Even as mediation in general stops being the “light hidden under a bushel” and grows in the public’s collective thinking, it almost seems that we face the same uphill battle each time we branch out into a new area of application. Yes, many people know about divorce mediation, even to the point where last year we witnessed a network television program on the subject, a notion unthinkable when we began. We see widespread evidence of the success of using mediation in neighborhood disputes, organizational conflicts, and even schoolyard squabbles (Cleveland can be justifiably proud of its broad-based peer mediation programs in the public schools).
We optimistically expected that the public would quickly embrace mediation in the arena of elder care. It seemed only a reasonable next step. Since Baby Boomers first became the biggest part of our population, services have sprung up or expanded to meet the needs of new millions of us, from the burgeoning baby food industry to the multiplication of grade schools and then colleges, to increased demands for everything from cars and entertainment to (now, finally) the mushrooming growth of retirement funds and care facilities for the elder population. We were sure that the ever-increasing numbers of elders, along with increasing life expectancy and the complexities of caring for them, would create similarly growing demands for conflict resolution services. Many in the conflict resolution fields shared in this prediction and prepared ourselves for what would surely come.
The Problem: The experience of many practices is that the anticipated growth of this field simply hasn’t happened. No one seems to know we’re out here, and for the most part the population of potential clients is staying away in droves.
Patricia Bertschler (Bertschler and Cocklin, 2004) in doing research prior to the publication of her first book on the subject of elder mediation, found no previous books on the subject. Only scattered journal articles and a workbook comprised the “review of the literature” for that seminal work. It is still difficult to find meaningful statistics regarding the application of elder mediation nationwide. The Center for Social Gerontology, now active for some 40 years, has pioneered the use of mediation in guardianship cases only within the last decade or so. And it was only in 2009 that the Association for Conflict Resolution first created a division dedicated to conflict in the elder arena.
Our experience in Ohio is consistent with the report of Blair Tripp of Elder Decisions Inc., an established practice in greater Boston. Tripp notes that even though her group is recognized and approved to receive referrals from several area courts, actual referrals are very rare. In general she observes that there is “very little awareness” of the availability of elder mediation as a resource, either among the general public or potential referral sources.
The Survey: Two practices in Ohio have combined forces to examine the question of whether, and to what extent, elder care facilities in this area are aware of the availability of elder mediation as a resource to be used in serving their clients; and to what extent they actually use this resource.
Northcoast Conflict Solutions (NCS) is a private practice of mediation and conflict resolution in the greater Cleveland, Ohio area. NCS was established in 1997 and has provided mediation services primarily in the areas of divorce and family, church, organizational, and school conflict. NCS began providing elder mediation services in 2004.
Practicing in central and southern Ohio, Capital Mediation Associates headed by J. Christopher Scott has a strong history of mediation service and training. Scott himself was Delaware and Franklin Counties Municipal Courts’ mediation program. He co-developed a mediation program for the Better Business Bureau in central Ohio, and partners in programs offered by Capital University in Columbus, Ohio.
Researchers from Northcoast Conflict Solution and Capital Mediation Associates constructed an 11-item questionnaire (see Appendix 1) and cover letter (Appendix 2) which were presented to administrators and admissions directors of elder care facilities.
Beginning in January 2011, researchers Patricia Bertschler and Laura Poisson identified 74 care facilities in and around Columbus, Ohio and 70 similar facilities in northeast Ohio, primarily the greater Cleveland area. These facilities were identified on a very useful website, AssistedSeniorLiving.com. Selected facilities included nursing homes, skilled nursing facilities, assisted living facilities, and facilities providing a combination of these services. Independent living facilities were not included. Northeast Ohio counties represented included Cuyahoga, Summit, Lake, Medina, Geauga, Portage, and Lorain. In the Central Ohio area, surveys were conducted mainly in Franklin and surrounding counties.
Researchers phoned representatives of these facilities and asked for a few minutes in which to present the questionnaire items verbally. All responses were recorded, and respondents were invited to offer comments regarding their conflict problems and methods of dealing with them.
Results: Of the 74 care facilities in central and southern Ohio, we were able to contact 42 and to secure responses from 15. Of 70 northeast Ohio facilities listed, we were able to contact 43 and secured responses from 32.
Of these respondents, only one stated that she was familiar with the availability of elder mediation as a dispute resolution option; all others were unable to distinguish among litigation, arbitration and mediation. Those who answered regarding their methods of dispute resolution all reported that they attempted to resolve conflict “internally” and/or referred cases to their legal counsel.
Other findings from central and southern Ohio include:
- Most facilities consider the ombuds role the primary influence in conflict control or perceived prevention of conflict.
- Most facilities do not like to admit that conflict exists.
- Of the three facilities that admitted to conflict, the source of conflict was listed as follows:
- Residents who wanted to stay in assisted living and were too ill to do so
- Conflict between or among residents who do not get along
- Conflict within the facility was described as “very private” and was handled in-house.
- One facility reported having a monthly Residence Council to help deal with conflict between residents.
- One facility reported including a clause in the contract that directs the process for conflict management.
Comments from northeast Ohio include:
- When conflict arises, 5 call their attorneys first; 27 try to resolve conflict internally.
- One admitted being sued in the past.
- One knew the difference among mediation, arbitration and litigation.
- Three staff members are trained in mediation among 32 organizations; 3 others stated interest in future mediation training.
- “Families upset with level of care” ranks as #1 problem among 28 organizations. “Placement for levels of care” ranks #1 among 3 responders. “Internal conflict among staff that is disruptive” ranks #1 for 1 responder.
- 32 responders state that contracts do not include provision for mediation. All state that arbitration is first line of defense in contract wording.
- Other comments include:
- “We have an open door policy with staff and families which cuts down on conflict.”
- “We use a staff liaison more trained in conflict resolution when upsets arise.”
- “Out-of-town family members are the worst!”
- “The majority of problems are over petty things which staff handles internally very well. For big problems, we call our attorney immediately before it gets out of hand.”
- “We have an Advisory Council made up of 2 staff members, 2 residents, nursing home administrator and 2 family members. They meet monthly and this seems to help cut down on conflict because residents feel heard.”
Conclusion: Despite our optimism, it is not terribly surprising to realize that the field is still relatively unknown. It has been suggested that the status of elder mediation today is comparable to that of other once-new fields of practice. Counseling and psychotherapy for the general public were unheard of 50 years ago, and are now mainstreamed in everyone’s consciousness. And divorce mediation, virtually unknown 20 years ago, has survived a difficult infancy and may now be considered a field in its adolescence.
To put it mildly, much remains to be accomplished before elder mediation reaches similar status in the public’s awareness. Several years of networking, writing, free public service talks, and one-to-one conversations with decision-makers in the elder care industries have scarcely made a dent in the consciousness of professionals who care for elders. While some who care for older adult family members have told us that our services might have been useful when their families were in conflict, they typically learned of us long after the fact.
Professionals in conflict resolution clearly have much work to do to help elder mediation reach the kind of public awareness and acceptance already enjoyed by mediation in other areas. While we are not discounting one-on-one contacts with older adult facilities, we believe that making inroads at broader, state or national levels will better serve the field of elder mediation. Contracting insurance companies, Employee Assistance Programs, elder attorney groups as well as counseling groups such as the National Association of Social Workers (each state has its own chapter) and the American Counseling Association may yield greater exposure.
This has been our experience in Ohio. We are interested in the experience of others around the states who work in the area of Elder Mediation.