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Healthy futures

Identify and address sources of conflict when making decisions about long term care

Marlene S. Stum, Extension Specialist and Professor — Family Social Science

Reviewed March 2017 by author.

How will your family cope when faced with the dilemmas and decisions regarding long term care? Decisions regarding a range of issues — from how to pay the bills to caregiving roles — can challenge family relationships. Take time to understand potential sources of conflict in advance. Then learn strategies to avoid or reduce the impact of these common conflicts!

Sources of Conflict

The experiences of families suggest that there are seven potential sources of conflict commonly experienced.

Families may disagree about one or many of these topics. A single conflict may have multiple sources. The diagram below shows that potential sources of conflict may happen in any order.

conflict diagram

Strategies to Avoid Conflict

Here are seven strategies to avoid or reduce common family decision-making conflicts.

1.  Clarify Perceptions of Problem and Care Needs

2.  Clarify Different Perceptions about Suitable Solutions

Clarifying different perceptions about suitable solutions — that is, quality and quantity of care — includes making clear the role of informal and formal support systems.

3.  Clarify and Acknowledge Different Attitudes, Beliefs, or Values among
Family Members

4.  Clarify and Renegotiate Roles

Clarify and Renegotiate Roles Figuring Out Fit

Impact of Caregiving

5.  Improve Communication Skills

6.  Identify and Acknowledge Unresolved Prior Conflicts

7.  Acknowledge Different Decision Making Processes

It helps to acknowledge that family members have different ways of perceiving situations and methods for making decisions.

You may find it useful to work through decisions involving value or role conflicts between two or more people with the following process and steps (Danes & Rettig, 1986).

Step 1: Clarify how each person views the problem.

If you are the one who first becomes aware of a problem, seek clarification of the problem from those involved in the outcome. First find out if they too are concerned. Try to identify whether what is actually happening differs from what they would like to have happen.

Step 2: Make a commitment to work on the problem.

If others agree that change is desirable, then get a definite commitment from them to think about possible solutions. When you get this kind of commitment, the others have begun to face the problem. Three sessions could eventually be planned. One might deal with stating personal needs, another with finding alternatives to solve the problem, and another with choosing an alternative most likely to meet the needs of several people at the same time.

The following guidelines might help the first two sessions flow more smoothly:

Step 3: State personal needs.

The objective is to define the problem before generating alternative solutions. Give each person a chance to state his or her priority values and particular needs. Each person needs to explain how what is happening is different from what needs to happen.
Allow a time delay between stating personal needs and considering alternatives. The delay allows time for tensions to decrease and could be anywhere from an hour or two to one or two days, depending on tension levels. Assign each person the homework of creatively thinking about alternatives.

Step 4: Consider the alternatives.

Find creative alternatives by brainstorming without analyzing possible negative or positive effects. The more ideas created, the better. Ideas are generated first by the individuals and are then combined to simultaneously meet the needs of several people. Again, plan a time delay, but make it longer than the previous delay to give private time for thinking as well as tension release.

Step 5: Select a solution.

There are two objectives: to analyze the goal and value issues of the family members, and to study how the preferred solutions protect these values and allow for individual needs. Discuss the pros and cons of each alternative. Examine the situations to discover if you are willing to accept the results of one or another of the alternatives.

You may or may not need more time before deciding which alternative best meets the conflicting values and needs of the family. This will depend mainly upon tension levels that surfaced during your negotiations. When there is an agreed upon goal and a willingness to commit time, money, and human energy to the action plan, then everyone has clearly accepted the solution. If this does not happen, you may need to go back to step one and reclarify the problem.

Step 6: Evaluate the choice.

Set a trial period for the accepted solution. Having a trial period may be less threatening than a hard and fast decision. It may allow everyone to cooperate because they know that it is not a "forever" commitment. Plan to review the new strategy soon after it has started and to discuss how it is working. Then make any necessary adjustments. The people involved need to discuss whether their most important values are being preserved. Successful social decisions may bring people closer together and improve future communication.


Barnett, A. & M.S. Stum. (2012). Couples managing the risk of financing long term care. Journal of Family & Economic Issues. 33, 363-375.

Cicirelli, V. (1992). Family caregiving: Autonomous and paternalistic decision making. Newbury Park, CA: Sage Publications.

Danes, S., & Rettig, K. D. (1986). Solving family problems involves social decision making. St. Paul, MN: University of Minnesota Extension Service.

Gwyther, L. (1995). When "the family" is not one voice: Conflict in caregiving families. Journal of Case Management, 4(4), 150-155.

Stum, M. (2007). Financing long term care: Risk management intentions and behaviors of couples. Financial Counseling and Planning. 17(2), 79-89.

Stum, M. (2001). Financing long term care: Examining decision outcomes and systemic influences from the perspective of family members. Journal of Family and Economic Issues, 22(1), 25-53.

Stum, M. (2000). Later life financial security: Examining the meaning attributed to goals when coping with long term care. Financial Counseling and Planning, 11(1), 25-37.

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