Family disagreement with a plan of care can create ongoing difficulties for staff in providing quality person-centred care. There may be times when families refuse to participate and oppose progress towards a palliative care plan.

It is important to recognise that behaviour of this kind may arise from family distress as well as reasoned opposition. Families may be expressing a range of emotions including guilt, loss and grief for the person with dementia.

Where they previously cared for an aged care resident at home, they may feel excluded and diminished, with the result that they belittle those who have taken over this role. Equally, even where staff would like to make changes in accordance with family requests, the facility organisational structure and processes may not make this possible.

Depending on their level of involvement and frequency of visits, family members may not have a good understanding about the persons’ decline in health and associated care needs. Case conferences provide a useful opportunity for family to feel their concerns are placed ‘on the record’, whilst also providing staff with an opportunity to give information and support.

It can be beneficial to have more senior members of the health professional team in attendance so junior staff feel supported and families feel their concerns are being taken seriously. Attendance by a GP may be useful to provide a third party perspective on the person’s clinical situation. The authority that many families associate with medical training may also increase acceptance of a plan of care where they are querying the expertise of other health professionals and care staff.

Further information on engaging families in case conferences as well as strategies for managing conflict is available.

Last updated 13 October 2015