Mediation believe in Better Process…Better Outcome.