People are often unprepared when faced with difficult decisions about the care and maintenance of older relatives. Family meetings can be the best way to address these issues.

When family members confront problems together, discuss issues and support each other, the dignity of the older relative can best be preserved. In many cases, family members can become closer themselves as they work toward a common goal.

However, to make this a positive experience, one member of the family should take responsibility for gathering information and planning the agenda for the first family meeting.

An outside assessment should be done to evaluate the physical and psychological needs of the older individual, such as the primary physician's evaluation based on a recent exam. Vision, hearing and mobility assessments should be done. An occupational or physical therapist can also evaluate changes needed in the home to help maintain autonomy and provide a safe environment.

Today, geriatric medical teams are available to evaluate the problems associated with memory deficits and dementia. Geriatric care managers also specialize in assessing the daily needs of an elder and can recommend appropriate services and resources in the community.

The most important goal of a family meeting is to work together on a plan for the older relative's future. The group should stay focused on that goal and not revert to petty rivalries and unresolved family issues. Everyone should participate and give opinions that can be discussed by all.

If you feel that a family meeting might deteriorate into a fight among the participants, it might be best to ask an outside professional to take charge of the meeting. This can minimize friction and keep the meeting focused.

It is important to include the older person at the meeting so that he or she can participate. This is the time to distribute any medical and psychological reports to the group. Seek a consensus and, perhaps the biggest challenge, ask for commitments from family members.

Each person should accept a responsibility to make the plan a success. !f a person cannot contribute time, perhaps they can contribute financially toward the costs associated with the care plan. Recognize that there may be some people who want their voices heard, but are not willing to accept any responsibility.

Don't expect too much from the first meeting. Follow-up meetings may or may not be a good idea. Communication can be by telephone, fax or e-mail. Responsibilities can also be delegated on a rotating basis so that no one is left burdened with a specific responsibility.