Telling the truth is considered a good thing. In my care-giving job we can’t always do it and still be ethical. Our first duty is to preserve the lives of our guests, the residents of the Dementia Care community. Disease has robbed them of their capacity to make decisions consistent with their desire to live in safety. We can’t allow them full freedom to act or they would die. It’s not just that they could not operate a motor vehicle safely. They would wander into the street, oblivious to oncoming traffic. In order to preserve their dignity, we must lie to them. In my profession, this is called gentle deception.
A reed-thin man in his nineties is determined to get on the bus. He wants to go somewhere where all the people he believes would be waiting are long dead. In order to get him to go to bed, we tell him the bus doesn’t run this late. We don’t tell him the bus to where he wants to go doesn’t stop within 50 miles of here. Tomorrow he won’t remember wanting to go.
Another is wheelchair-dependent. He circles the facility endlessly, complaining about the “bad signal in the magnetic strips” under the hand-rails that line the walls. We aim our walkie-talkies at the area he’s pointing to and hit the volume button, which makes a beep-beep sound. We tell him that means the magnetic signal has been re-aligned. He’s satisfied, and will allow us to assist him to dinner.
There’s a charming, neat, well-spoken lady who re-frames her view of the care home every few days. She has been in this funeral home, awaiting guests for the planned viewing of the body. She has been staying here at the college, awaiting the arrival of her parents. Some days she will pass by in the hall and say that she is going to the movies tonight, or that she is moving her things upstairs. She gives us the opening for the deception by asking where she’s going to be sleeping. Each time we show her back to her same room, saying “Look. Your things have arrived ahead of you.” She’s delighted.
When you are answering a question from one with no short-term memory capacity, the fluidity of their time-reference makes answering difficult. They might ask when dessert will be served. If you answer something specific like “In 10 minutes”, they will ask the same question a minute later. It’s possible they’ve already eaten the dessert. The best answer to offer is any ambiguous one. “Soon” is a good stand-by. Ambiguity forces the brain to work on the problem, in lieu of triggering the repeat-loop.
After the deception, the next step is to set them to a task, even if the task is to rest. Brains that can’t follow their own sense of direction still seek out direction. Help me with this. Let’s go see what the nurse is doing. Look how nice it is outside. Let’s go for a walk. If you go to sleep now, you’ll be up bright and early to work on it.
Several residents are visited by terrible, unsettling anxiety and feelings of dread. They say things like, “Something’s wrong!” in a tone of alarm. We tell them they are safe, and we will protect them, like any good parent would say. Parents know they can’t protect their children from all harm. You say it to reassure someone you love, to help them conquer fear. You know it isn’t true. It’s the right thing to say.