Don’t Contradict the Person with Dementia

I am glad to see that a lot of dementia communities are seeing the importance of not contradicting people with dementia. There are a lot of ways to say this but my favorite is my brother’s. When our mom (who had dementia) was still alive he would always say, “You need to live in her world.” Let me give some examples of how we did this with our mom.

In order for my examples to make sense, I will give you a bit of Mom’s history. She and dad retired at our family’s summer lake home and would travel to their condo in Florida during the winter. After Dad died and her dementia had progressed, she spent all of her time in Minnesota so my brother could take care of her.

When I would call Mom I would usually start a conversation about the weather because this was one of the topics that she loved to talk about. (Weather is a big topic of discussion in Minnesota.) One day during the winter, after I told her that in Tucson it was nice and sunny, she said, “Well it’s not nice and sunny in Florida; it is actually snowing!” Then she went on about how unusual it is that Florida was having snow. I knew she was in Minnesota, but I never corrected her. As far as she was concerned she was at their condo in Florida. I thought it was amazing that she was focused on the oddity of it snowing in Florida, but as she looked out at the snow on the lake outside her window, she could not see herself as being in Minnesota.

While training in England with Penny Garner, I got to observe a person with dementia being transitioned into a memory care facility, so of course I was the logical choice to transition our mom into a memory care unit. I stayed with Mom the first three days of her transition, ensuring that she stayed contented. During that time, she would say of her new room in the care facility, “Isn’t this a nice condo? You know your brother Jeri bought it for me!” The majority of the time she thought she was in a nice new condo (which she loved and was very proud of how it was decorated), and I did not contradict her; in fact I built on what she said. I would answer, “Yes, this is a lovely condo, Jeri did a great job I also said many times how nice and warm it was (she loved being toasty warm). I would admire how everything matched and point out what a lovely view she had from her window. Seeing her so happy and proud in her “condo” warmed my heart. What difference did it make that it was actually a room in a care facility? If she was happy and proud, I wasn’t about to shake her reality.

Here is one of my favorite memories of my mom: A few months after I transitioned her to the memory care facility I went up to Minnesota to check on her. During my visit I realized just how happy Mom was. She didn’t know Dad died because his death happened late enough into her dementia journey that she never took in the fact of his death. I learned never to contradict her when she said something about Dad coming home soon. It would only have made her unhappy. She just expected my dad to walk through her door at any time, and she was happy in that expectation. As I reflect on that day, I am comforted to know that because I didn’t contradict her by explaining that Dad was dead and he wouldn’t be coming home, and instead just let her live contentedly in “her world,” it definitely created a safe haven for her and kept her at peace.

I would love to hear stories from others with loved ones who had or have dementia and how they joined their loved one to “live in their world.”

 

 

 

Learn from the Expert (the Person with Dementia)

In the early days of our training in the SPECAL method of dementia care with Penny Garner in Burford, England, my sister Margo and I learned how important it is to learn from our mom (the expert) who had dementia.

After Dad died, when Margo and I would call Mom, one of the first things she would say is, “I wonder where your dad is.” Before we met Penny we would use the common sense answer, “Mom, Dad is dead.” After she heard that answer from me, at times she would ask if she had been at his funeral and who else was there. She seemed to have no recollection of having been at the wake or funeral service. I would tell her that she had in fact been there and tell her about the service, highlighting a few of the people who were there.

Common sense tells most of us that filling in the facts for someone with dementia is a good thing to do, but it became pretty obvious that filling in the facts for our mom didn’t help at all because a few minutes later she would ask, “Where is your dad?”

Besides just not being effective, this filling-in-the-blanks practice also chipped away at Mom’s self-esteem. After months of continually being corrected, her confidence was low.

We learned from Penny that Mom was not taking in the facts of what we said when we tried to “set her straight” about our dad, but she was taking in all of the feelings of sadness. Our truthful answer was making her feel sad and having no positive effect whatsoever.

Through Penny’s insight we learned that we needed to find an answer that mom would be content with, easing her anxiety. We also learned that if we tested a few answers and listened closely to her responses, she would “teach” us what the best answer was.

Once we opened ourselves to the idea of providing our mom with an answer that would keep her content and not contradict her world-view, through trial and error, we eventually found the best answer for Mom. We tried, “Dad is fishing,” and, “Dad is at the grocery store,” with fairly positive results, and we tried a few other answers that didn’t seem to provide much comfort at all.

One of the things we learned in this process is that the best answer for our mom would have to be an answer that accomplished two things: 1) it would make her feel that Dad was safe and well, and 2) it would provide a very easy-to-accept explanation for his absence.

Our dad used to own a heating and air conditioning company in Minnesota. He was on call 24/7. During the winter he had a lot of calls in the middle of the night, so we tried, “Dad is on a service call,” and it worked beautifully. When we used that answer Mom would usually say something like, “Oh, that’s right.” At that point we would change the subject to something Mom liked to talk about. After we started providing this new answer for only a short period of time, she started asking, “Where’s your dad?” less and less often.

We still had a lot to learn from the expert (Mom), but it was with that breakthrough that we knew we were on the right path to creating a safe haven for our mom.

If you are interested in learning more, I would suggest getting the book Contented Dementia by Oliver James. It is all about Penny Garner’s highly effective SPECAL method of dementia care.

I would love to hear other’s thoughts around this topic.

The Question-less Question: A Way to Engage a Person with Dementia in Conversation

One of the best things you can do to reduce the anxiety of a person with dementia is to not ask them questions. That is definitely easier said than done.  My mom had dementia and passed away last December. I did not live in the same state as my mom so a lot of my communication with her was over the phone. I wanted to know how she was, but I knew I couldn’t ask the question straight out. With my mom, if she sounded a bit down, I would start the conversation with, “I feel as if I am getting a cold,” in hopes of matching her energy and making a connection. If she wasn’t feeling well she would always respond with what was wrong with her. Her answers might be, “My stomach is not just right my head is feeling ‘squishy.’” (This usually meant the beginning sign of a stroke, as she had vascular dementia.) If she was feeling OK her responses would be more along the line of, “Oh that’s not fun.” Because I engaged her with a statement rather than a question, she could easily (and comfortably) form a response.

This is a person-centered approach, meaning it’s highly customized to each person, so it may take a few times to find just the right statement to get your question-less question answered.

Here are some common questions transformed into possible “question-less questions.” Remember, yours will be customized to the person you’re talking with.

Transforming Questions into Statements

How are you? You seem cheerful today!…or …You seem a little restless today….etc.
What’s the weather like out there? I’d heard it was supposed to be sunny today.
What would you like to eat? I was thinking of making a salad, and I thought you might like one too.
What did you do today? I see you have a puzzle started—you’re really making progress!
Where are you going? That looks important…I’d like to come too if that’s okay.
What is this? Well, this looks interesting…
What are you watching? This show looks good, but I don’t know much about it.
Do you have to use the bathroom? I was just going to use the bathroom, but trust me, you’re going to want to go first…
Are you tired? You look a little tired.
Did you hurt your arm? There’s a bump on your elbow. Let’s take a look at that…
Will you teach me about these trees? I wish I knew the names of some of these trees.

It was a hard thing to learn, but with practice, I’ve gotten pretty proficient at asking question-less questions when I’m working with people with dementia.

It helps to know a little something about the person. I knew that my mom loved talking about the weather. (It’s a Minnesota thing.) Instead of asking her how the weather was in Minnesota I would start with the weather here in Tucson. I’d just say, “It’s really hot here in Tucson.” By naming the city/state rather than saying “here” or “where I am,” this also relieves anxiety for the person with dementia as they do not have to go searching in their memory system for where you are talking about.

The method is simple: Give them short descriptive sentences to take in. This in itself reduced mom’s anxiety and allowed her to join in on the conversation with ease. As time went on, I realized what topics mom loved talking about and would only focus on those topics. That, along with not asking questions, not only reduced her anxiety but made her feel as if she was on top of her game, which boosted her self-esteem.

We would love to hear how other care givers found ways to reduce the anxiety of people with dementia!