Bess’ Alzheimer’s disease has progressed to late stage. She lives with her husband, Don, in a small town. They have four adult children, three of whom live several hours away and one who lives across the country, who are anxious and unsure of what to do as their mother continues to decline. It is time for a family meeting, but where do they start?

A family meeting to discuss how to best handle a loved one’s declining health has the potential to build bridges or create divisions among family members. A guide, SOAR, offers points for family members to discuss and items to facilitate decisions. This valuable and easy tool provides structure for conducting the family meeting. SOAR is an acronym for Synchronize, Organize, Analyze, and Recognize.

S = Synchronize

The first step in holding an effective meeting is to get all family members involved, meaning that everyone must be present. Getting people together can be tough and as difficult as it may be to balance everyone’s schedules, this is a vital first step. Having a clear purpose, a convenient time and location, and an attitude of teamwork motivates people to attend.

Since distance can be an obstacle, explore creative options. For example, if Bess’ out of town daughter cannot meet with the family in person, she can still participate via a phone or internet conference.

Whether or not the loved one participates depends on his or her current medical condition. The loved one has the right to make their own medical decisions unless incompetency or dementia interferes. As Bess’ mental capacity prohibits her participation, Don hires a caregiver for the meeting.

Bess’ family meets at a friend’s house where the out-of-state daughter can be contacted by an internet conference website. Their meeting begins by reviewing Bess’ current mental and physical status. This summary gets the entire family “on the same page.”Next, they decide what topics to address. Limiting topics and taking the time to get consensus may make it necessary to hold several family meetings.

Ideas for topics include: personal care, finance/bills, transportation, cleaning, groceries/food, legal issues, doctors’ appointments, community resources, safety, emotional support and housing. Discussing everyone’s expectation creates an atmosphere of honesty and a willingness to listen to each other. Though this discussion may produce awkward and uncomfortable feelings for some family members, it helps to acknowledge and accept their feelings.

Written communication is vital, so notes should be taken and sent to everyone.

O = Organize

Categorizing is the next step. Who is doing what? What needs to be explored?What deadlines need to be established?

Other good organizational questions to discuss are: What are our options? What do we need to know? What if (fill in the blank) happens? What can each of us contribute? Who else needs to be involved? How will daily schedules, holiday and emergencies be handled? Talking in advance about difficult situations will lessen future problems and clarify communications.

Emotions may be fragile as sensitive issues are discussed. Remember organizing provides structure, not ownership. All decisions should be flexible and considerate of all involved.

Designate a note taker to record how tasks are divided. If one person is taking on too many assignments, this will be clear to see in a written summary. Or is that okay with that person? Sometimes it is helpful to have one person in charge as the coordinator, but openness is necessary about this issue. What if that person makes a decision not all agree with? Talking ahead of time will reduce problems later.

In Bess’ case, the three siblings who lived closer each offers to take a day a week to give their dad a break. The daughter who lives across the country volunteers to pay for the home-delivered meals as her contribution. They exchange key phone numbers such as cell and work numbers and agree to back one another up if scheduling conflicts arise. The family plans a second meeting to visit area Alzheimer’s units with Don. This way, if that option is needed, the family will know the area’s resources.

A = Analyze

Coming to consensus on decisions is not always easy. Gaining factual knowledge and recognizing things will not always run perfectly is a good start. Agree ahead of time that everyone will try to work together and acknowledge that adjustments will have to be made. Analyze and reassess the planning as the situation progresses.

Assess how the skills of family members are being used. For example, having someone in the family with a healthcare background can be beneficial. This person may know community resources and the right questions to ask. What frequently happens, though, is other family members rely on that person as the expert. Health care providers understand and know the medical system, but are also emotionally involved and may need additional emotional support.

Evaluate if all family members have been included. Sometimes in-laws or “significant others” are uncomfortable in participating, not understanding how much they should speak up. They may have wonderful skills to offer.

R = Recognize

Recognize the emotional factors that underlie all family meetings. These meetings can be a powder keg waiting to explode. Remember family members will be at different places emotionally. One may have territorial feelings. “I am the daughter, I have to do everything!”Some may feel frightened or uncomfortable at the prospect of caring for a sick person.

Respect the other person’s right to express feelings, even to say no. If the tension becomes too great, bring in a third party, such as the social worker or a minister, to facilitate the discussion.

Acceptance of her mother’s current condition by one of Bess’ daughters slows down decision making by her family. After consulting with Bess’ physician, this tension is eased by reminding her to “remember what the doctor recommended.”She is now better able to accept the planning.

Many difficult relationships arise out of misunderstandings and miscommunications. Using effective communication techniques diffuses the potential powder keg of disagreements. The use of “I statements” and empathetic listening are two communication skills that strengthen relationships.“I statements” focus on how the speaker is feeling and does not judge the other person. For example, the speaker says, “I feel nervous when…” instead of “You should be doing…”

Listening with empathy to each person expresses the desire to understand how the other person is feeling.“Let me listen and help me understand what you are feeling.”Many times if a person feels that he or she is heard and someone recognizes their feelings, they are willing to cooperate and help with the problem affecting his or her personal feelings.

The grieving process with all its emotional stages– anger, denial, etc., is already happening. Give people time to digest what is happening and realize that everyone is dealing with deep emotional turmoil and changing roles. Listening and forgiveness decreases the emotional impact for family members.

Family meetings are an effective means of discussing difficult topics. The stress and confusion in Bess’ family lessened after a series of meetings to clarify issues and to create a plan of action. Instead of a family falling apart due to the tension, misunderstanding, and miscommunication, a family can SOAR. SOARing creates the atmosphere for openness to discuss the full range of topics to best plan for the care of a loved one.