Making Caregiving Decisions

Here’s a process to make those tough decisions easier.

Caregiving decisions can be hard to make. They are often complicated, involving many different, sometimes conflicting, factors. Consequences can affect other people’s lives and health—usually people who are very important to you. They often involve unfamiliar, unexpected circumstances. And they almost always come with time pressures, emotional pressures, and stress.

Caregiving Decisions Are Too Important To Make Alone

Involve as many family members as possible in the decision-making process. Some family members may be able to see the situation more objectively than the stressed, harried, time-pressured caregiver. Other family members can help get a caregiver to open up and start talking about a problem that may have been silently tearing him or her apart. Multiple people can come up with more ideas and information—and can share the information-gathering tasks. (But please remember that even with people as close to each other as family members clear, objective and supportive verbal and non-verbal communication is vital.)

One essential family member to include is the care receiver. His or her perspective on the problem will differ from everyone else’s and add important insights. And involving them in decision-making, to the extent their capabilities permit, will increase the likelihood of their agreeing to the decision itself.

Decision-Making Is Easier When You Do It Step By Step

By breaking big decisions into these separate steps, you turn a potentially overwhelming problem into manageable pieces of problem-solving:

  • Find the biggest problem within the problem.
  • Figure out what goal you need to accomplish.
  • Get information.
  • Examine alternatives.
  • Make an action plan.
  • Give your decision time to work.
  • Evaluate how well it’s working.

Write all these steps down, and use your written list as a checklist. Go through the entire process step by step, without skipping a single one. And remember that it is simply not possible to do it all in one sitting; some steps will take time—particularly information-gathering and giving your solution time to work.

Finding The Biggest Problem Within The Problem

Every big problem is actually a series of problems—time problems, cost problems, financial problems physical or logistic problems—affecting the caregiver, the receiver, and the family members in different ways.

The key to solving these problems is dealing with them one at a time, starting with the most important one. But how do you know what’s most important?

A good way to start defining the problem is by having each family member involved, starting with the caregiver and including the receiver, describe it as he or she sees it. This will help the entire family see the overall problem as a whole. It may also help generate new ideas that could lead to possible solutions.

If no one problem emerges from this discussion as the key issue, then priority should go to:

  • A problem affecting the caregiver’s health or safety.
  • A problem affecting someone else’s health and safety.
  • The problem which, when solved, will produce the greatest positive changes in the most other areas.

As you move on through the next decision-making steps, it will become apparent whether you selected the best problem to deal with.

Figure Out What You Need To Accomplish

What specific goal do you want your decision to achieve? Which specific results will tell you how well the solution is achieving it?

Too many families skip this step. And shouldn’t. After all, in you don’t know what your decision is supposed to accomplish, you’ll never know whether it’s working. And in order for your decision to work effectively, everyone in the family has to keep the same goals in mind and pull in the same direction.

The family member whose goal should carry the most weight is the one who stands to be most affected by the decision. When this person is a care receiver who can’t speak for him- or herself, another family member should act as an advocate.

You Can’t Make Decisions In A Vacuum

Maybe your family already has all the information it needs about all the alternatives for meeting its stated objective. But if not, this is the time to gather and evaluate it.

Four basic kinds of information about the care receiver are essential to consider: physical and functional information, psychological information, financial information, and social information.

Some decision factors may depend on outside information, from sources like your loved one’s doctor, community agencies, private professionals and services, or other articles found on the FamilyCare America Web site. Others can come from the family’s personal knowledge (about the state of the care receiver’s finances, for example) and values (for example, will Uncle Harry, who’s lived on a farm all his life, really be comfortable with an apartment in a large sheltered care facility?). Checking with friends, neighbors and peripheral family members may uncover additional solutions or sources of help.

Don’t Limit Your Alternatives

The more alternatives your family considers, the better the chances of arriving at the right one. And the fewer limits you impose on the process, the more alternatives you’ll consider and learn from.

Collect all the relevant ideas, information, and facts you can. Consider any and all of the ways you can to achieve your goal. Encourage everyone to brainstorm ideas. At this stage, never prejudge the value or feasibility of an idea, regardless of its source.

Then, when all the ideas are on the table, weigh them against each other. What’s the possible good from each one? The possible harm? How acceptable does it sound to the people it will most likely affect?

The most successful alternative will probably be the one that:

  • Has the fewest undesirable consequences.
  • Appeals most strongly to the person most involved (usually the caregiver or receiver).
  • Has the most family members’ support.

It usually won’t be the perfect choice. It may not even be the best choice. But it is a choice, and as such is worth trying out and testing. Remember that a choice not to try anything different is a choice, too, and could be a valid one. And if by this point you’ve failed to come up with even one way to achieve your goal, then maybe you should revisit your goal for a more appropriate or realistic one.

Decisions Aren’t Decisions Until You Implement Them

Decisions in the abstract never change anything. So after reaching your decision, make a plan to put it into effect. Make a list of which steps to take, in which order, and who should take them. Figure out which specific criteria will tell you whether or not the plan is working—and how much time you should allow to find out.

Write down all these parts of your action plan, so you can measure its progress and effectiveness against this checklist.

Give Your Solutions Time To Work

No solution, even the best possible one, can change things overnight. So agree on a specific trial period after which you can evaluate how well your action plan works.

How long should that trial period last?

  • Long enough for the people involved in the new plan to at least start adjusting to it.
  • Long enough for potential or unexpected problems to surface, but
  • Short enough to correct mistakes early.

Agree, too, that anyone who has doubts or conflicting ideas will put them aside throughout the trial period and devote their best efforts to making the plan succeed; there’ll be time for evaluation and changes at the end of the trial period.

Make sure that everyone has a clear idea of what’s expected of them throughout the trial period. And that the family as a whole defines in advance what indicators will tell them that the plan is succeeding, failing, or falling somewhere in between. Those indicators should be as objective and specific as possible. If the problem was that the caregiver was getting too little family help, for example, than the indicator should be some measurement of family cooperation, not whether or not she’s “feeling happy” with the results after 60 days.

Evaluate Your Results

As the trial period ends, evaluate the results against your criteria. The important thing here is not how the results compare to some abstract ideal, but whether the plan you decided on makes things better than before.

  • Has the plan actually changed things?
  • Who’s better off than before, and how?
  • Who’s worse off, and how?
  • How much improvement has the plan brought about?
  • Is there observable progress towards achieving the stated goals? Is there enough?
  • Have unexpected obstacles arisen? Unexpected benefits?
  • Should we give the plan more time? Or start working to change or replace it?

One of a trial period and evaluation’s biggest benefits is that it often redefines the problem—or, at the least, gives you new information. With this new information at hand, the family can get together and go through the decision-making process again, setting new goals and testing different action plans on the basis of the added knowledge, information and experience this trial period has provided. As you do, you’ll be moving closer and closer to better and more workable solutions.

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