Entry 01 of 08 · The meeting

How to have a family meeting about aging parents that does not blow up

The Family Caregiver Alliance agenda, adapted for a family that mostly talks in a group text.

If you are looking up how to have a family meeting about aging parents at this hour, the last one probably did not happen in a room. It happened in a thread, at speed, with your brother replying from an airport and your sister sending a thumbs-up to nothing in particular. Then somebody typed the sentence about the will, and everyone went quiet. A meeting is not a thread. It has a start, a chair, an agenda, notes, and an end. That structure is the whole trick.

Who gets invited?

Everyone who does the work or will do the work. The Family Caregiver Alliance says to include everyone who is or will be part of the caregiving team, which may include a family friend, neighbor, or paid caregiver. So the neighbor who takes in Mom's mail has a seat if she wants one. The brother in Dallas has a seat, on video, camera on. The sister who holds the power of attorney has a seat and an item on the agenda with her name on it. If a spouse has been driving Mom to physical therapy, that spouse is on the team whether or not anyone said so.

Leave out the people who are only there to comment. A cousin with opinions and no Tuesday is not on the caregiving team. You can send her the notes.

Should Mom be in the room?

Usually, yes. It is her life, her house and her money, and a meeting about her that she is not invited to will feel to her like a conspiracy, because it is one. The exception is specific. FCA says that if someone has dementia or another condition where they might misunderstand the purpose of the meeting, it might be appropriate to hold at least the first meeting without them present. If that is your family, hold the first one without her, decide what you are going to ask her and how, and then hold the second one with her at the table.

Who runs it?

Not you. That is the hardest line on this page and the one that matters most. The sibling who does most of the care has the most to say and the least patience left to say it. If you chair, every item sounds like a bill. FCA's guidance is that someone in the family introduces the idea of a meeting, arranges the date and location, creates an agenda and sends it out to everyone ahead of time. Give that job to the sibling who does the least. It is his first line item, and it costs him one hour.

If the last thread ended in a way you are still thinking about, get a referee. FCA says that if communication is particularly contentious, arrange a family meeting that includes an outside facilitator, such as a social worker, counselor, religious leader or friend. The referee decides nothing. She keeps the meeting on the agenda and the history off it.

The one-page agenda

FCA's family meeting guide lists the topics a first meeting should cover: the latest report from the physician, sharing of feelings, daily caregiving needs, financial concerns, who will make decisions, what support the primary caregiver needs, respite, problem solving, and a schedule for the next meeting. Here is that list, in the order that keeps a family from arguing about item six before item one is settled.

1. What the doctor said. A report, read out by whoever was in the room. No interpretation. If nobody was in the room, that is the first job assigned.
2. What Mom needs this week. Rides, meals, the pill box she already has, laundry, the stairs, nights. Concrete. Count the hours.
3. Who is doing it now. Names and hours. This is where your load becomes visible without you saying a word about it.
4. Ten minutes for feelings, with a timer. FCA is blunt that all feelings are appropriate and need to be expressed and acknowledged, and people will talk about them if they feel safe. Give it the ten minutes. Then move.
5. Who decides what. Who holds a power of attorney, for health and for money, and what it says. If nobody knows, that is a job, not a fight.
6. Money. What Mom's own money covers, what is left over, and how the rest gets split. Come with the ledger, not with a grievance.
7. Who takes what. Each person leaves with at least one line item and a day of the week.
8. Relief for the one doing the most. A weekend off is a task on the list, not a favor.
9. Next meeting. FCA says family meetings need to take place regularly, and it helps to schedule them at a given time, perhaps the same time each month. Put the date in the notes before anyone leaves.

Three questions to settle before anyone talks about money

Money is item six for a reason. Open with it and the meeting becomes a negotiation between people who do not yet agree on the facts. Settle these first: what she actually needs this week, using Medicare's list of bathing, dressing, using the bathroom, climbing stairs, cooking, food shopping, house cleaning, paying bills, and driving to appointments; who is allowed to decide, because Missouri's health care power of attorney is a separate paper from the money one and the Missouri Bar says you do not need a lawyer to complete its free health care form; and whose money it is. Mom's money pays for Mom first. The CFPB tells family agents to never mix her money or property with your own or someone else's.

Ground rules that hold

• One person speaks. The chair keeps a list of who is next.
• Nothing before this year. The 2009 loan, the wedding, the favorite child. Not on the agenda, not in the room.
• The out-of-town sibling takes the notes. He can type. It gives him a job and gives you a record.
• Decisions go out in writing within a day. Three lines per decision: what, who, by when.
• The thread is for logistics only. Ride swaps and pharmacy pickups. Anything with a feeling in it waits for the meeting.

One line item ends more meetings than any other: the shift nobody can cover. When the honest answer to "who takes Thursday nights" is nobody, the family is choosing between wearing out one person and paying for help. A non-medical in-home aide can take a scheduled shift, meals, company, being in the house overnight, so the meeting settles who pays instead of who suffers. New Plan Care, an independently owned company in Chesterfield, is one such option in west St. Louis County. It is also the paid placement on this site, labelled below.

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