What does an elderly care lawyer do

"Advocates" of the patients

In particular, caregivers who have been in the job for a long time will agree with this statement: While relatives were grateful, cautious and cooperative at the beginning of the 1990s, many caregivers today perceive them as demanding, controlling and dominant. Why is that so - and how to deal with “difficult” relatives?

Even if it does not suit many employees in nursing: Nursing work is increasingly perceived by the public as a service. In the past, nursing tended to be professional health care plus Christian charity, that is, “nursing with a heart and a vocation”, but today it is work with a clear economic equivalent. This makes it comparable to many other service occupations. Relatives respond to this change by increasingly:

  • are more self-confident and act like this,
  • want to be informed more,
  • are more informed,
  • consciously live out their customer role,
  • ask increasingly critical questions,
  • Use the complaint channel confidently and naturally.

Precisely for the reason that relatives are increasingly changing to the customer role, they have a “more powerful” position vis-à-vis the caregivers. They select the service on behalf of the person in need of care, for example the nursing home or the nursing service. They know the way to complain, which they also use. In advance they have informed themselves extensively what they can expect from the care and they are morally superior to the care workers.

Family member has a powerful position

Whether in a hospital or a nursing home, a patient or resident is in a weak and dependent position. He is often unable to adequately express and represent his needs because he is too weak to do so or simply because verbal language is no longer available to him. This can be the case with impaired consciousness, aphasia due to a stroke or, even more seriously, with dementia.

Here the relative now jumps into this role by making himself the “advocate” of the person to be cared for. The position of a lawyer is a morally superior role, since the relatives take it selflessly and self-sacrificingly. The nursing staff cannot hold an equally moral position - quasi on an equal footing. Only a “service ethos” can be countered here. In the event of a conflict, a relative is in an ethically more powerful position than the employee. This becomes even more powerful when the ethical position is combined with the customer role.

A real practical example from a hospital should help to clarify this fact: Ms. Braun visits her old mother in the hospital. She fell at home and broke the femur. When Ms. Braun enters her mother's patient room, she sees that her mother has nothing more to drink. The mineral water bottle on the bedside table is empty. According to the mother's information, she has rang several times about it, but so far no one from the staff has reacted to it. Angry, Ms. Braun storms into the office where several nursing staff are standing together. Immediately she rumbles off: “What kind of sloppiness is this? My mother hasn't had anything to drink in a long time. Did you win your lottery exam? I demand to speak to the responsible doctor immediately! We were in this hospital for the last time ”.

What happened here? Why does Ms. Braun have the “right” to be able to speak to employees like this? In the practical example, we experience a daughter who stands up for her old mother, because the old lady cannot represent her concerns to the employees herself. In addition, many old people are very obedient to authority, so that they submit to their fate.

Here the daughter now takes on this role. She makes herself a lawyer, that is, her mother's advocate. In doing so, she takes a moral position. Since she suspects a mistake by the employees, she skips several stages in the complaints system. She also uses her customer role by pointing out that she will choose a different hospital next time. Indirectly, it threatens to weaken the hospital's economic base. At the same time, it also occupies an economic position.

Tips for dealing with “difficult” relatives

  • Structured work with relatives that starts early must be offered: concerns of relatives are specifically asked, the guilt experience is ascertained and an understanding of the relatives' point of view is developed.
  • The relatives must be seen as a “second-order patient” - this term comes from palliative care - because they also need support.
  • Relatives want to finally be praised for their difficult task. Often they spontaneously "temporarily" took on the caring role. In most cases, however, this takes many years. Caregiving relatives do not receive any recognition or praise from the family. That is why it is so important that nursing and support staff give this recognition.
  • Relatives are experts too! It makes no sense at all for nursing staff to enter into a competitive situation with relatives - "I have exams!" Versus "I have known my mother for 60 years!" what experience they have gained in the domestic situation.
  • This also means that care workers share their knowledge with relatives, for example through tips on how to carry out individual actions when dealing with the person concerned. Employees should take a look at their fingers and explain their actions. This conveys appreciation to the loved one.
  • The facility should offer realistic help by providing understandable information material and arranging local self-help groups.
  • Do not run away from the "difficult" family member, but approach them and specifically ask about their needs.
  • Relatives must also be seen and perceived as customers.

The misery in the home

If a person in need of care changes from home to a hospital or an inpatient care facility, it is important to make clear from which life situation the relative is experiencing this change, namely:

  • At the beginning of the home care situation, the relatives usually found themselves unprepared in the role of helper.
  • The home care situation then lasts an average of 6.7 years.
  • Caregiving relatives are older themselves and in need of support.
  • In addition to the other everyday and professional activities, care is provided with considerable expenditure of time, physically and psychologically.
  • Caregiving relatives are increasingly becoming socially isolated as acquaintances, neighbors and friends turn away.
  • Caregiving relatives provide basic and treatment care services that actually require specialist training.
  • A care service is only involved in 30 percent of home care situations.
  • Care is provided under insufficient spatial and technical conditions.
  • Caregiving relatives are completely absorbed by the person in need of care. Even if they can leave the situation at short notice, they are still mentally tied to the person being cared for.
  • Relatives are constantly worried about whether they will be able to cope with the demands in the long run. This creates a permanent situation of excessive demands.
  • Role patterns dissolve, for example in the case of dementia (“When parents become children and yet the parents remain”).
  • The permanent exhaustion leads to an increased potential for violence, which also increases the guilt life.
  • Relationships with other family members are increasingly falling into a crisis, so that families increasingly break up under the care situation.
  • No gratification for the domestic situation is to be expected.
  • “Light on the horizon” is the death of the person to be cared for, but what the caring relatives “may not” wish for.

These aspects make it clear that caring relatives are maximally overwhelmed at home. If, for example, a change to inpatient care is now being considered, this is a decision that is made on the basis of a “situation of failure”. This in turn creates frustration, which is then expressed in conflicts with nursing staff. This frustration also increases in hospitals if an acute event, such as a fall, suddenly occurs.

Appreciate loved ones

Many caregivers are completely exhausted and burned out. It is therefore no wonder that they are much more likely to experience depression than the non-caring population of the same age. In addition, they hardly receive any recognition for their “24-hour, seven-day-a-week” job - especially since women mostly take on this role. Caring men, on the other hand, get a lot more recognition for this family work - “It's just a man; that he does it anyway! "

Even if institutions do not get their relatives 'work refinanced in any way, they have to react to this changed relatives' attitude with a specialist offer, for example by a relatives representative. If not, they support the development of “difficult” loved ones.