When I first started working in dementia care, I learned the same things that everyone else learns.
I learned about Teepa Snow’s philosophy of “Redirection and Distraction,” which was part of her Positive Approach to Care technique. I also learned about Naomi’s Feil’s “Validation” technique. I learned that “lying” was a no-no, but that you could dance around someone’s reality by saying things like, “Sounds like you miss your mom,” or, “Tell me how you feel about that.”
One day, very early in my career, a resident of mine was asking about her husband. “Where is my husband? He was supposed to pick me up an hour ago!” she cried. Using what I’d learned, I sat down with her and began to engage.
EMBRACE/EMBRACING THEIR REALITY™ is my trademarked phrase.
“Sounds like you miss your husband,” I offered. She looked me dead in the eye, squinted, and bit her lip. “Yeah. And I want to know where he is. Why does no one actually say anything around here?” she demanded.
This shocked me. But, I did what I’d learned: I validated her feelings and asked her how she felt. I realized, though, that I hadn’t actually answered her question. I’d just redirected her. I “validated” her world, but I didn’t actually go there with her.
Another time, I spent two hours trying to get a very irritated resident off of a bus. The bus had taken Eileen, one of my favorite residents, to the doctor’s office. This had not been a particularly enjoyable ride, and by the time she got back to our assisted living community, she was not in a good mood.
We tried everything, but could not get this woman off the bus. I tried to redirect her. I tried to distract her. I tried to chat with her about where she’d been and even tried to explain that the bus was not going to be able to take her to her house, which is where she wanted it to go.
Finally, I asked the bus driver to drive us around for a little bit. He ended up taking us to the back of the building about ten minutes later, and I told her that we “had to get off here, so that we could transfer to another bus later to eventually take her home.” Hearing this, Eileen got off the bus. We went inside.
My staff was thrilled that she was safely inside the building, but I was completely exhausted. I was also confused: had I done this whole thing the wrong way?
I was so confused by this—this feeling that I’d “lied” to get her to leave the bus with me—that I actually emailed Teepa Snow, who I’d met at a conference. As busy as a woman as she is, Teepa got back to me pretty quickly. “It sounds like you did the right thing. You did what you needed to do,” she replied.
That was great to hear, but it left me thinking…if that, then what? If it was okay for me to do that, but it’s technically a lie, how is that in-line with the dementia care theories I’d learned?
This was when I started developing my Embracing Their RealityTM theory.
Teaching families and care staff to “never lie!” to people with dementia is too confusing. (See an article by Feil here.)
Dementia care is a gray area, and telling people to “always do this, but not this, but sometimes this” just doesn’t work.
Here’s what Feil says in her article, “The Myth of the Therapeutic Lie: Lying Is Not Validation” —
From Feil’s article
I respectfully disagree with Feil when it comes to what “lying” really means. I don’t believe that a person living with memory loss can truly grieve appropriately. I believe that grieving or understanding about changes in one’s life requires two things: an understanding of the passage of time and the ability to retain information. People living with dementia have neither.
And, if we were really sticking to the don’t-lie-thing, we would never introduce baby dolls and stuffed animals, right? I mean, that would be lying. That would be telling them that these were real, when we see them as not-real.
If you know me, you know that I’m all about the TANGIBLE. I want you to be able to use my stuff, apply it, and feel good about it. I want you to succeed in your positive dementia care.
When you embrace someone’s reality, you understand that their reality has shifted, and you must shift with it. Here’s my favorite (and very true) example:
I had a resident whose son had died a few years earlier. This was obviously devastating. In good news, she’d forgotten he died. (Hey, this is a good thing that she forgot!) One day, she came to my office. “Hey hon,” she said. “Do you know where my son is? He hasn’t called in a while.” I paused and considered this. “Where do you think he could be?” I asked.
“Well…I guess he must be busy with work,” she replied. “That makes sense, he’s probably at work,” I nodded. “Can I call him?” she asked me. “Sure,” I said, and picked up my work phone. I dialed my own cell phone number and let it go to voicemail. As soon as it did, I handed her the phone. “Here, you can leave him a message,” I smiled. She left her son a voicemail on my phone. “Thanks, hon, I feel a lot better,” she nodded. It never came up again.
Notice what I did here: I asked her where her reality was. I let her answer, and then I agreed with, and added on to, her answer.
The next time someone is looking for a loved one who has passed away, don’t simply ignore, distract, redirect, or validate: ask them where that person is.
Them: Where’s my mom?
You: Where do you think she is?
Them: I think she’s at work / I think she passed away / I think she’s at the store
You: That makes sense!
When we use questions, we find out where someone’s reality is. When we listen, we can join them and Embrace Their RealityTM and avoid feeling like we’re “lying” — we listened, we agreed, we solved!
Even when someone is hallucinating, you can help them solve their troublesome reality.
Her: The room is on fire!
You: (Find a fire truck noise on your phone) Don’t worry, the fire trucks are coming!
That’s a simplistic version of an actual encounter I had with one of my residents who was living with dementia. She believed the building was on fire, so I pulled up a fire truck sound on YouTube and played it for us. She calmed down immediately.
So was it lying that I said a fire truck was coming to save us from a non-existent fire?
In summary, here’s what I teach:
- Throw out the word “lying.” Getting hung up on this word will only stress you out. You’re not lying when you’re finding out where their reality is and then going there.
- We are living in THEIR reality. Just because it’s not true for us, doesn’t mean it’s not true for them. Who are we to say what is true?
- When someone asks you a direct question, find out what they believe the answer is, and then do that. “Where do you think she is?” is a great example. Check out the webinar replay link I included earlier in this blog post for more on this.
- You don’t need to get creative and “make something up out of the blue,” but you do need to be able to “yes, and” your loved one with dementia. Agree and then add on.
- Using phrases like “therapeutic lying” or “white lies” or “fiblets” only confuses caregivers further. No one wants to feel like they’re lying.
I think there's more to dementia care than just "redirect, distract, validate." And I think we can all learn to embrace someone else’s reality.
Still not sold on this concept? Still thinking, “But how is this different from other dementia care philosophies?” Watch one of my webinar replays here for an even more in-depth review of what I teach.