In the mid-80s, Larry Bird was the most brazen and competitive player in the NBA. The Boston Celtic forward was so dominant that, to avoid boredom, he would find ways to challenge himself during games. The right-hander once handicapped himself by spending an entire half shooting with only his left hand. Care Consultants who find their work an insufficient challenge can, likewise, provide themselves with a major handicap by taking advantage of an opportunity that presents itself at the beginning of a contact. Before we get to that, please read the following scenarios with the following question in mind: Who’s the client?

The daughter of an elder contacts you. She reports the following: Her father is maintaining marginally at home. He attends a day program three days a week, but she feels this is not enough to provide the support that he needs. Her brother is power of attorney (POA), but the POA has not been activated since Dad is still able to make his own decisions. However, because Dad has not dealt well with his finances and is now in debt, her brother has stepped in to pay bills that Dad can’t cover. Because her brother is paying the bills, he believes that he should make all the important decisions for their father, even to the to extent of telling Dad not to take prescribed anti-depressants because he (her brother) believes them to be ineffective.

Who’s the client? The daughter who hired you and signed your fee agreement? The son, who’s been appointed the POA, is paying father’s bills, and might even be expected by the daughter to pay for your services, because, after all, you’re going to be evaluating their father’s needs and making recommendations? Let’s look at a few additional examples:

A woman suffers from early Alzheimer’s disease. Her daughter has arranged for in-home care, but it is insufficient to address that her mother is no longer capable of preparing meals or of, without supervision, safely taking prescribed medications. Her daughter manages her finances and knows that the needed 24-hour, in-home care is not financially feasible. Her daughter contacts you because she wants you to talk her mother, who still (legally) makes her own decisions, into moving to an assisted-living facility.

Who’s the client? The daughter who hired you? Or her mother who, while suffering from cognitive disabilities and memory loss, still has the legal right to make her own decision? And:

You are hired by a lawyer, the POA for an elderly woman, and on whose behalf asks for your assistance in dealing with the assisted-living facility where she resides. You contact the facility and the director complains that the POA’s client is disruptive and that they’ve exhausted their repertoire in trying to deal with her. But, much to your pleasant surprise, the director gushes over your stellar reputation and states that she’s delighted that you will solve their problems with this woman.

Who’s the client? The lawyer who hired you? The gushing director of the facility?

Who’s the client for dummies

In nearly all professions, determining who’s your client is simple. If you’re a doctor, your client (or patient) is the one with the booboo, and is always the one under whose name the service is charged. If you’re a lawyer, your client is going to be the one for whom you’ll be advocating or defending. If you’re an accountant, your client will be the one whose financial interests you’ll be looking out for. If you’re a counselor — okay, that one can get a little tricky because, while there may be an identified client for the requirement of insurance reimbursement, a family or marriage counselor might view the collective group as the client. Nevertheless, in nearly all cases, the care consultant deals with the issue of who’s the client more than any other profession.

So how can you be the Larry Bird of care consultation? How can you handicap your work with your clients? By regarding anyone but the elder as your client². No matter what, in your practice, you’re going to be dealing with conflicts among those involved with an elder in need. People see things differently, and those differences of opinion will often be the very reason you’re hired. But it’s one thing to work to resolve the conflicts among the elder’s posse. If you’re confused about who’s the client, you’ll be wasting your time trying to solve conflicts within yourself. Even Larry Bird avoided that thankless challenge while doing his job.

When numerous parties are involved, and if there are conflicts, your work can get difficult, very difficult. But if you seem to be having an especially hard time, ask yourself: Did I forget who the client is?

How it happens, how to avoid it.

When you have been hired, you’re being paid twice: you’re being paid money (indirectly, if you work in agency), and you’re being paid a professional compliment. It’s normal to feel gratitude towards the person who made the decision to retain your services, and it would be downright weird to respond along the lines of thank you for hiring me, but don’t expect to be more favored than that of other involved parties. Nevertheless, you must get that across in the form of making it clear that the elder is your client, and that every involved party is important in how they can serve the goal of assisting you in coming up with a plan and executing that plan to serve the needs of the client.

Getting across that the elder is the (one and only) client is an ongoing process. It will be reflected in how you gather information, in that no family member will be considered a more reliable informant than any other, unless demonstrated otherwise. It will be reflected in the manner of sharing information among those involved; you will make it clear to everyone that you will share information as necessary, and only as necessary, in a manner which will help you create a care plan for the elder. It will be reflected, most of all, in the care plan itself.

At the same time, focusing on the needs of the client does not mean ignoring the needs of everyone else. Parents who take care of an infant need to eat, sleep, and relax, if they are going to give the child the best care. That also goes for everyone involved assisting in the care (whether directly or indirectly) of the elderly client. So, if a member of the family is taking on the bulk of responsibility by, for example, taking the client to lots of appointments, or doing the bookkeeping, or acting directly as a caregiver, then providing some relief for that person is in the best interest of your client.

Footnotes:

¹The difference between family therapy and care mediation is discussed here.

²In theory, a lawyer, doctor, or care facility might hire you as a consultant to deal with one of their clients. If the contract is between you and the lawyer, or you and the doctor, or you and the care facility, (which means that they, not the elder, are paying for your service) and you don’t work with the client directly, then that becomes the rare case where that lawyer, doctor, or care facility is your client rather than the elder. Do not be surprised if this never happens in the life of your practice. Why? Because lawyers, doctors, and care facilities nearly always want to be lawyers, doctors, and care facilities rather than car consultants. They’re hiring you to take those responsibilities off their shoulders. This is a good thing for everyone concerned because you’re the expert on what you do. Likewise, you won’t be dispensing legal advice, medical care, or direct care to the elder, though one of your main jobs may be gathering information to aid the lawyer, doctor, and so forth.