Human Services organizations are no longer just admitting the client/resident. The organizations are also “admitting” the family and/or legal guardian, and all the variables that go with those relationships. In today’s litigious environment, it is imperative to have a process in place to train staff on setting realistic expectations to manage those difficult unexpected events and communicate information to the family/legal guardian.

Managing challenging family relationships begins during the intake and screening process. Acquiring outside community assistance can be very intimidating and overwhelming for both the client/resident and the family/legal guardian. Many times, they do not understand the types of services or levels of care offered by the organization or what to expect from the caregivers during the day-to-day oversight and care. Having the family complete an Expectations Intake Survey will make sure that the care organization can meet the needs and wishes of the client/resident and family/legal guardian.

Having realistic brochures, handouts and websites that are accurate about the services provided and not overstated is the first step to setting realistic expectations. Some Human Service organizations tend to make unqualified claims concerning their services or products, which leads to making promises and assurances they cannot keep, and eventually will lead to family distrust.

Once the intake and pre-screen evaluation and survey has been completed, setting realistic expectations with the client/resident and family/legal guardian will help determine if the client/resident is an appropriate fit for the organization and the services/level of care provided there. Based on the client/resident’s healthcare diagnosis and medical conditions, provide education on the organization’s policies, the types of service and emergency assistance the organization is willing to provide and not willing to provide (e.g., one-to-one supervision, behavioral modification techniques utilized, leaving the premises without permission, drug/smoking use, etc.). Having the tough discussions during the intake process allows the client/resident and family/legal guardian the opportunity to make an informed decision on the client/resident’s care.

Setting realistic expectations can also provide the family/legal guardian with education on the risk factors associated with the client/resident’s healthcare diagnosis/conditions which could have a potential adverse outcome. Additionally, it will help prepare the family if there is a decline in the client/resident’s health which may require a transfer to a higher level of care, or any adverse event. Document what education has been provided, the acknowledgement that the family understood the information provided and the potential adverse events associated with the healthcare diagnosis/conditions. If the client/resident does not want to abide by the organizations policies and guidelines, depending upon the severity of the risk, the organization can utilize a Negotiated Risk or Hold Harmless Agreement; the organization’s legal advisor should review both.

Managing client/resident and family expectations takes time; however, setting realistic expectations not only assists with managing the risk, but it also fosters a level of trust with the client/resident and family/legal guardian.

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