Have you had a difficult conversation with your loved one, such as about them moving to a care facility, only for them not to remember a thing about it a short while later? This happens frequently when a loved one is living with dementia, and can leave families distressed and unsure how to respond.

Original article by Teepa Snow, MS, ORT/L, FAOTA, with minor updates by Valerie Feurich, PAC Team Member

 

 

 

By Valerie Feurich

As the dementia progresses, a person’s declining safety awareness or mobility may make a move to a facility or higher level of care a dire need. Yet, if the person isn’t aware of their changing abilities or thinks they can still safely live where they are, chances are they won’t be fond of that idea.

So, what can you do as a concerned care partner? Below are 5 tips to help you better navigate the situation.

1. Realize this information may seem new to them, even if it isn’t

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When a person is living with a form of dementia, such as Alzheimers Disease, their brain is experiencing chemical and structural changes. What that means in daily life is that some abilities, such as the one to form and store new memories, may no longer work as it once did.

This can lead to frustrating situations for care partners, and scary ones for the person living with dementia. How? While you may have a hard time understanding that your loved one does not recall seeing all the moving boxes that you packed over the weeks, their brain may compensate for this missing information by creating stories of theft, vandalism, or any other scary scenario that can leave them frightened.

Remember that this reaction is not voluntary, but an altered reality created by their brain without their choice. As hard as it may be, try not to get upset with them. Because even though your person living with dementia may not remember things you’ve said, they’re likely to remember how you made them feel.

2. Put your relationship first, always

Why?

Because your chances of achieving positive outcomes when working with one another, no matter whether it is a care partner, family member, co-worker, or other type of relationship, increases exponentially when you enjoy each other’s presence. Try to think of it this way – if someone was rude to you or made you feel stupid, how inclined would you be to help them when it was needed? Or if someone forced you to do something you didn’t want, would you happily embrace them the next time they came to visit? Quite unlikely.

The same goes for your relationship to the person you’re concerned about. So, if you can tell that the topic of moving creates tension between you two and could escalate, back off and consider trying something else.

3. Consider whether someone else would be the better messenger for this

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Depending on the relationship that you two share, you may be better off asking someone else for help. Often a third party or authority figure, such as your person’s trusted physician, health services, adult protective services, sheriff’s department, or local fire chief (in case of fire risk) could have a talk with the person you’re concerned about.

Now, consider not approaching this by saying to your mom Look, Mom – Dr. Smith stopped by to have a talk with you, as it’ll be clear that you were the one to initiate the chat. If possible, rather see if this conversation can happen when you’re not around, such as at your mom’s next doctor’s visit.

Chances are, you may need support as well. This can be a life-altering experience for both of you, and ensuring you have support and help can make this a little less daunting. Consider meeting up with a geriatric care manager, social worker, patient advocate, or start with a free 30-minute, non-obligatory phone consultation with one of Teepa Snow’s Positive Approach to Care Consultants. With them, you can talk through or try out different strategies to solve the situation.

4. Include the phrase for right now

Whether you approach this difficult conversation topic, or you have someone else do it, one phrase you can use to try to make the change feel less permanent or overwhelming is for right now. It could be used in a sentence like So they (authority figure) want you to go and be somewhere else for right now. They’re saying right now, staying here is not an option.

How does that help? By incorporating for right now, the person is less likely to resist as it makes the move feel less permanent. It allows them an element of hope, and decreases the chances of the situation escalating.

5. Offer a sense of control by giving choices

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A study published in the American Journal of Occupational Therapy, September/October 2000, Vol. 54, 504-508, noted “A significant positive correlation (= .54; p = .01) between the amount of choice residents perceive they have and their quality of life was found.” Chances are, you’d also prefer to have a say where and how you’re going to live.

While asking a person living with dementia an open-ended question like So where do you want to live, mom? is likely to yield an unhelpful response like I want to live at home. Try offering a simple this or that type choice instead. By offering two options, your person living with dementia will have an easier time making a choice.

Extra tip: Try to keep the questions simple early on, and don’t ask things like Would you rather live with me or live with Harriet? Instead, keep it more general like Would you rather live with family or in an apartment in a building where you have your own room? Once you get a response and idea of which choice they’d rather pick, you can continue offering this or that choices to help narrow things down to the solution they like best.

Conclusion:

If your person living with dementia is not aware of the changes they’re going through, trying to point out their deficits during a time when you’re also trying to get them to leave their home or perceived safe space, is likely to end poorly. Don’t blame or judge to avoid creating a barrier between you two, and try to make the person feel that you still value them.

While your person living with dementia may not remember things you’ve said, they’re likely to remember how you made them feel. To protect your relationship going forward, consider letting someone else step in and be the messenger. By adding the phrase for right now and offering simple this or that type choices, you can offer your person a continued sense of control over their life, even while it may be going through some major changes.

If you’d like to read more content like this, please visit www.teepasnow.com/blog.

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