Although conflict has its place, and can be valuable at times, it also tends to limit the cooperation necessary to accomplish eldercare goals. Specifically, conflicts between elders and their care providers, or between competing caregivers, tend to inhibit productive interactions. Conflicts cause elders to decline necessary care, leaving them with unmet needs, or they prevent caregivers from getting along so decisions can be made to meet needs in a timely manner.
Scenario
Bill, a recent stroke survivor, is 78 years old. He says he can still drive safely. Janet, his daughter, believes Bill is unsafe behind the wheel. Janet tried to take away Bill’s keys, but Bill indicates he intends to continue driving anyway. Bill and Janet are in conflict over this issue. They don’t communicate very well because each is certain the other is wrong.
Elderhood
This discussion begins with a statement concerning the value of elders. Most everyone recognizes that individuals move from childhood to adulthood. However, in American society, we often ignore the phase of life following adulthood. Elderhood is the life phase following adulthood. It is a distinct phase of life which begins as the body changes and we move beyond the period when society values an individual based on physical or financial productivity.
Childhood is marked by education and the pursuit of “fun.” Adulthood is marked by productive activity. Elderhood, on the other hand, is marked by the distribution of wisdom. Conflicts can emerge when elders refuse to accept change (or don’t understand change) and measure their self-worth in terms of productive activities that are no longer possible or practical. Conflict can also emerge when others discount an elder’s value by assuming that one’s inability to engage in typical adult physical behavior means that the elder is no longer a contributing and valuable member of the family (or society). Either view is unhealthy and leads to conflict. In short, a person’s value is not measured in terms of what he or she can do.
If we fail to re-evaluate how we think about elderhood, then conflict is inevitable. The reason why is because elders will reject any plan of care, or any suggestion that labels them as dependent. As a result, elders resist adaptation to changing circumstances. In an adult-only society, dependency is punished and conflict arises due to fear of punishment.
Elders (and those who relate with them) must learn, among other things:
- How to change from a low-functioning adult into a high-functioning elder?
- Why the elder look is attractive?
- How to embrace elderhood?
- What things elders do better than anyone else?
- Why humanity needs the things that only elders can do?
- Why thinking of yourself as an older adult can sabotage one’s elderhood?
- How to keep your family’s “Chain of Wisdom” strong?
- Why distributing wisdom makes elders feel great – emotionally and physically?
- Ways to distribute wisdom in modern society?
- How to encourage people to ask for your advice and stories?
The reason why it is important to consider elderhood before approaching conflict is that conflict cannot be resolved unless each party is respected. A person is not mentally or emotionally disabled simply because he or she is aged. Elders have rights, including the right to engage in activities and behaviors that others believe are inappropriate. As with all members of society, it is only appropriate to impede an individual’s activity when it would harm someone else or when it would constitute abuse or neglect. For example, it is never appropriate to permit another person to commit suicide, but it might be appropriate to refrain from interfering with someone’s right to go skydiving even at an advanced age.
Good Communication
Communication is how we interact with other people. Communication skills let us tell others what we think, how we feel and what we want. They are imperative when attempting to resolve conflicts. They allow us to avoid misunderstandings that lead to conflict by clearly expressing our expectations and desires.
Good communication:
- Build trust between parties
- Shares information
- Enhances relational satisfaction
- Involves each party in decision-making
- Helps those receiving information make better decisions
- Leads to more realistic views and expectations concerning the relationship and outcomes
Good communication helps people avoid conflicts. Dr. Wendy Levinson, a medical researcher, discovered a link between poor communication and malpractice litigation. She found that people don’t sue doctors they like. Instead, they sue doctors who have poor bedside manners. Breakdowns in communication fuel distrust and pent-up anger.
When there is a potential conflict, we suggest that you begin by determining whether a conflict really exists. For that reason, we believe the use of informal means of resolving disagreement is appropriate before you allow potential conflicts to escalate. It is possible, for example, that there is no conflict; it may be that you simply have a breakdown in communications. For this reason, try alternative means of communicating your message if the other party is not responding. If you have been leaving telephone messages that go unanswered, consider a face-to-face meeting. Alternatively, you could write a letter or send an email; we caution, though, that written messages may not be received the way you intend them because they do not relate nonverbal aspects of communication such as tone and inflection. You should have someone else, who is not part of the dispute, read any written communication before you send it and ask them to let you know if the message sounds overly threatening. It could be sending a message you didn’t intend.
What are some of the common issues that arise in the context of elder care? The following is a non-exhaustive list based on materials developed by the Center for Social Gerontology:
- Health/Medical Decisions
a. Who should provide care
b. What care is needed
c. Who should make decisions
d. Should non-decision makers be given medical information? If so, how much information should they get - Financial Decisions
a. How should money be spent/spending priorities
b. How should investments be handled
c. Concerns over unwise spending - Living Arrangements
a. Where
b. With whom
c. Who decides
d. How much independence/supervision - Communication Issues
a. What information is needed or missing
b. How to share information with those who need it - Family Relationship Issues
a. How should the family deal with sibling rivalries, new spouse or companion, death of spouse, caregiver or other changes in relationships - Decision-Making
a. Who should have authority to make decisions
b. What input (if any) should others have - Respite Care and Support for Caregivers
a. Establishment and maintenance of healthy boundaries
b. Who establishes boundaries
c. What are the boundaries
d. Who will assist caregivers and when
e. Who does what
f. What type of assistance will be available
g. Who will pay for it - Personal, Household care and maintenance
a. Identify caregiver/service provider
b. What type of care/service is needed - Safety/Risk-taking/Autonomy
a. What safety issues are identified
i. Driving
ii. Falling
b. Is the level of risk understood and acceptable
c. Should autonomy be limited - Needs of Other Family Members/Caregivers
a. Dependent children
b. Grandparents caring for grandchildren
c. Career demands
d. Reimbursement for services
e. Visitation issues - Less Restrictive Alternatives to Guardianship
a. What alternatives exist
b. Who should be guardian if one is needed - Inheritance issues
a. New estate plan versus old plan
b. Spending funds now that reduce potential inheritance
When you communicate, be civil. There is no real value in communicating in a discourteous manner. Doing so causes others to put up barriers and to be defensive. Instead, follow the old adage: Win friends and influence people. Being nice will frequently engender cooperation more readily and more effectively than any other conflict resolution technique.
If there is disagreement, be careful how you express yourself. The use of “I statements” such as “I am concerned about your safety when you drive” are a less confrontational way of framing the issue than a “You statement” such as “you’re a danger on the road.” A variation on this technique is “When you … I feel … Is that what you intended?” This sort of dialog allows you to establish facts in a less confrontational manner. If the issue between you and the other person is poor communication, it may be that a discussion of this sort will allow you to resolve the crisis without escalating it into a conflict.
Conflict and Negotiation
Negotiation occurs every day. Sometimes, as negotiations break down, conflict is the result. Therefore, it is imperative that we understand healthy negotiation strategies as well as healthy methods of resolving conflict.
Truths about conflict
Conflict occurs when two or more values, perspectives and opinions are perceived as contradictory. Conflict can occur under the following circumstances:
- Intrapersonal conflict (being conflicted) – when you’re not living according to your own values;
- Interpersonal conflict – When your values and perspectives are threatened; or
- Potential conflicts – Discomfort from fear of the unknown or from lack of information.
Where two or more decision-makers coexist, conflict is inevitable. Conflict can be good if appropriately managed. Everyone has different skills, talents and information and it is more likely that good outcomes will result when these assets are brought together to address problems. The price for doing so, however, is the possibility of diverging values, perspectives and opinions.
Conflict is often needed. It:
- Helps to raise and address problems.
- Energizes work to be on the most appropriate issues.
- Helps people “be real”, for example, it motivates them to participate.
- Helps people learn how to recognize and benefit from their differences.
Conflict is not the same as discomfort. The conflict isn’t the problem – it is when conflict is poorly managed that is the problem. Conflict is a problem when it:
- Hampers productivity.
- Lowers morale.
- Causes more and continued conflicts.
- Causes inappropriate behaviors.
You should view positive conflict as an opportunity to clear the air, to reinforce goals and build relationships. There are, however, negative situations when you need professional assistance. For example, in cases of abuse, mediation is not the answer; you should call law enforcement. If someone has stolen from you, or has committed an act that requires legal redress, then failure to contact an attorney on a timely basis could impact your rights. You must recognize that not all conflict can be resolved without assistance.
Negotiation Strategies
What is negotiation? It is a form of communication designed to get what you want. In this memo, we take the position that healthy negotiations should be principled. Principled negotiation stays on the merits (the issues) instead of focusing on a haggling process. It requires that each side participating in negotiations should look for mutual gains. Where interests conflict, each side should look for some independent standard acceptable to all parties that will determine the result.
Principled negotiation considers the relationship between the parties, but does not focus solely on it. Negotiators who seek only to preserve relationships may end up with an unwise agreement. Consider, for example, Della and Jim in the O. Henry story, The Gift of the Magi. There, Della was so intent on giving Jim a Christmas gift that she sold her hair to buy him a chain for his watch. Little did she know that Jim had sold his watch to buy Della hair combs. Each was so concerned about the relationship that they failed to communicate and reach a wise solution that met their respective needs.
It is also worth mentioning that some people do not play well with others. Those who focus solely on the relationship to the detriment of the issues may find it impossible to reach a worthwhile agreement with a party who either does not value the relationship, or who values something else over the relationship.
Unfair negotiators use a variety of tactics discussed in the Harvard Negotiation Project, Dealing with Difficult People & Difficult Situations. Among them are stonewalling, use of attacks, and tricks.
Principled negotiation begins by attacking the problem, not the people involved. It is important to separate people from problems because, when you attack a person, that person becomes defensive, closed and emotions begin to entangle the issues. The goal is to come along side of the other parties and work together to resolve “the problem.”
Conflict Resolution Strategies
A breakdown in negotiations will sometimes produce conflict. Even where there is no apparent conflict, a breakdown in negotiations may produce resentment that leads to conflict. When conflict occurs, parties need to understand how to resolve conflict in a healthy manner.
When conflicts arise, there are at least two ways to respond: by focusing on the relationship and focusing on the issue. Each is important.
When focusing on the relationship, it is important to observe the behavior of each party. Which behaviors are creating conflict; which ones are acceptable, objectionable, necessary or unnecessary? What is the perceived reason for the behavior? Once behaviors have been observed, it is crucial to maintain a fair, respectful communication style. Lawyers call this being “Professional.” Each person should be heard, so listening carefully is critical. It is also important to understand and accept the other person’s right to disagree about issues where disagreement is appropriate. Obviously, if someone has been harmed illegally or immorally, there is no reason to accept injustice; however, many relational conflicts involve matters that are less black and white and that are open for interpretation.
When focusing on the issues, the primary concern is to clearly identify the scope of the conflict. Frequently, parties in conflict escalate the scope of disagreement beyond what it should be as they become entrenched and seek to justify their positions. Thus, identifying the real source of conflict is the starting point in resolving it. The parties should determine whether alternative solutions exist; they almost always do. Alternative solutions should be placed on the table for discussion. The parties should openly discuss the viability, strengths and weaknesses of alternative solutions. What resources will be required to implement various alternatives and will an alternative solution resolve or merely mask the underlying conflict. From among the solutions, the parties should select the one that appears to resolve the conflict and develop a plan for its implementation.
Stakeholders: when examining conflict, the first step is to identify the stakeholders. Who’s rights (who’s life) is affected by the conflict? In what way will the stakeholder be affected?
- The elder/patient
- Family members
- Caregivers
- Funding sources (insurance companies, Medicare, Medicaid)
Sources of Conflict: Although conflicts generally involve specific issues, there is usually an emotional component as well. Some emotions are appropriate and others are not. It is important to understand why the conflict has value for each stakeholder.
- Power/Control
- Greed
- Self-interest
- Concern
- Fear/anxiety
- Ignorance
- Grief
- Loss of relationship
- Loss of dreams
Underlying goals:
- Protection of dignity
- Safety of the elder
- Safety (and sanity) of the caregiver/preventing burnout
- Quality of care
- Protection of assets
Conflict Accelerators:
- Aggressive behavior
- Bad personal chemistry
- An absence or leadership or poor leadership
- Resentment
- Worry
- Stress
- Guilt
- Impatience
Barriers to conflict resolution:
- Poor communication skills
- Ill-defined goals (failing to understand the true source of conflict)
- Unrealistic expectations
- Cognitive capacity (or lack of capacity)
- Limited sense perception (e.g., deafness, blindness)
- Unwillingness to consider compromise
- Time or sense of urgency
- Anger
- A perceived absence of resources to implement solutions
Solutions for dealing with difficult behavior
- Get everyone involved in the conflict together. Leaving parties out is a recipe for resuming the conflict later.
- Try to avoid involving those who are not stakeholders in the conflict. Their input is not critical to resolution and they may simply stir up additional problems.
- Involve everyone in the conflict
- Create physical space. This minimizes the likelihood that someone will feels “cornered.”
- Establish boundaries (standards of behavior).
- Invite critical feedback.
- Consider your response to rights vs. needs vs. wants.
- Develop respectful responses to disrespectful behavior.
- Do not shoulder the blame for criticisms that are not yours to own.
- Listen with respect and respond with care.
- Stick to issues and behaviors.
- Choose and use a level of assertion; especially try empathetic.
- Initiate contact with, “Specifically, how can I be helpful to you?
- Maintain your focus on, “We can work this out.”
- Expect respect. (“We can work this out when you stop yelling.”)
- Say what you mean in specific terms (we can’t read minds).
- Use fair humor (quips, toys, stickers, etc.).
- Keep congruent – words, tone actions.
- Avoid debate.
- Use sure signals for confidence. (Head up, face forward, eye contact, shoulders back, steady stance, posture straight, no leaning)
- Use silence to increase your calm. It’s valuable to “leave unsaid the wrong thing at the tempting moment.”
- Speak from the “same side of the table.”
- Tangible reminders to respond appropriately. Document facts of behaviors and situation.
- Build your credibility with your language and actions of that do not denigrate others at the table and that builds a win-win attitude.
- Give people a way out. Establish choices.
- Refuse the win-lose perspective.
- Stay calm.
People fight about things they care about. It we really believe this, then we should begin the conflict resolution process by exploring the various values and needs in play. What is it that we really want and why do we want it? What does the other party want and why? At a minimum, we should try to understand the other person’s position even if, after doing so, we still disagree. Understanding gives us a point of reference that may pave a road toward compromise.
To begin understanding the nature of conflict, you must first understand that the other side has already rejected your solution to the problem (as you have rejected theirs). Thus, your solution is not the beginning point in resolving conflict. Instead, need exploration and negotiation is the starting point. Until both sides have listened and made an attempt to understand the underlying needs in play, there will be no resolution.
You can only control two things: yourself and your attitude.
One approach to conflict resolution is the PAUSE principle:
- Prepare (get the facts, seek counsel, develop options)
- Affirm relationships (show genuine concern and respect for others)
- Understand interests (identify others’ concerns, desires, needs, limitations, or fears)
- Search for creative solutions (brainstorming)
- Evaluate options objectively and reasonably (evaluate, don’t argue)
Resources:
• R. Fisher & W. Ury, Getting to Yes: Negotiating Agreement Without Giving In (Penguin Books 1991)
• S. Leviton & J. Greenstone, Elements of Mediation (Cengage Learning 2004)
• W. Wilmot & J. Hocker, Interpersonal Conflict, 7th Ed. (McGraw Hill 2007)
• Web Resources for Communication Skills (a directory), at http://www.khake.com/page66.html (last checked 9/17/2009)
