Has anyone participated in family mediation to delegate caregiving responsibilities with siblings and to at least agree on a decision model for care decisions?

Back to the question of whether Mother should be at the session.

My experience is with family meetings, without a mediator. The care recipient is my husband and he has Lewy Body Dementia. We have had the meetings without him. This has allowed all of us to be more open and candid. We may need to discuss prognosis and probable next steps, but hubby may not need to hear that as candidly as we need to explore it. Many dementia patients are or can become somewhat paranoid. They don't always interpret statements correctly. If a dementia patient is present, you must deal with the dementia rather than focus on the purpose of the meeting. Speaking in love is not enough to make your intentions clear.

I am now reading a book, "Living with Lewy's" and the chapter I read last night specifically recommends family meeting without the dementia patient present. This is what prompted me to respond again.

Soverytired, your circumstances are different than mine, and you'll have to adjust for that. I know that if we have a formal family meeting regarding taking care of our Mother, she will not be included. She is 91, probably mild cognitive impairment but not officially diagnosed. She doesn't need to know if there are disagreements among her kids. She doesn't need to listen to the ones who have most contact describe to the other what her day-to-day impairments are (she would deny them and think we are lying or being mean). She just needs to know the ourcome, and be reassured that though of course she doesn't need any help (ha!), we are all ready to help when that is needed.

A mediator is a good step in the right direction but it sounds as if your family would benefit from a care plan that is developed by a certified geriatric care manager first. Often times when family members have a disagreement over the care needed/provided it's because they are either unaware of the real situation or uninformed. Mix in family dynamics and everyone suffers. I'd suggest calling in a certified GCM who will come to mom's home and meet with her, asses her capabilities, the care she needs now and in the future and will write up a care plan with her recommendations for home safety and quality of life and provide community resources. This should be shared with all family members. Once you have a professional plan you now have a solid place to start discussion of the care needed. If mediation is still needed, the mediator should be given a copy of the care plan - it will reduce the emotion and personal bias and give them a solid foundation of the issues to be discussed. Good luck and God bless.

Dear Soverytired, you are describing a situation in which, you're right, there is a lack of collaboration over a care plan. And it sounds like you just identified your goal -- collaboration over a care plan. I am a mediator and I can tell you that you just identified perfectly what your next step should be. I suggest that, for the next phase of this interaction with your family, you focus all your efforts on communicating explicitly AND demonstrating with ALL your actions!, that you believe it is both useful and possible to develop a care plan collaboratively. Your idea of mediation is a good one, because a third party CAN help. But if you put out there "let's do mediation" then the topic of the conversation becomes "should we or should we not do mediation?" Then it's easy to get stuck in, "No I don't want to do mediation" vs. "Yes we should do mediation" (especially when most people don't really understand what "do mediation" means!). Meanwhile, it sounds like you're already past that in your mind to "Should Mom be included if we do mediation?" Reel it back a couple of step to the original topic "Let's develop a care plan together." It's harder to respond with "No, let's not develop a care plan together." If you slowly build up that idea -- and don't jump ahead to "we can't do this because our family is so dysfunctional, we need help etc etc" -- and you get people behind the idea of working together, then the group may eventually discover it needs help, and may agree to go get that help together. Or it may not even be necessary. I'm trying to say that you are taking a leadership role in a family that does not have a history of collaboration, and you are trying to lead it in that direction. You'd like more collaboration over care, and you feel like mediation might help (and you're right), but on the subject of mediation you're encountering...guess what, a lack of collaboration! So, as a leader in your family, your job is to develop collaboration over this, too. Don't faint: what I'm proposing won't make it all take longer; it's the quickest way. Model collaboration in EVERYTHING you do, and frame it in ways that nobody would have the face to refuse. "We all want what's best for Mom, right?" Get agreement on that, even if it's "Jeez, what an insulting thing to say, of course we do." Then "If we can work together on what's best for Mom, I think that would be good, no?...." You may get "we can't work together, we always fight" or "No, because I don't like how you do it." Don't give up or get into a fight over THAT. Show a stubborn and courageous belief in the possibility of collaboration at THAT step, too! Respond with "oh, let's see if we can address that. What do you want to see happen?" You may very well get to something like "So, what's a good way to work together on this, are there times we could all talk on a conference call?..." and so on. Take it step by step, insist with yourself that you will always behave collaboratively, which will help you not take any old confrontational bait, and you will actually be showing your family HOW to do this. You can be a very powerful force for good in this way.

Update - Just to clarify, my last response should have been addressed to cindylaverty who needed more information to help...sometimes the expert opinions on this site are kind of 50,000 feet in the air so I decided to try providing additional information to see if I could get something more grounded.

I do appreciate your comments jeannegibbs, I have noticed that you are frequently there to offer comforting, non-judgemental words.

I have read and reread your answer and seriously, I am not sure if maybe you just provided an answer to me because no one else was answering? I would not be at this point if I hadn't exhausted other options and none of it makes sense to me either. We all grew up in an alcoholic, domestically violent home. Every adult in our lives was an alcoholic, our parents and stepparents. Secrets and alcoholic family roles are our norms. It has already been demonstrated that it is not possible to express ideas openly and honestly but everyone's actions are rooted in love, it's just the love as expressed in a dysfunctional family unit. I contacted a mediator based on advice on this site to get a third party involved. I feel like the process is still unavoidably confrontational to the elder and that is my concern which is why I really want to hear from others who have been through the process. I am my mom's primary caregiver. So when my sister decides that its a good idea to reduce HHC aides without having laid eyes on my mother in over 9 months, I get concerned that there is a lack of collaboration over a care plan. I know my mother is frightened, I don't want to frighten her and I don't want her to shut down. That is why I am looking for the pros and cons of involving the elder. On the one hand, I do not want her to feel like something is happening behind her back especially while I'm trying to preach a "no secrets" policy to the rest of the family in a family where the norm is secrets. On the other hand, she is cognitively aware but has an aging brain (90 yo) so I don't want to overwhelm her. So with that background, do you have any actual experience on how confrontation is minimized in family mediation and any opinion on whether or not the elder should or should not be involved or involved in some but not all parts?

Mediation can be extremely useful when a family is at odds regarding the care for an aging parent. Before you invest in mediation, however, have you and your "willing sibling" had a serious conversation with your mother? A conversation that is rooted in love and kindness and where you express your ideas openly and honestly but not in a confrontational manner? It seems like you need to understand why your "unwilling sibling" has the POA and does not want to be involved in making care decisions. POA can always be changed if it is not in the best interest of the senior. Why does your sibling NOT want to be involved? It doesn't make sense.
However, if you feel like nothing will be resolved (and that's the operative word) by just having the two "willing" siblings meet with Mom then a mediator will be able to help. I would want to know more about what your desired outcome will be with this meeting and be very clear that this is not in any way intended to make your mother feel uncomfortable or attacked.

So ask the mediator how he/she helps families reach the desired outcome. It's often a good idea to have an outside person who is not emotionally vested in the family dynamic guide you through the process. I assume you are trying to honor your mother's wishes and create the best possible care plan for her. If the "unwilling" sibling has POA, it doesn't seem like this is possible. The person who has POA must be willing to take on all the responsibilities of this role. The focus has to be about your mother and clearly you understand that. So get VERY clear about what your desired outcome is for mediation and then strategize with the mediator and your other sibling to find ways to make that a reality. Remember also that your mother is probably a bit frightened beneath her willingness to attend mediation. If you want to share more I'm happy to offer more help. Keep your eye on the end result and try not to get go into the weeds during the mediation. You don't want your mom to shut down. Best of luck.

Lordy, what can you accomplish without the POA? On the other hand, this might be an eye-opener for Mom, who can change the POA designation if she chooses.

Isn't one purpose of a trained mediator to reduce the confrontation and facilitate discussion?

I have no experience with mediation. I'm interested in hearing what others' experience has been, too.