ASK THE EXPERT: Managing the relative from Hell

Paul-Ridout

Paul Ridout, Managing Director of Solicitors Ridouts Professional Services PLC, on how to deal with unruly resident family members.

You’ve all had one!  Turns up at antisocial hours, interferes in care, upsets the staff, makes constant complaints without basis, instructs care changes against professional advice. These are difficult problems and need firm and fair handling. Here’s a few initial pointers:

  • Make sure you document any event- facts, times and dates (use a diary). Otherwise it will be denied!
  • Be understanding reasonable and proportionate – people do react nervously to change combined with the distress of a declining relative; do not be too quick UNTIL
  • It is clear you have a significant problem. Then act decisively and quickly.
  • Remember that the resident is your concern not significant others, however, significant they think they are.

CORE PRINCIPLE

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It is your home.  You have the right to control who comes, who goes and how they behave.  The only exception is CQC and even then they can be restricted if there is a reasonable excuse (which is an almost “never” event).

If you decide to restrict times or conduct of visitors, you may do so BUT you should have a good reason and act reasonably.  Be proportionate.  The diary will be a vital tool.

THE RESIDENT…has the absolute right to refuse any visitor for any purpose.  Unless the resident lacks capacity their decision is absolute.  Even if the resident lacks capacity, their wishes may be so clear that a best interests decision to exclude may be obvious.  In borderline cases a more measured decision should be taken to what is in the residents’ best interests.  Remember it is the resident’s interests (and the interests of other residents) which have to be balanced.  The interests of visitors are not relevant.

THE VISITOR…has effectively no rights, particularly if their conduct is unacceptable.

The expression “next of kin” has no meaning and carries no rights.  The only person with any rights is a person who holds a Lasting Power of Attorney which has been effected by a lack of capacity and, then, only in the particular areas permitted finance and/or health and welfare, or, a Court of Protection Deputy.  Even those would not be able to assert their rights of representation to counter a provider’s decision to exclude for good cause.

THE LOCAL AUTHORITY

These decisions are for the Provider – You.  The Local Authority has no power to override your decision.  However, it will be reasonable for you to be expected to explain your decision.  Safeguarding is most likely engaged where the impact of conduct on the resident is considered.  The visitor has no right to visit against a clear decision to exclude.  It will be rare that there will be any credibility in the proposition that the resident is at risk of harm by a visitor being excluded or visits managed.

CAMERAS

Hidden cameras are becoming more prevalent.  The use of such cameras without the consent of both the provider and the resident is unlawful.  BUT… Cameras can be useful protection for staff and residents.  You may remove cameras.  The cameras are the property of whoever placed them.  In such circumstances we recommend a joint agreement as to the placing and use of cameras to give comfort.  Now there are even real time apps which enable oversight at any time.  The steps should be taken by agreement and managed by the provider.

THE REGULATOR (CQC)

The Regulator will expect provision of facilities for visitors.  However, it is for you to manage the detail.  CQC cannot force you to permit access against your reasoned management decision.  Once again your diary is vital as is the rationale for the decision.

DO NOT be scared of the disruptive visitor.  You are in control.  Effect their control quickly (once you have made the reasonable decision) firmly and fairly.

AVOID discussion and stay out of expensive litigation.  This should be simple if you have prepared your DIARY and REASONABLE ACTIONS.

 

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25 Comments

  1. Jools said:

    Utterly shocking. You don’t seem to grasp that it is the resident’s home, not the provider’s. Neither do you grasp that you need to be working WITH relatives, no matter if they present as ‘difficult’. Difficult usually means ‘worried to death’ that the person they love – and know much better than you ever can – is totally dependent on the care of strangers. Just think how you would feel if you had to entrust your child, mum, dad etc., to the care system. It isn’t rocket science, just basic psychology with a good pinch of humanity.

    • Ted Goodman said:

      At first I thought this article was deliberately written so provocatively to make a point of some sort. But I couldn’t find one. This Is legal advice; and such us one lawyers view. Probably not someonr who has had to endure the horror stories People tell me regalarly. . I’ve spent my working life in social care, managing and inspecting and regulating care homes of all sizes and for people with a wide range of needs, as well as being a family carer. I now work with other family carers and organisations trying to improve care services. There is, in my view, a strong link between the standard of care and the way care home staff and managers view relatives. And as a consequence, how these relatives present themselves. Good quality care homes invariably see it as important to welcome relatives, work with them and make sure they are involved jointly in caring for the person the care Home is being paid to look after. When a relative has a concern, they are not frightened to raise it. They know they will be listened to and their concern resolved quickly. The care Home doesn’t get tangled up in high cost and disruptive complain investigations and they don’t have to waste money on costly legal advice to tell them what they should already be doing – working together for the good of the person they are, or should be, both interested in.

      In contrast, poor care homes are the ones generally who have difficulties with families. But that is because they won’t listen and think they know better. Just because family members are visitors doesn’t mean they aren’t still carers. Poor care homes forget that at their peril. They may be impressed by this legal advice. I’m certainly not. Good care homes don’t need either to find ways of circumventing CQCs requirements,

  2. Jonathan Ritchie said:

    One day soon you will be elderly and may end up in a care home. Is this how you would wish your family to be treated?

  3. D Boyle said:

    Very disappointing to see people so transparently helping care homes to behave in this way and legitimize this type of behavior. Do you have any consideration at all regarding the emotional effect of banning people from visiting their own family often due to raising concerns, and the effect on the resident?

    I note your firm also provide advice to care homes and health providers on how to get around and contest points and issues raised by the CQC. Please examine the effect of your advice on vulnerable people and adjust your advice to teaching these providers to conduct themselves with integrity in the first place.

  4. Lou H. said:

    There are so many things wrong with this article I don’t know where to start. Do you realise (do you even care?) that the experience of having a relative or loved one in a care home can be incredibly distressing; many things you would consider ‘unruly’ are just the normal responses of someone filled with difficult emotions – worry about their loved one, guilt that they’re not able to care for them as they feel they should, anger that the people who are supposed to be looking after their loved one aren’t listening to the people who know the resident the best, and so many other things I don’t have space to list here.

    Yes there will be times when family and friends are too close and emotionally involved in an issue to be able to see the way forward as clearly as they might like, and long-term care home staff may have the knowledge and experience needed in such cases. However, the solution isn’t to ‘manage’ them and see them as ‘unruly’ and ‘from hell’; the solution is certainly not to prevent them from seeing their loved one, and their loved one from seeing them. It’s to work with them to address and alleviate their concerns, and to recognise that they are human – that they’re worried and need those worries addressed, not pushed to one side. When care home staff sit down and discuss the issues with the ‘unruly’ family members, and each party really listens to what each other is saying, there’s a good chance they can not only alleviate concerns, but actually improve the way they care for the resident and improve relations with the family.

    The fact is that while many workers in care homes are loving, dedicated people with a passion for what they do, there are some who don’t care, and/or who have a paternalistic ‘I know best, so you’ll do as I say’ attitude when really they don’t understand the individual needs of the residents. Anyone working in a care home who thinks they always know what’s best for residents is in the wrong job.

    And care homes are absolutely not the staff’s home – they work there, they don’t live there. It’s the residents’ home.

    A far more understanding and humane (and human), and less degrading, way of considering the issue would surely be an article entitled ‘Helping alleviate the concerns of distressed relatives’.

    • Susan Macaulay said:

      “‘Helping alleviate the concerns of distressed relatives.” Yes.

      Even better: “How to fix a broken healthcare system that fails to meed the needs of consumers.”

  5. Pam Henderson said:

    Yes, you might see me as a family member ‘from hell’ but if I had not rung alarm bells that my son was being harmed in a care home, the staff would not have! They hid the facts for weeks, no records of injury, even though it needed a doctor’s attention on two occasions. Yes, I would continue to be a relative ‘from hell’. if it meant my son was safe! And yes, I would take video of the evidence if necessary! You say it is unlawful, under which law is that?

  6. Julie Ali said:

    Troubling to see such cynical advice provided to continuing care providers but I guess it is useful to see the risk management process spelled out clearly for us.
    Families who advocate for vulnerable customers of continuing care businesses are very vulnerable to retribution in Alberta which includes banning, cease and desist letters followed by expensive lawsuits. All these matters serve the businesses, the health authority and the government of Alberta to minimize non-compliances in the system that the “partners in care” are fully aware of and do little to resolve because such efforts require money, interest and oversight. Penalites are non-existent.

    I don’t expect this situation to change but certainly as families engage in class action lawsuits, the advice provided by this article will become more essential to the continuing care providers who don’t bother to document anything becxause this sort of information can be used against them. I’d advice families to follow the rules of engagement spelled out in this article very carefully. This is the reality of the continuing care system in Canada and everywhere else. Advocates and family members of the customers are simply problems to be managed.

  7. JC said:

    In nearly 30 years of experience working in hospitals and care homes I have NEVER met a “relative from hell”.
    I have met relatives who love those close to them and get labelled “difficult” by staff whose self-concept as an “expert” is so brittle as to be damaged when someone from outside their little fiefdom dares to suggest that there might be a better way to do things, or that we might have missed something important, thanks to our institutional habits and the professional blinkers we wear.
    Relative who care, who question, who dare to speak up when they think things aren’t right – these should be welcomed and nurtured. Our duty of care should extend to them also.
    We NEED to be challenged.
    Attitudes like yours lead to abuse and even death for vulnerable people. This I know from first hand experience.

    • Susan Macaulay said:

      Thank you JC! If more healthcare professionals shared your attitude, we would be able to build a better healthcare system together and soon there would be fewer complaints.

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  9. The Mother said:

    You should be totally ashamed of yoyrself for writing such – ye gods I don’t even have the words!

    Let me explain ‘difficult’ relatives for you …

    Relatives are labelled as ‘difficult’ when they dare to stand up for the rights and needs of the person they care about. Mostly, we are proud to own that label because it means we are doing the right thing.

    We are supporting the person we care for against appalling standards of care, against waking night staff who sleep on duty – leaving those we care for with no care. Against those we care for being left in urine and faeces for hours on end. Against those we care for being verbally, emotionally, financially, physically and sexually abused by the people who are paid to look after them.

    And let me give you a bit more information – we have to stand up against these things even when the person we care for receives publicly or privately funded care in their own home!

    Your encouragement of providers to ban loving relatives who dare to support those they love and care about is sickening. If you don’t want to believe that people are so neglected in care homes etc. google the names of Thomas Rawnsley, Connor Sparrowhawk, Nico Reid, Stephanie Bincliffe et al.

    Hang your head in shame – this article is nothing more than a direct encouragementf the abuse that so many people are trying to protect their loved ones from.

  10. Flash Bristow said:

    I’m sorry but this article is shocking. While I personally do not live in a care home, an elderly relative does – and also a close friend works in one.

    I’m disabled myself and if I was a resident and staff excluded a visitor of mine I would be terrified. Sometimes I need people to recall things for me, advocate for me, or just keep me company. Trusted close friends who have seen me vulnerable and know what I need when that happens. If my visitor was excluded for speaking up and looking out for me, you’d be cutting off my method of communication, of support – a lifeline.

    Your words are harsh and come over as slightly supercilious and completely lacking empathy. I guess that in your profession you’ll have the luxury of affording assistance to stay independent in your own home; consider what would happen if you became vulnerable – perhaps having falls? – and had to be placed in the nearest care home. It’s hard enough to be uprooted and told that a pre-furnished room is now your “home” – it may be a dwelling but it takes a lot to become someone’s home, their safe space. And if they want the basic right to invite a visitor to their home, they should bloody well be able to. If staff can’t manage this situation (unless of course a crime, such as assault on a member of staff, is committed) then I have to ask what confidence we can have in them? Are they running a home, or a prison?

  11. James said:

    I think we are misinterpreting what a difficult family member is…

    This is a difficult subject in general, the article was written by a Solicitor remember not a care giver….

    My thoughts… Family members concerned for the welfare of the resident are not difficult but as you say, scared and afraid, perhaps feeling a little guilty and powerless. That is a human reaction. Fine. Discuss move forward together as human beings.

    Difficult family members are things like, I want a green banana, that cup of tea is 1 degree to cold, you haven’t skinned the grapes, please wash my mothers clothes separately from everyone else’s. Ringing the call bell every 5 minutes for non emergencies, demanding more time from care staff than other residents. Needing care staff to always be available when there are other residents being attended to, always challenging staff while caregiving. These are the sort of issues the article relates to and can cause conflict.

    I have never experienced an occasion where we have refused entry to a family member and I would suggest it would be a failure on the provider’s part if it escalates to that point.

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  13. Gail Weatherill said:

    Over the course of four decades in the care of our elders, I have never seen a more egregious load of rubbish masqueraded as “professional” advice! I don’t know what decade you are stuck in, sir, but it is most surely not in the 21st century. Horrible, just horrible.

  14. Louise said:

    I think maybe this so called ‘Expert’ needs a bit more educating on the day to day running of a care home… the manner in which this was written is dispicable, families of loved ones in care need understanding and compassion. They are coping with their loved one being in a strange and unknown environment in which they need to put their trust in.
    I could write plenty of examples, but think it would be pointless. Paul, this type of attitude is many of the reasons why many care homes are failing.
    If a family member has need to feel concerned then it needs to be addressed in an understanding manner in order for both families and residents to feel secure… I think maybe a few training courses are needed your way my friend! Maybe you would be interested in attending a few? Communication, SOVA, and Care in a Vulnerable setting may be beneficial to you perhaphs?

  15. Mum said:

    Hmmm, I have seen both sides. I have been someone that has worked in a professional care role & a family member. Firstly I’d like to hear your definition of “difficult family member”. This is because I have met those family members that are a) angry or b) controlling.
    With those family members that are a) angry this can be because of frustration for specific reasons. Any good care provider should be able to talk, explain & reason with these family members.
    On the other hand those who are b) controlling can be very challenging to work with. Sometimes I am ashamed by these family members. They manipulate situations to their interest not to that of the person being cared for. These are the ones that need to kept at arms length from the person in care. They can inhibit independence for the person in care.
    Sometimes though they have been let down by the system. They won’t have received training (like many of the provider training programmes have). Without this training, where people are challenged over what’s in that persons best interest, they sometimes don’t realise that they are being too controlling.

  16. adele meader said:

    Would you like me to come and offer you some training and a little more insight?

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