On any given day in long term and post-acute care (LT/PAC) centers, the arrival of an upset family can turn an otherwise calm day into a crisis. These unplanned meetings can be, unfortunately, fairly commonplace, and they often simply do not go well. In addition, there are several reasons these meetings can go sideways.

How those incidents are handled can make a huge difference in the reputation of the organization, potential lawsuits, and the general day-to-day peace of mind in the workplace. 

If upset families are a recurring issue for members of a leadership team, then how can they be handled more smoothly and with more satisfying results? First, one must accept that upset customers are a part of any business, and these interactions can be especially volatile when people are representing their loved ones, or believe they are representing their loved ones.

There are several simple things leaders can do to prepare their teams for these encounters. 

S​tay Calm

​Get the family to a quiet area. The facility leader must stay calm. It is amazing how often otherwise good caregiving staff make these situations worse. The author has often seen team members say, “You cannot cuss me—I won’t tolerate it,” when a family member lets a “damn” slip into a sentence. But think about it for a moment. The family member may think the facility did something terrible to their Mom. 

Without passing judgment on anyone, curse words are nothing most leaders haven’t heard before. It is imperative that the situation is given a chance to settle down. When there is a fire, one will have better results using water to douse it than gasoline.

Let The​m Finish

The meeting leader must let family members finish what they came to say. They have practiced their speech on the entire drive over to the building, running through it in their minds and possibly getting more and more angry in the process. If the facility leader interrupts them, or, even worse, keeps interrupting them, they will simply go back to the beginning and start again. All that will then be accomplished is that the family will be even more frustrated. The best suggestion is to let them finish completely. 

How does one know when they have finished? It’s very simple. There will be silence, and they will say, “Aren’t you going to say something?” That is the cue for the facility’s meeting leader to speak. At this point the family may still be angry and on edge but, at a minimum, they have at least temporarily run out of steam.

This is the point for the leader to calmly run through the list the family made of the pertinent issues. Any issues that the family feels have been misunderstood will be clarified at this juncture. 

There should be no attempt to defend or debate any item yet; this is simply a restating of the family’s issues as the family has presented them. Restating their issues is the best way to be sure that the issues as seen by the family are correctly understood. This in no way “agrees” or “disagrees” with the family’s view. Always ask questions for clarification where needed.

Work Toge​ther

Sometimes the family member will apologize or get defensive as a rant winds down. In the author’s experience, it has always been effective to say, “You are upset because you love your Mom; that is your job. Let’s work together to find an acceptable solution.” This helps, and it is very true. The love they feel for their family member has led to their anger, whether justified or not.

The facility leader should not argue about details (this leads to missing the forest for the trees). The author has seen team members want to argue, saying, “You said there were two pills in the bed; we only found one.” Well, the fact is that the pills are supposed to be inside the resident, not in the bed. That is the point, not the number of pills in the bed. In the big picture, this is anything but a debate to be won; the only victory comes from a workable resolution.

Follow ​Some Rules 

There are a host of resources out there about “rules” for arguments. Without rehashing a long list of those here, there are a couple of key ones to remember. Saying “calm down” rarely accomplishes any calming of the situation. The family member sees this as a debate where the stakes are high.

Saying, “I know how you feel” seems to be another bad line. Even though the author (after 36 years in the business) has had multiple relatives pass away in long term care facilities, it is clear that family members do not think that most facility leaders know “how they feel.” It simply isn’t a line that usually works. The often repeated rule against saying “always” or “never” applies here as well.

Bring In the Te​am

It is the job of the facility leader—the administrator or director of nursing (DON)—to “land” the upset family. Once the conversation becomes reasonable, it is time to bring in the team. When dealing with a current resident, which is the situation most of the time, it is critically important to involve line staff in the solution phase. 

Far too often, the administrator or DON decides on a solution and then sends a message to the floor staff saying, “This is what we decided to do.” Their response can range from, “I guess that’s OK,”—still with no involvement or investment—to “That just will not work,” to even, “Oh, they said we’d do that, did they?”

A far better way to achieve success—once calm has been restored—is to invite the nurse and certified nurse assistant (CNA) for the resident into the meeting. Let them help structure the plan for a solution. They know the resident and often the family best, and they know what has the best chance of success. The family may have a much tighter relationship with the staff on the unit, and may also feel more empathy toward them. 

Finally, it is important to remember that the frontline team will work so much harder on their idea than they ever will on management’s idea.

Build​ a Safety Valve

Anyone who has done this kind of work for any time at all certainly knows that the best laid plans can collapse like a house of cards. So, to protect the team, the organization, and the leader, it is best to always build in a safety valve. Most of these conversations end reasonably, and with a good plan in place. 

Historically, it is not at all unusual for a family member to say to the author, “I am so glad we had this talk, I feel a lot better now.” Given this opening, the leader should always stop them right there and say the following: “You are supposed to feel better now; I am a professional talker, it is my job to make you feel better.” Then continue, “But hold that compliment. I’ll call you next week and we will see how this plan—the one we all made together—is working. Then you can thank us.” 

One must never miss making the follow up call, or the leader can simply ask the family to call back on “X” day to report on the progress. This gives an opportunity to harvest a compliment or make slight adjustments to ensure the plan’s success after getting feedback.

One should also never fail to immediately follow up with the floor staff to thank them for their help and good ideas. This is a key opportunity to get a win with the staff and promote a positive, team culture. They want positive feedback.

Tap into ​CNAs

This subject matter is a prime opportunity for CNA customer service experts, a topic that was covered in the July issue of Provider. Think of all the time, energy, and negativity generated by meetings with upset families. If the CNA team has leaders trained in customer service, trained to watch for the signs of a family situation escalating, and prepared to help deflate these situations, then some of this negativity can be avoided. If half of these situations could be eliminated, the savings in potential litigation alone would be huge, not to mention the benefit to the community’s reputation. 

Leaders at all levels should be trained to deal with these situations, and there are plenty of reasons for smart organizations to empower their frontline staff to be the first line of defense when families begin to become disenchanted with service.

This subject matter provides a perfect opportunity for role-playing in-service training. These will not only be effective, but can be fun for staff as well. They have all been through a tough family meeting at one point or another, and will relish the opportunity to play the part of the family. 

Practice makes perfect. This also allows the frontline team to see that the organization’s leadership team truly understands the challenges the frontline team face with their day-to-day interactions with family members. The organization that wants to stay ahead of these issues does so with training and a positive team culture. 

Customer service starts on the floor. By the time a family member is shouting in the lobby, a lot more work will be needed just to start down the tough road to service recovery.Remember, the only victory comes from a workable resolution for both sides. Families see this as a high stakes contest. It is a high stakes contest for the organization as well. 

Greg Dowdy is chief operating officer for American HealthCare, which has 17 facilities in Virginia. He has been doing this job for 36 years, in which time he may have accidentally learned a thing or two. He can be reached at gdowdy@ahc.cc. Please also view Dowdy’s LED Talk at www.providermagazine.com.​