11. Module 10 · Supporting relatives

11.3. Case, consolidation & transfer

Case, consolidation and transfer

Two cases and what to take away

Case study

Feelings of guilt relieved

After her mother’s move into a care home, Mrs L.’s daughter is plagued by feelings of guilt (‘I shunted her off’) and at the same time exhausted from years of caring. She is demanding and critical towards the staff. A carer recognises the distress behind this, takes time for a conversation, acknowledges the daughter’s years of loving care, relieves her feelings of guilt (‘You gave everything for a long time; the move is not a defeat but the best thing for your mother now – and you remain an important part of her life’), and involves her. The daughter relaxes and the cooperation becomes a partnership. The case shows how understanding and relieving relatives resolves conflicts and helps everyone.

Second case

Mr Demir and the unannounced visits

Mr Demir (fictitious), 58, visits his father, who has dementia, at all hours, often at night. He changes his father’s clothes, rearranges the room and tells staff what to do. A colleague, Jonas (fictitious), says that “he is controlling and impossible” and suggests restricting the visiting hours for him. The nurse in charge asks for a conversation instead. Mr Demir says that he was his father’s main carer for five years and that he cannot sleep because he fears that his father is afraid at night. The nurse acknowledges his years of care, explains how night shifts work and shows him the care plan. They agree that he can come in the evening for a fixed time, that he brings familiar music, and that the night team texts him if his father is restless. He also receives the contact for care counselling and a local self-help group. After two weeks the night-time visits stop and the team notes that his father sleeps better with the music.

Analysis. (1) The behaviour that looked like control was fear and worry (Figure 10.2, stage 4). (2) The team answered the need behind the complaint and not only the behaviour (Figure 10.3, steps 1–3). (3) Involving him in the care plan used his knowledge as an expert on his father (Module 5). (4) Clear agreements gave both sides predictability. (5) Pointing to counselling and a self-help group addressed his own strain (section 7a SGB XI). (6) Restricting visits would have deepened the mistrust and cut the person off from an important relationship. Limits were still possible: if safety or the rest of other residents had been at risk, the team would have spoken with the manager first.

🗂️ Flashcards – think first, then open
Why are relatives called ‘the second patients’?
They also suffer: they grieve for someone still alive, carry years of strain and often feel guilty.
What are the five steps of a conversation with a relative?
Listen, acknowledge, inform, involve, agree on a next step.
What may lie behind a harsh complaint?
Worry, guilt, helplessness or grief. Answer the need as well as the facts.
What does section 45 SGB XI offer relatives?
Free courses from care insurance funds that make caring easier and reduce strain, also at home on request.
Are relatives always the decision-makers?
No. Decisions come from the person, or from a person with a power of attorney or a legal custodian. Confidentiality rules apply.
How can you relieve guilt after a move to a care home?
Acknowledge the years of care, say the move is not a defeat and show them their role in the person’s life.

Key messages

  • Relatives are people affected alongside and partners, not visitors or a disruptive factor.
  • Their grief is a farewell in instalments, and guilt and exhaustion are normal.
  • Needs change over the journey: ask, do not assume.
  • Answer the need behind a complaint, and admit real mistakes openly.
  • Relatives are experts on life history, but decisions follow the person’s rights and confidentiality.
  • In Germany, care counselling, care courses and short-term leave exist: point to them without promising.
Reflection (for yourself, nothing is submitted).
  1. Which relative do you find hardest to deal with, and which feeling might lie behind it?
  2. When did a conversation with a relative change a conflict into cooperation, and what did you do?
  3. What do you know about the support services in your region, and where could you find out more?
  4. How do you protect your own energy after difficult conversations?
For your everyday work – checklist
  • ☐ I greet relatives by name and ask how they are, not only about the person.
  • ☐ I ask relatives about life history, habits and favourite things and write them down.
  • ☐ I give time for a conversation and use the five steps when there is conflict.
  • ☐ I know where to refer relatives for counselling, courses and self-help.
  • ☐ I follow confidentiality rules and tell the team leader when I reach a limit.
Transfer to practice

Exercise: Think of relatives whom you experience as ‘difficult’. What distress (worry, guilt, grief, helplessness) could lie behind this? How could you approach them more empathetically, involve them and relieve them? Do you know counselling/relief services you could point them to?

Voluntary self-declaration – saved in your course account. Once all modules are marked as done, your confirmation of participation will be available.