The Whys and Hows of Family Councils

Published In Caregiver Advice and Resources

Robert Kriegel says it was a hefty hike of 5.5% in fees at his lifecare community in San Francisco that provided the impetus. A small group of residents who played bridge together there let their ire fly freely while conversing over the cards and decided to find out whether other residents were also upset that management had not signaled or explained the change. Many were. Their solution was to band together and form a Family Council, summoning the strength of numbers to urge the administration to be more forthright about budgeting and expenses. It worked.

“This is going on at senior facilities all over the country,” Kriegel says. “People who came of age during the 50s tended to be more peaceful types. But those who matured in the 1960s and 70s want to be more in control.  We tend to say: ‘I’ve invested and I have expectations. I am not a patient, I’m a resident.’ Family Councils give a voice to the residents who truly want to be proactive, to go forward and to let their views be known.”

Indeed, Family Councils, or organizations of friends and relatives of residents in senior living facilities—including independent living, assisted living, and nursing homes—are increasingly formed as catalysts to help improve the quality of care and address other concerns from the outside in.

Family vs Resident Councils

Family Council and Resident Councils are frequently confused, as a matter of semantics, but are very different animals.

Most facilities have a group in place, commonly labeled a Resident Council, composed of staff and elected or appointed residents who meet regularly. The loftiest goals of such groups are to give residents power in shaping how the facility is run and help administrators by specifying the needs and concerns of residents that are going unmet. While some Resident Councils help make inroads, most take on a formulaic feel that does little to change the realities of those who live there.

There are many reasons they often fall short. The biggest is that Resident Councils are usually run by facility staff or administrators, and most residents are simply afraid to speak up about perceived problems for fear of retaliation. Most meetings are run rotely—with staff speeding through a checklist of potential concerns: food, activities, staff, cleanliness—and without the opportunity for residents to truly air what might be on their minds. Those who remain members of Resident Councils tend to adopt laissez-faire or defeatist attitudes to problemsolving, commonly lamenting “We tried that five years ago and it didn’t work,” rather than bringing in fresh ideas or novel approaches.

By contrast, Family Councils are better poised to rock boats that need rocking. They’re composed of residents and interested friends and family members; administration and staff members are usually apprised of concerns raised at meetings, generally in writing, but can only attend if invited to do so. There is more opportunity and incentive for residents to speak freely. And it’s hard for administrators to ignore the concerns raised by family members, who are very often the ones responsible for paying the bills.

What the Law Requires

Those interested in forming Family Councils—which usually begin as a small core group of like-minded individuals—are often pleased to find that the law is on their side.

Federal law has long provided that residents have the right to have family members and other representatives meet with other family members and representatives. As mentioned, staff members can attend only if invited and agreed upon by council members, and facilities must “act promptly” on grievances and recommendations the group raises.

And recently revised federal regulations have strengthened the clout of Family Councils, specifying that:

  • Residents have the clear right to participate in family groups
  • Facility administrators must demonstrate responses and rationales to issues raised, and
  • Facilities must take steps to make residents and family members aware of upcoming meetings, such as posting fliers or distributing notices to them.

Also, many states set out additional protections and laws. California law, for example, provides that facilities cannot interfere with the formation of Family Councils, must allow them to meet in a common room at least once monthly, and post notices and minutes of those meetings. Most importantly, it cuts down on institutional foot-dragging by requiring facilities to respond to Family Council’s written requests or concerns within 10 days.

Steps to Starting a Family Council

Residents chomping at the bit for change, though, should be forewarned to proceed tactfully and respectfully—and a bit slowly. Robert Kriegel, one of the founding members of the Family Council at his facility, emphasized it is also important to remain upbeat. “At our meetings, especially the initial ones, we had to keep saying it’s not a gripe session; we have real problems to solve,” he says.

Seasoned Family Council members provide some additional tips, summarized below.

Get Organized. Start by gathering a small but motivated group of residents, family members and friends. At that introductory meeting, explain the purpose and importance of Family Councils, gauge whether there is group interest in forming one, and if so, appoint temporary officers such as a chair, vice-chair and secretary who will serve to keep momentum going and record notes of the meetings.

Suss Out Concerns. Find out whether other residents have concerns they feel aren’t being adequately addressed by the administration or by any existing Resident Council. Circulating a questionnaire to residents with room for open-ended responses may be a start, as well as holding an open meeting of potentially interested residents and outsiders in which they’re encouraged to air and record their concerns in small groups or on index cards.

Start Small.“One of our first strategies we adopted was to take on things we could succeed with,” Kriegel says. At his facility that included making improvements to the AV system and reinstituting the furniture sale with donations from residents who are downsizing or deceased—niggling concerns for many residents who were polled in a questionnaire.

Another small but nettlesome quality of life issue was the new washers and dryers installed in the common laundry room—stacked machines that many residents found tough to operate. “A lot of people here are under 5 feet tall and couldn’t reach the door to the top machine. Management actually provided them with tongs to transfer their clothes—not a good solution for people who might be unsteady on their feet,” Kriegel said. “It was humiliating, too.” Members of the nascent Family Council did a little research and found machines that were three inches shorter. And management agreed to the purchase.

Communicate. Once a group decides to start a Family Council, send a letter or request a meeting with the administrator to give transparency to the idea and assure him or her that the goal is to facilitate solutions rather than stir up dissent. After that, be sure to inform and communicate with other key players in the facility: Resident Council members, staff social workers, the director of nursing, and social activities director.

Seek Support. Gently pick the brains of members of Family Councils in other facilities that have been operating for a while, asking about the problems and triumphs they’ve encountered along the way.

Finally, the guidebook “Organizing Family Councils in Long Term Care Facilities,” published by California Advocates for Nursing Home Reform, contains valuable tips for forming family councils in any state and type of facility.

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