This article is the third in a series exploring the challenges people may face when they choose ‘aging in place’ at home. While health care and personal needs may be complex, the family members or attorneys may also have to manage the entire household. With the added complexities and potential disputes arising around other issues such as access or finances, the family and attorneys may seek a skilled third party to facilitate options.

Speaking recently at a wills, estates and trust practice group meeting in a large Toronto law firm, the discussion quickly turned to the increasing complexity of managing personal care issues and that families are finding it more difficult to decide on the most cost-effective and best quality of care. Not surprisingly, transitions from one situation to another, such as hospital to home, or home to retirement home, were described as particularly difficult to manage.

The reality is that a family member or an attorney for personal care becomes the de facto care coordinator and manager. Most people simply do not have the time or expertise to manage ‘care in the home’ and find it challenging, stressful, and time-consuming.

An earlier article, Proposing an Elder Care Planning Framework for Decision Making, discussed how complex and multifaceted elder management can be. Clinical care needs may trigger a range of care decisions and require solutions that include financial and legal considerations. We need to find innovative approaches and bring new skills to the table to manage these situations.

Finding innovative approaches to more complex cases

As complexity increases, we have found success with a more holistic approach. While healthcare providers may have additional training in elder care, they are still confined by their scope of practice. Adding a management consulting approach and facilitation skills can bring both advisors and families substantial value. Care decisions can be integrated with financial and legal decisions so that a realistic and cost-effective care management plan can be put in place.

For example, in our practice, we often work with trust companies who are the attorney for property for an elderly client. The attorney for personal care may also be elderly, and the trust officer may recommend an independent third party who is not aligned with any trust company or financial services group to facilitate options for care within an annual cost envelope.

Before making decisions and spending funds, it is important to assess what the client needs and wants. These are often quite different especially if the client does not have the cognitive ability to understand their actual health and care needs. Once the health and care assessments are complete, the current reality should be compared to future needs and wants. This comparison identifies gaps where services are required or need to be revised. Discuss priorities, goals, and timelines with the various parties. Document the best options and their fiscal impact to enable cost-effective decisions. Only then can a realistic budget be set.

What is a facilitator’s role?

The International Association of Facilitators (IAF), to which I belong, defines the facilitator’s role as follows.

“At the heart of facilitation is a deep shared belief that complex challenges faced by groups… can be solved through dialogue, trust and understanding created with good group process.”

“Facilitators fill an impartial role in helping groups become more effective. They set aside their personal opinions and support a group in making its own choices. Facilitators act as process guides and create a balance between ensuring individual participation and producing meaningful results.”

How can skilled facilitators help advisors plan for complex care situations?

Typical actions might include the following:

1. Prepare Background for Group Discussion
   1. Interview key stakeholders to determine different opinions, understanding of issues, etc.
   2. Assess communication abilities and levels of trust.
   3. Design process, agenda.
   4. Research specialized knowledge is required.
2. Lead Sessions to Build a Care Management Plan
   1. Build a positive group dynamic for discussion.
   2. Agreeing to rules of behaviour may be required before sessions.
   3. Lead discussion to define goals, brainstorm ideas and options, etc.
   4. Define conclusions, goals, action plans, and next steps.
3. Manage Meeting Dynamics
   1. Direct and moderate conversation. Encourage everyone’s participation.
   2. Address conflict constructively.
   3. Summarize, clarify questions, and document notes of the meeting.
4. Follow-up and Next Steps
   1. Draft reports. Share resources and material.
   2. Set the next meeting and participants.

Advisors, families, and attorneys for personal care need to prepare to manage more complex cases with our aging population. Innovative solutions are required, and independent third-party facilitation can help search for pragmatic, cost-effective solutions.