Working with families in long-term care

Effective communication with families can improve clinical process and outcomes in long-term care. Such communication may be challenging to long-term care clinicians, who may feel they lack requisite skills or are uncomfortable with potentially charged and negative emotions that may result. These barriers can be overcome by using models of family behavior and of physician involvement in family counseling to foster understanding and organize family meetings. We present such models in this article. The first of these, the Pearlin Stress Process Model offers a framework for understanding family adaptation to long-term care. Within the Pearlin model, family function is a critical intervening variable. Structural Family Systems Theory is therefore examined next to guide to recognition of family characteristics that impact communication. We focus on translation of these theories to long-term care practice through clinical case vignettes. Applying the Levels of Physician Involvement in family oriented care to long-term care, we then suggest an organizing, stepwise process for the family meeting itself. We conclude with strategies for conflict management and a discussion of the importance of the interdisciplinary team in family care.