Experienced care managers know that every family they work with comes with its own unique history, rules, and secrets. Harmful secrets, new and old, may be exposed when families are in crisis or transition. As an objective third party, a skilled care manager can help clients and their family members successfully navigate these minefields. Doing so requires good interpersonal skills, empathy, and an understanding of family dynamics and conflict resolution.

Harmful family secrets are those that create tension, conflict, and interfere with effective care planning. For example, out of fear of giving up her car keys and independence, an aging parent may hide the fact that her vision and reaction time are not what they used to be. Or maybe she hasn’t told anyone she’s fallen, but someone finally notices the bruises. Adult children have their secrets too. Maybe the son taking care of Dad’s checkbook has some financial problems of his own, and skims money from Dad’s account. Other common family secrets include bankruptcy, sexually transmitted diseases, multiple marriages, and children that not everyone knows about.

People keep secrets for many reasons. They may be ashamed or embarrassed, fear being judged, or don’t want to make uncomfortable changes. The care manager’s role is not to “fix” long-standing family problems, but to ensure that each person feels heard and understood. Building on the family’s strengths is the key to gain cooperation and facilitate good decision-making. Of course, any secrets that put the client at risk of abuse or neglect must also be addressed through the appropriate channels.

When a client appears evasive and avoids a particular issue that may impact a care plan, the care manager may try to elicit a family history, perhaps through the use of a genogram or through a trusted person who is aware of the family secrets and can facilitate a discussion. It can be challenging to guide a family through the emotional fallout when damaging secrets are revealed. Even if there is some relief that the secret is now in the open, relationships may be strained. The ultimate goal is to encourage family members to be on the same team in caring for the client and keep moving forward.

If you would like our assistance for your family, please contact us at (512) 814-3228.