By Judith Graham Kaiser Health News
You’ve reached a standstill with your mother and father, who are in their late 80s. You think they need some help in the home, but they vigorously refuse. You’re frustrated because you want to make their lives easier. They’re angry because they think you’re interfering in their affairs.
Can negotiation and dispute resolution techniques used in the business world help defuse these kinds of conflicts?
Yes, say a group of researchers at Northwestern University. And they’re on to something.
These experts have developed a training curriculum on negotiation and dispute resolution for social workers, care managers, and health care professionals who regularly work with resistant older adults. Materials for family caregivers are being developed, too.
Instead of avoiding difficult issues or simply telling people what to do (“You’ll need home health aides several times a week for the foreseeable future”), professionals learn to elicit what’s most important to older adults and approach arranging care as a collaboration, not an edict from on high.
“People get into so many arguments when they get older. It’s something I see every day in my work,” said Lee Lindquist, chief of geriatrics at Northwestern University’s Feinberg School of Medicine, who’s leading the project. Its goal is to de-escalate conflicts and make it easier for older people to receive needed support, she said.
In May, Lindquist and her team planned to launch another part of the project: a trial of a computer-based training program for family caregivers of people with mild cognitive impairment or early-stage dementia. The program, called NegotiAge, features avatars of older adults and allows caregivers to practice negotiation techniques under different scenarios.
“You get thrown different situations, different emotions, and you get to play the game of negotiation as often 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 widely available.
In the meantime, there are several steps family caregivers can take to forestall or resolve conflicts with older parents.
Preparation is essential for any type of negotiation, advised Jeanne Brett, professor emerita of dispute resolution and organizations at Northwestern’s Kellogg School of Management and a member of the NegotiAge team. “You want to think through answers to several fundamental questions: What issues 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 believe they’re taking those positions? And what’s going to happen if we can’t reach an agreement?”
It’s helpful to write down answers to these questions in a planning document. Be sure to include yourself among the parties and spell out your goals for the conversations to come.
What might this look like in practice? Let’s say you want your father, who’s in his early 90s, to stop driving, because he’s started getting lost and his vision isn’t great. The people with a stake in the discussion include your father, your elderly mother, you, your two siblings, and your father’s physician.
Your mom may be concerned about your father’s safety but hesitant to raise the issue for fear of provoking an argument. One of your siblings may agree it’s time to take away the car keys, while the other may think Dad is still fine on the road. The doctor may recommend a driving evaluation and subsequently offer his professional opinion.
Look for Common Interests
Your job is to find areas where these parties’ interests intersect and work from there. Everyone wants your father to remain active and see his friends on a regular basis. Everyone wants to ensure he doesn’t injure himself or anyone else on the road. Everyone wants to respect his desire for independence. No one wants to label him incompetent.
Brett distinguishes between positions, such as “I’m not going to stop driving,” and interests, or the reasons why someone takes a position. In this case, Dad may be afraid of becoming isolated, losing autonomy, or giving up control over his affairs. But he, too, may worry about hurting somebody else unintentionally.
Negotiations have the best chance of success when they address the interests of all the parties involved, Brett noted. Don’t adopt an adversarial approach. Rather, emphasize that you’re on the same team. The goal isn’t for one side to win; it’s for people to work together to find a solution to the issue at hand.
Don’t assume you know why your parent is taking a certain position (“I don’t want to go to the doctor”). Instead, ask follow-up questions, such as “Why?” or “Why not?”
If an older person snaps, “I don’t want to talk about it,” don’t back away. Acknowledge their discomfort by saying, “I understand this is difficult,” while adding, “I care about you and I want to know more.”
Lindquist favors starting difficult discussions with patients with open-ended questions: “What are some things you’re having issues with? What are you doing that you wish you could be doing differently? What would make your life easier?”
Listening carefully and making the person you’re negotiating with feel heard and respected is essential. If one of Lindquist’s patients tells her, “I make my own choices, and this is what I want,” she might respond, “I agree you’re the boss, but we’re both here to make your life better, and I’m worried about you.”
Negotiations with family members are often charged with emotions that can easily spiral out of control. But don’t reciprocate if someone gets angry and lashes out.
“When you’re buying a car, if you can’t agree with the dealer you’re talking to, you can go to another dealer. When you’re in a conflict with a family member, you don’t have this option. You’ve got more stubbornness and more defensiveness about disabilities,” Brett said, “and preserving relationships is even more important.”
Redirect your focus to brainstorming strategies that can help solve the problem at hand. Get creative and put lots of options on the table. Invite your parent to respond and ask “Why?” or “Why not?” again as needed.
If you find yourself going round and round without making progress, try saying something like, “We could argue about this all afternoon, but neither one of us is going to give in. Let’s set aside our arguments and come up with five ways that you can get to activities without your car,” Brett said.
Don’t expect to agree on a strategy right away. “You can say, ‘Let’s bring in Mom and talk about this later,’ or, ‘Let’s think about this and check in with each other next week,’” Lindquist suggested, noting that many negotiations take time and can’t 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 compromised vision, wanted to resume driving in 2021 after recovering from a serious fall. Brett and the couple’s daughter couldn’t convince him this might be risky, but the older man, then 89, agreed to get a driving evaluation at a facility associated with a Chicago hospital. When they recommended he stop driving, he gave up the car keys.
Brett later hired a neighbor in the small town in France where they now live to ferry her husband to appointments several times a week. Twice a week, she drives him to a nearby village where he has coffee with friends. He gets out into the world and she doesn’t worry about safety — an outcome both can live with.
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