Tag: embracing their reality

“But what if their reality doesn’t make any sense?”

I’m asked questions like this often. “What if what they’re telling you…just doesn’t make any sense? It can’t happen. If I Embrace Their RealityTM, aren’t I lying…because what they’re saying will never happen?” The short answer: no! If you’re doing what’s true for them, you’re doing the right thing. Once you know where their reality is (either by asking questions to get you there, like, “Where do you think your mom is?” or by listening carefully to what they’re saying in that moment) then you’re ready to Embrace Their RealityTM. “I need a cab!” Paul said, motioning to the phone. Paul was one of my residents, and, at the time of this story (circa 2014, 2015) his delusion was brand new. “Oh, where do you need to go?” I asked. “I’m sure we can get you a cab this afternoon.” “I’m getting married soon,” he smiled. “I need flowers…a cake…invitations…all those things!” I knew that this eighty-something-year-old man probably wasn’t getting married soon, but that didn’t matter. This was his world, and in his world, he was getting married. I smiled. “That’s great! Who is the lucky lady?” I asked. He announced her name to me with a big grin on his face. “She’s the most beautiful woman in the world,” he said. Suddenly, the concern over getting a cab was gone. Instead, he was focused on telling me about this woman he loved. “Are you married?” he asked me. I laughed, “No, I’m not,” I said, recognizing where this was going. “How old are you!” he asked. “I’m 25.” His eyes widened. “…And you’re not married yet?!” he exclaimed. “You’d better get hitched soon! A man needs a wife, and a woman needs a husband. I don’t want to be alone anymore.” Side note: I was only 25 at the time of this interaction and I didn’t get married until I was 31. It always made me laugh how quickly my residents became anxious about my marital status as a woman in my early 20s. If you’re interested in unsolicited relationship advice, hang out in senior living. I could have done a lot of things here. I could have said, “No, I can’t call you a cab…you have to stay here!” I could have said, “That doesn’t make sense, you aren’t getting married.” Instead, I took interest in his story, and it made both of our days that much better. I learned something about this man and was able to live in this beautiful reality that he had constructed. No, he didn’t end up getting married, but in the grand scheme of things the facts of that day didn’t really matter. Now, what if the cab issue kept coming up? This is where you EMBRACE HIS REALITY and use my little trick of “Delay, delay, roadblock, delay.” Examples: “Paul, let’s get lunch here first, and then I’ll call the cab.” “Hey, the weather isn’t looking great, can we go tomorrow?” “The cab is always late. Let’s get something to eat while you’re waiting.” Telling him “there’s no cab” isn’t going to end well.

“Dad knows he’s 98 but still thinks he’s working! How is this possible?”

I had the most lovely conversation with a 98-year-old man a couple days ago. He is in a moderate stage of dementia, very friendly, and clearly very passionate about the work he used to do. When I meet people with dementia, I always quickly assess what REALITY they are living in. I want to ensure that I Embrace Their Reality the best that I can, so I use context clues to figure out where that reality is. “What did you do today?” I asked Dan cheerfully. “Oh, not much,” Dan replied. “The boss was at work, so we lazed around,” he laughed. “We do less when he’s there!” Okay, so that clued me in immediately: he believed he was still working. Dan and I got into a great conversation about his work, all in the present tense. Out of sheer curiousity, I worked Dan’s upcoming birthday into the conversation. Often, people think they are much younger than they actually are. “How old will you be on your next birthday?” I asked. “Ninety-nine!” Dan replied proudly. Okay, so he actually knows his numerical age. We talked about that in the present tense, too. What’s SO interesting to me when talking to people living with dementia is how they speak about their world. Their world is often an amalgamation of facts: some current, some past, some never. The KEY is to figure out where that reality is, listen, understand, and live in it with them. Dan knew that he was 98, but he also believed that he was still working. If we think logically, these two things cannot exist simultaneously. But, in his reality, they did! People with dementia will often take facts from different parts of their lives and combine them together to create a new reality. This new reality makes perfect sense to them—even if it doesn’t make sense to us.

Resident-to-Resident.

One of my favorite parts of caring for individuals with dementia is watching their interactions with one another. Think of any classroom you’ve ever been in: there are countless personalities, numerous lifestyles, and genuinely different types of people to account for. A memory care community is the same as any other large group of people, but with the addition of a serious mental health condition.  There are “cliques” even within memory care. People find like-minded individuals and pair off with them. Roommates stick together like sisters or brothers would. There are people who the staff knows to keep separated. The most interesting interactions, to me, appear when two people are on very different functioning levels of dementia. Some of our residents are incredibly high-functioning; in fact, it may take a couple of minutes for a person to realize that the resident isn’t just a visitor. There are many other residents who struggle with ADLs (Activities of Daily Living) such as toileting, bathing, eating, or even moving around the community.  Last night I watched, happily, as a resident brought one of the Clare Bridge Baby Dolls to dinner with her. For this story, I’ll call the resident “Anna.” She sat down and cradled the baby, resting its head in the crook of her elbow. Anna truly believed that the baby was real, and it was a beautiful sight to watch her engage with it. Other residents, however, seemed taken aback. One resident, who we will call “Helen,” motioned for me, and I went to her side. “What is she doing? She’s trying to feed her dinner to a doll!” Helen whispered in my ear. I smiled and whispered back, “She thinks it’s real.” Helen shrugged and smiled. “Well, at least she’s enjoying herself,” she said.  I love Helen for this. She didn’t nudge Anna and tell her that the baby wasn’t real. She just shrugged, smiled, and kept on with her meal.

Everyone can see I've been crying.

“I don’t want to sit in there. She’s turned on me, and everyone can see I’ve been crying.” She was sure that her daughter wasn’t coming to visit, and that her daughter hated her for an unknown reason. She was also sure that not eating dinner was a good way to take revenge. All of the convincing in the world couldn’t coax her to the dining room. “No, they can see that I’ve been crying,” she said. I could have told her that this was a terrible revenge plot; that not eating wasn’t the best way to get her daughter to come visit. That her daughter would probably be in tomorrow. Instead, I decided on a new route. This resident hails from England, a place where I spent a semester during college. While there, I learned that everyone drinks tea. A lot of tea. And they drink it with milk. I walked her back to her room, and then went to the dining area. A Resident Assistant and I prepped her tea and milk, and I brought this to her in her room. She was suddenly smiling again. “The English take their tea with milk, don’t they?” I asked. After she finished her tea, I brought her a plate from the dining room. We sat together on her bed while she told me about England, her daughter, and her life after marrying an American soldier. She ate everything on her plate without any coaxing. I even brought her dessert to her room. It didn’t take any arguing, tricks, or coaxing—just a little adjustment and patience—and we had a lovely, quiet dinner.

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Rachael wrote "16 Things I'd Want If I Got Dementia" in 2014 and it's circulated the globe many times over. Download your free copy here!