At a time in everyone’s life, we come to find ourselves in a situation where the music stops, and we must go on.  The unfortunate truth about life is that the unexpected will happen. Some of us learn from it, some of us change because of it and some of us find our life’s calling because of it. The latter was the case for me.  After our dad picked us up from middle school, we spent that afternoon like we had every afternoon that month. We went to the oncology unit at the hospital, where my brother was admitted.



I remember him. I remember the man in the dark blue sarong the same way I remember the lines on back of my own hand. He was hunched over next to a column on a dirty platform at a railway station in Calcutta, India in the middle of the harsh summer sun. His hands were withered, his fingers and toes looked like tiny nubs, and he was completely malnourished and alone. He had opaque blue eyes, as if fog had taken place of his irises and pupils.



I studied insects in college; my favorite insects were the bees (I found them diligent and so helpful to humankind).  One of my favorite classes was about medical diseases caused by insects. My professors noticed my interest in the medical side of things and connected me with a professor who did clinical research. Our work focused on a clinical trial for children with intractable epilepsy and exposed me early on to patient care and patients.


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So, what can you do? Watch for Anxiety, Depression and other emotional changes in your patient.

Why does this help with conflict in Eldercare? The commitment to an elder and the cost of the expanded treatment becomes much more when Alzheimer’s is involved. Memory Care units are available in Senior Care Communities but often there are not enough and being able to pay for it is a burden on the family. Keeping someone at home with this illness, costs less money, but the cost of commitment and sacrifice is huge for that family. Many family members tend to disappear when they hear the words financial and time commitment. Then the depression sets in.

Your office can help by recognizing these people when they come to you.

Understand how important this battle is for your patient. Give them your idea of seeking outside help like an eldercare mediator, a counselor or if necessary an attorney. Have your list prepared to send home.

Write your advice on the patient portal. Show them how to use your patient portal. Discuss using the portal as means for the adult children to keep up with the latest medical visit. Also, revisit the HIPAA release for adding others to the form.  You will be surprised how much this helps keep the conflict away and families reconciled. It is simple and it works.

Being a Physician, you can be asked to treat symptoms effecting your patient you would not expect. Your patients that are elderly believe they have a very special relationship with you, like a beloved and trusted niece or nephew. You are the wise counsel for all that matters, the Doctor knows best. Sometimes they want you to make their family stop fighting.

There are adult children who live out of the area who feel they are being left out when it comes to knowing and understanding what medically is going on with their parents. This is causing a conflict that you can fix. It is a question about which family members can see the elder person’s medical records. The conflict grows as your patient ages. They usually feel the sibling who goes to the appointment is not asking enough questions or the right questions when it comes to their parents, and are not explaining it back to them adequately.

HIPAA is often misunderstood and sometimes misused by certain family members as a tool against siblings or other family members to wield power in the decision-making process. Exchanges of “If you really cared, you would be here at the appointments” or “fine, you come and take care of them if I am not doing it right!”.

When you see this it probably means discussion is beginning on changing living arrangements for the parent. This can be a one of the greatest points of contention for a family. All the emotions are involved.


Recently I worked with one such family who took the fight everywhere they went. They were disruptive and embarrassing when they would arrive at the physician’s office. The police would be called. The whole family of ‘extras’ were banned from the office and elder protective services became involved. The sad part is they are not the only family doing this.

These adult children seem to revert to acting like juveniles. That can be understood if they are truly wanting the best for their parents, unfortunately there are those who just want to put them nicely away somewhere so that they become someone else’ problem, the sooner the better and “what is my share of the estate?”.  We’ve seen this too many times lately as in the family referenced above.

One may have a medical power of attorney and believe they do not have to share information. Relationships will be broken and mom or dad will be the ones who suffer as they wonder why some of the family never comes to see them anymore. That can be the start of the spiral decline in the health of that parent. Keeping the mental health of an elder in a good state is as you know all too well the key to their physical health and dying too soon.


Dr. Dani Vandiviere is a conflict and bullying specialist and CEO of Summit Conflict Resolutions and Trainings. She is the President of the Bluegrass Continuity of Care Association, a founding member of KY Association of Senior Services, a member Association for Gerontology, and an Elder Care Conflict Trainer and Mediator. She also offers training programs for the workers in the Eldercare industry, medical professional, elder’s families, organizations and businesses.

To learn more contact Dr. Dani at, or 859-305-1900.