Why is “no” the default answer?

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dementia-by-day:

When you work in dementia care, you get used to hearing the word, “no.”

“No, I don’t want a shower.”

“No, thanks, I don’t want to go.”

“No, I already took my pills.”

“No, I don’t want to do any crafts.”

Sound familiar? While there are some people out there who say no just to be contrary, most people with dementia who say “no” do it because they don’t really understand the question.

The best example of this is a female resident I had at one of my communities. Megan was really friendly and loved going on outings, but if you asked her if she wanted to join you, she’d say no. “Hey Megan!” the staff would say. “Do you want to go get ice cream with everyone?” Megan would pause, think for a second, and say, “No, thanks, I’ll stay here.” I came to realize that she didn’t really understand what was being asked of her: instead of thinking about the ice cream, she got overwhelmed at the idea of “going anywhere” and left it at that.

When Megan was told to, “Come with me,” or, “Can you help me?” she would join, no matter what it was. I began offering my hand, telling Megan to come with me, and leading her to the bus for outings. When she asked, “Where are we going?” I’d tell her that we were getting ice cream. She’d be thrilled.

Here’s what I recommend: don’t give someone with dementia the opportunity to say no. Avoid the ask. Asking someone with dementia if they “want” to do something is a sure-fire way to hear “nope!” 

Instead, say, “Come with me,” or ask that person for “help” with a task. 

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Rachael Wonderlin is an internationally-recognized dementia care expert and consultant. She has a Master’s in Gerontology and is the author of two published books with Johns Hopkins University Press. Rachael owns Dementia By Day, a dementia care consulting and education company.

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