Conflict and Conflict Resolution During Hospice
People are surprised to learn there is often conflict when a loved one is in hospice. Unfortunately, some disputes do not cease when people are near death. On the contrary, family members can become more entrenched in their positions creating stress and anxiety for their dying loved one.
Most would assume families would be able to put aside their differences and work to peacefully coexist, if only for the sake of their dying family member. Sadly, that is often not the case. When a loved one is near the end of their life, the landscape is rife with emotion such as grief, guilt, uncertainty, and fear of the unknown. In addition, a sense of helplessness, exhaustion, and loss of control are present. When people are at their most vulnerable, they often lash out at someone else, either another family member or the hospice team. I have been a hospice volunteer for more than fifteen years and I have seen how emotions and grief can take over in an already desperate situation. Hospice nurse, Cathy Truehart relates in her book, The Miracle of Hospice: A Personal Journey of a Hospice Nurse, “unresolved conflicts from years or even decades before may arise again… not only erupting but intensifying.”
When people are at their most vulnerable, they often lash out at someone else, either another family member or the hospice team. I have been a hospice volunteer for more than fifteen years and I have seen how emotions and grief can take over in an already desperate situation.
Where does this conflict come from and why do these disputes arise? Many quarrels erupt between staff members, who, each wanting what is best for the patient and family, often come from different backgrounds or cultures, and disagree on how to best achieve that goal. There is often conflict between family members, siblings typically, who revert to their places in the family hierarchy and think they know what is best for Mom or Dad. Family dynamics play a huge part in these conflicts and bad feelings usually do not change or improve when siblings age; people often just get louder and more entrenched. Childhood animosities and perceived slights bubble to the surface in times of strife. Many roadblocks exist that keep people from having beneficial conversations, among them are a lack of trust and poor communication, bad habits that have existed for decades. Siblings never forget how to push each other’s “conflict” buttons.
Family dynamics play a huge part in these conflicts and bad feelings usually do not change or improve when siblings age; people often just get louder and more entrenched.
Disputes often arise between the family and the hospice itself. This may include difficulties between one family member and a particular staff member(s) or between the entire family and the hospice administration. Sometimes staff refer to a family as “difficult” when the family insists they want some kind of something that the hospice will not or cannot supply. This might include requests such as, “how come Mom can’t get a type of medication or why can’t the nurse come every day?” Many of these disputes center on demands that are not met due to either Medicare rules or unreasonable expectations on the part of the family. One of the myths/expectations is that hospice provides at-home care 24/7. In reality, hospice is on call 24/7 and provides nursing care or specialized services only when needed. The hard reality is that family or paid care-givers have to fill the gap and attend to the dying loved one during the many hours that hospice does not cover.
Resolutions are often hiding below the emotions and until those emotions are recognized and dealt with, the conflict will stretch out, fester longer, and the parties will never be satisfied with the outcome.
Mediation is a possible solution to these end-of-life conflicts. Whether the conflicts involve families or co-workers, a dispute resolution process lead by a skilled mediator can help guide the disputants to a workable solution. The mediator’s goal is to separate interests from positions and to make sure everyone at the table not only has a voice but is actually heard by the other parties, all within a safe setting. A fundamental tenett of the process is attempting to deal with the underlying emotions and dig into why the parties feel the way they do. Resolutions are often hiding below the emotions and until those emotions are recognized and dealt with, the conflict will stretch out, fester longer, and the parties will never be satisfied with the outcome. The mediator cannot hope to change the family dynamics or resolve decades-old sibling rivalries, but with patience and perseverance, perhaps the siblings’ commonalities can help them reach a consensus and forge an acceptable agreement for the benefit of their loved one. The mediator should be part of the hospice team helping patients, families, and team members foster healing relationships to bring peace during the final days of a person’s life.