Elder Care Mediation: The Future is Now By Judy McCann Beranger **
For the past two decades, Family Mediation Canada has been promoting
mediation as a valuable option for an ever-growing range of issues
facing Canadian families. Mediators are being required to become more
diversified in their training as the needs of families become more
diversified. The advancing age of our population, combined with our
desire to provide all citizens with a better quality of life, has
resulted in elder care issues steadily finding their way into the field
Mediation in the field of elder care typically involves many players --
predominantly family members who are concerned or affected by the
decisions of the elder person involved, and who may be called upon to
participate in present or future care. The focus is on keeping the
myriad of relationships growing and respectful, and, if the situation
involves care giving, encouraging choices and plans that work for both
the person receiving care as well as the caregiver. A successfully
mediated outcome will ensure that maximum function and independence are
promoted, while opportunities are provided for healthy interaction with
others. Content areas of such mediation include decisions around living
arrangements, environmental interventions, decisions around therapeutic
interventions, new marriages, new partners, grandparenting, primary
caregivers, paid caregivers, family disputes, nursing home decisions,
medical decisions, financial issues, issues around religion, plans for
rehabilitation, plans for caregiver support, holidays, driving,
caregiver burden, activity-focused care, estate issues, and other
"end-of-life" decisions. The success of mediation in this setting is not
unlike other areas in that people are more likely to invest in
agreements that have been co-authored.
One example of a growing area in the field of elder care mediation is
with Alzheimer Disease and other related diseases. Since 1991, the
Alzheimer Society in Prince Edward Island has been very active in this
area, and has witnessed a dramatic increase in the demand for this
service. Research tells us that for every person with a progressive
dementia, the lives of at least nine other people are significantly
impacted. This number often includes many senior caregivers. The needs
of people affected can be very complex and long-term. The research also
tells us that 94 per cent of people with a progressive dementia living
in the community are cared for by family or friends. With a rapid rise
in the senior population (the baby boomers), the prevalence of Alzheimer
and other related diseases is expected to double by the year 2030, with
the largest increase occurring in those 85 years and older. This means a
rise in the number of family caregivers, as well as an increase in the
number of years they will be called upon to provide such care.
Consequently, the demand for mediation in this field can only be
expected to rise sharply throughout the next decade.
Collaboration and co-operation among those service providers who deliver
community care, home care, counselling and mediation services, etc.,
will serve to provide families with an improved quality of life. Ideas
for ways of helping are generated as people come together and talk about
how they can move forward together, and assist each other through some
very difficult times. In the context of elder care mediation, there are
unique characteristics or emphases that require the mediator's
attention. These include:
Supporting the elder person's right to maintain independence and
to have a voice for as long as possible -- including the
decision as to what extent the elder person can actually
participate in mediation sessions.
Being intuitive and understanding of the complexity of this
Focusing on the strengths while recognizing the losses.
Recognizing the need for a follow-up component as a result of
the progression of the disease itself.
Recognizing that the dementia-specific knowledge of the mediator
is a prerequisite for elder care mediation.
Creating a safe and trusting environment in which deficits and
cognitive impairment are normalized and compensated for in a
specially designed structure.
If we compare the cost of people
prematurely accessing health services , due to the family's inability to
resolve on its own the challenging issues that inevitably arise in
caring for the elderly, to the cost of resolving these same issues
together in mediation, the cost of mediation is minimal.
Across the nation there are trained mediators who can be contracted
directly by families or by health care systems, non-profits,
governments, and the like who are truly interested and passionate about
providing mediation services in the elder care arena. A recent report of
the Canadian Institute for Health Information concluded that compared to
20 years ago, older Canadians can now look forward to a longer and
better quality of life. The professional practice of mediation is
well-positioned to play a vital role in ensuring that such a prediction
comes to pass.
** Judy McCann Beranger is the Executive Director of the Alzheimer
Society of Prince Edward Island and President of Family Mediation Canada
(2003-2004). This article first appeared in the Fall 2004 issue of
"Resolve," the Family Mediation Canada magazine. Reprinted with