You hit a dead end with your mom and dad, who are both in their late 80s. You think they need some help around the house, but they adamantly refuse. You are frustrated because you want to make their lives easier. They are angry because they think you are meddling in their affairs.
Can negotiation and dispute resolution techniques used in the business world help defuse these types of disputes?
Yes, says a group of researchers at Northwestern University. They are onto something.
These experts have developed a training curriculum on negotiation and conflict resolution for social workers, care managers, and health care professionals who work regularly with resistant older adults. Materials for family caregivers are also being developed.
Instead of sidestepping difficult issues or simply telling people what to do (“You’re going to need home health aides several times a week for the foreseeable future”), professionals are learning to work out what matters most to seniors and treat arranging care as a collaboration, not a decree from above.
“People get into a lot of arguments as they get older. It’s something I see every day in my work,” said Lee Lindquist, MD, chair of the department of geriatrics at Northwestern University Feinberg School of Medicine, who leads the project. Her goal, she said, is to de-escalate conflicts and make it easier for seniors to age on the required support.
In May, Lindquist and her team planned to launch another part of the project: piloting a computer-based training program for family caregivers of people with mild cognitive impairment or early-stage dementia. Called NegotiAge, the program creates avatars for the elderly and allows caregivers to practice negotiation techniques under different scenarios.
“Different positions are thrown in, different feelings are thrown in, and you can play the negotiation game as much as you want,” Lindquist said. Nearly $4 million in funding for the project comes from the National Institutes of Health. After evaluating the program’s effectiveness, Lindquist hopes to make NegotiAge more widely available.
Meanwhile, there are several steps family caregivers can take to prevent or resolve conflicts with older parents.
Bring
Preparation is essential for any kind of negotiation, advises Jane Brett, professor emeritus of conflict resolution and organizations at Northwestern’s Kellogg School of Management and a member of the NegotiAge team. You want to think about answers to several basic questions: What are the issues that need to be addressed? Who are the parties invested in these issues? What are the parties’ positions on each of these issues? Why do you think they take these positions? What will happen if we can’t reach an agreement? “
It is helpful to write down the answers to these questions in a planning document. Be sure to include yourself between the parties and make clear your goals for the upcoming conversations.
How might this look in practice? Suppose you want your father, who is in his early 90s, to stop driving, because he is starting to get lost and his eyesight is not good. People who have an interest in the discussion include your father, your elderly mother, you, your siblings, and your father’s doctor.
Your mom may be worried about your dad’s safety but is reluctant to bring up the issue for fear of provoking controversy. One of your siblings might agree it’s time to pull out the car keys, while the other might think Dad is still okay on the road. The doctor may recommend a driving assessment and then provide a professional opinion.
Find common interests
Your job is to find the areas where these parties’ interests intersect and work from there. Everyone wants your dad to stay active and see his friends on a regular basis. Everyone wants to make sure they don’t hurt themselves or anyone else on the road. Everyone wants their desire to be independent to be respected. Nobody wants to call him incompetent.
Brett distinguishes between attitudes, such as “I won’t stop driving,” and interests, or reasons why someone should take a position. In this case, the father may fear becoming withdrawn, losing autonomy, or relinquishing control of his own affairs. But he, too, may worry about unintentionally hurting someone else.
Brett noted that negotiations have the best chance of success when they address the interests of all parties involved. Don’t take an aggressive approach. Instead, stress that you are on the same team. The goal is not for one team to win. People must work together to find a solution to the problem at hand.
ask questions
Don’t assume you know why your father took a certain stance (“I don’t want to go to the doctor”). Instead, ask follow-up questions, such as “Why?” or “Why not?”
If an older person blurts out, “I don’t want to talk about that,” don’t hold back. Acknowledge their discomfort by saying, “I understand this is difficult,” while adding, “I care about you and want to know more.”
Lindquist prefers to start difficult discussions with patients with open-ended questions: “What are some of the things you have problems with? What do you do that you wish you could do differently? What makes your life easier?”
Listening carefully and making the person you are negotiating with feel heard and respected is essential. If a Lindquist patient tells her, “I make my own decisions, and that’s what I want,” she might reply, “I agree with you that you’re the boss, but we’re both here to make your life better, and I’m worried about you.”
Brainstorming strategies
Negotiations with family members are often fraught with emotions that can easily spiral out of control. But don’t reciprocate if someone gets angry and flogged.
“When you buy a car, if you can’t agree with the dealership you talk to, you can go to another dealer. When you’re in conflict with a family member, you don’t have that option. You have more stubbornness and more disability defense,’” Brett said. Maintaining relationships is more important.”
Redirect your focus to brainstorming strategies that can help solve the problem at hand. Get creative and bring lots of options to the table. Invite your parents to respond and ask, “Why?” or “Why not?” again as needed.
If you find yourself wandering around without making progress, try saying something like, “We could argue about this all afternoon, but neither of us would give up. Let’s put our arguments aside and come up with five ways you can help yourself,” Brett said.
Don’t expect to agree on a strategy right away. “You could say, ‘Let’s bring Mom and talk about this later,'” Lindquist suggested, “or, ‘Let’s think about this and check in with each other next week’,” noting that many negotiations take time and cannot be rushed.
Bring in a third party
If all else fails, appeal to a third party. This was Brett’s strategy when her husband, who has Parkinson’s disease and poor vision, wanted to resume driving in 2021 after recovering from a serious fall. Britt and the couple’s daughter couldn’t convince him this might be too risky, but the older man, then 89, agreed to get a driving evaluation at a facility associated with a Chicago hospital. When recommended to him to stop driving, he gave away the car keys.
Britt later hired a neighbor in the small town in France where they now live to drive her husband to appointments several times a week. Twice a week she takes him to a nearby village where he drinks coffee with his friends. Go out into the world and not worry about safety – an outcome that they both can live with.
KFF Health NewsKaiser Health News (KHN), formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs in KFF– The independent source for health policy research, polls and journalism.