The downturn in our country's economic health can affect older adults, their families and their caregivers in unexpected ways.

A significant change in the financial strength of retirees' assets may impact caregiving options. Although available money for in-home care or for a planned move to an assisted-living facility may be significantly reduced, the need for a higher level of service may still be evident. Conflict is a natural outcome when people are forced to change. When change is forced upon us, it is important that we find ways to manage conflict so that everyone can embrace the changes in harmony. Families may be forced to re-evaluate viable alternatives. How can older adults' needs be met effectively, while curtailing expenses and appropriately making other family adjustments?

...Perhaps one of the children (or grandchildren or nieces/nephews...) recently lost their job, making them available to provide care directly. This relative may even desire to move in with the elder-in-need. But - just because a family member is available, is this person the right caregiver? Does he understand what is required? Or might she provide inadequate care or ignore, inappropriately influence or even abuse the elder? How are these decisions made and what if everyone does not agree? Are other family members able to discuss these issues or do these changes just happen?

...Perhaps a family member who has been providing the bulk of the caregiving activities now finds it necessary to take on a second job, limiting time available to care for the elder. Who can pick up the extra slack? If the family cannot afford to hire regular caregivers, what other options might available? Can other family member step up and provide care? What if everyone else in the family lives far away and/or already overextended? Can the family make these decisions in a proactive way or is it more like "management by crisis"?

...Perhaps your parent and a friend have decided to become roommates to reduce costs. Maybe your mother has offered to rent out the extra bedroom to someone she just met! What if family members disagree - some family members are relieved that Mom won't be alone, yet others recognize potential danger? Do family members have the skills and the desire necessary to have these difficult conversations?

Such changes should prompt heartfelt family discussions. Some families are well-equipped with lots of trust and good communication skills. However, when everyone is already stressed over their own situations, such discussions can erupt into family disagreements about obligation and duty, guilt and money. These can be challenging times for even the best of families. There are some things that you can do to help yourselves survive these times.

We recommend these tips for maintaining a peaceful environment:

• Show respect for each other -- let each person have an opportunity to share their ideas and concerns

• Have an open mind -- agree that times are tough and creative options may need to be considered

• Maintain composure - avoid hysterical reactions so that all parties can stay focused

• Don't hesitate to present your ideas and thoughts - sharing any suggestions will help you to feel involved

• Stay positive - remember that you are all inter-connected

• Keep your sense of humor-these are not easy times but a little well-placed humor can go a long way to help everyone keep their perspective.

Even in the best of times, families may not always be able to speak with each other effectively. This becomes more difficult during tough times. It may seem easier to avoid these issues, yet "sweeping things under the carpet" may prove harmful.

When conflicts persist and productive communication is not happening, an elder mediator may be able to help the family resolve issues by facilitating difficult conversations. As an impartial third-party, a mediator helps the group establish ground rules that ensure that all parties respect each other and have a chance to share their thoughts. Disagreements may stem from misunderstandings about the need for care, the cost of care or the options for care. Through the elder mediation process, new ideas are often generated that consider everyone's concerns. Elder mediators are well-versed in issues that affect families/older adults and can offer clarification and/or direction to appropriate resources, as appropriate.

Debbie Reinberg started working in the geriatric field in 1987. She is currently a partner in ELDEResolutions (http://www.elderesolutions.com), a professional mediation and eldercare services company in Denver, Colorado. Her experience includes implementing Senior Health Centers (hospital-based geriatric outpatient primary care programs) and professional geriatric care management.
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