How to Take Families from Outraged to Understanding

Written by Steven Buslovich, M.D., co-founder and CEO of Patient Pattern. Originally posted by McKnight’s Long Term Care News on Oct. 2, 2020 – Read it here.

The COVID-19 pandemic is causing fears, anxieties, and uncertainties for everyone, and these feelings can manifest in anger and rage. Physicians and other practitioners are often the targets of these tirades, and they need to be prepared to deal with them. But, at the same time, there are some efforts they can take to prevent the fear and uncertainty that elevate into outrage.

There are several reasons family members have been angry and frustrated during the pandemic. Perhaps the main one is that they have a skewed understanding of their loved one’s condition and/or possess unrealistic expectations about outcomes. As a result, they are surprised and angry when Mom or Dad doesn’t do as well as they expected or, worse, when their family member is hospitalized or dies.

It can be difficult for families to accept that someone they love is seriously ill or maybe dying. It’s hard to believe that they’ll never play golf with dad again or enjoy a weekend at the beach with mom. They may want to hold on to the parent they know and love.

The key to helping these families and preventing angry confrontations or accusations is communication. But you can’t start the conversation with the facts. Start by trying to understand where the family members are coming from. Do they feel guilty? Did they have a good relationship with their loved one? Were there unresolved issues?

Only when you understand all of this can you begin to present clinical information, such as an assessment of the person’s frailty level, that is, how vulnerable the person is to extreme, sudden, health changes triggered by events such as an infectious disease outbreak. How frail someone is will contribute significantly to outcomes.

It is important to help families see their loved one holistically so they are more likely to have or be open to realistic goals and expectations; and they are less likely to be surprised by predictably unfavorable outcomes.

Of course, facts and clinical information often isn’t enough to calm an angry family member. You need to:

  • Help the family see their loved one realistically. Two men, for instance, can have similar height and weight. They can have common interests and enjoy the ballgame on TV and a beer together. But one may have more underlying conditions and problems, be taking more medications, and have a lower Mini Mental Status Exam score; and that man is more likely to have a poor outcome if he contracts COVID-19. Yet, if all his family sees are two similar men, they are more likely to be angry or upset if both men get sick but their dad is the only one who is hospitalized and put on a ventilator. They may attribute dad’s condition to poor care and not his frailty.
  • Listen. You can explain to families about their loved one’s condition and possible prognosis, but don’t assume they heard or understood you. Ask them to tell you what they heard, what they understand, and how they feel about it. If you can provide written materials, do so and encourage them to pursue more information and share their questions with you. Note that in very emotional situations, it may not be the right time to try to share lots of information. If these cases, you need to focus on de-escalation.
  • Get the team on board. Give nurses and CNAs the information and skills to communicate accurately and sensitively, as appropriate. Make sure they know what they can and can’t say and when it’s appropriate to refer the family to the physician or other team leader. Make it clear that it’s never okay for them to be in a situation where they feel threatened or abused.
  • Be transparent and prompt. If a resident has COVID symptoms, tests positive for the virus, or has an accident or acute condition change, report this promptly to the family. As difficult as these conversations may be, waiting can make the families feel excluded or ignored. When you talk to them, be empathetic, but present facts and a timeline – what happened and when, what you’ve done, and what you can/will do. Tailor medical advice or treatment recommendations to each patient and address the family’s specific feelings, needs, and concerns.
  • Never match their emotion. These are challenging, stressful times for everyone, but getting into a shouting match won’t make your message any more palatable. Acknowledge their feelings, keep your tone calm and steady, respect the person’s space, and offer choices and options. Ultimately, be firm, lay down the law, and set clear limits.

One of the greatest contributors to family anger during the pandemic has been the inability to see their loved one face to face. While your priority is and should be keeping the patients safe, team leaders need to work together to find ways — whether it’s videoconferencing, ‘window’ visits, live streaming, or other efforts — for families to see their loved ones and know that they are being cared for.

Everyone is grieving right now, whether it’s for a lost life, the inability to work, or the loss of ways to socialize, eat, shop, and pursue entertainment. By understanding the many things families may be mourning for right now, you can ease their fears and defuse their anger. You can empower them to find peace and help ensure their loved one is comfortable and enjoys the best possible quality of life under the circumstances. It’s cliché but true: We’re all in this together.

Steven Buslovich, M.D., CMD, MSHCPM, is the co-founder and CEO of Patient Pattern, and a practicing geriatrician and certified medical director of post-acute and senior care facilities. He is an active committee member of the American Geriatrics Society’s (AGS) and the Society for Post-Acute and Long-Term Care Medicine (AMDA). He is a subject matter expert in frailty, complex care management, geriatric pharmacology, compliance and PDPM. Buslovich is the recipient of AMDA’s Shark Tank Innovation Award. He completed his residency at Yale School of Medicine, and his Geriatrics Fellowship at Icahn School of Medicine at Mt. Sinai.

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