As dementia care providers, we want to be completely honest with our clients and patients - this helps build a sense of trust and develop rapport. However, when someone has dementia, their memory loss and confusion can serve as a barrier in them getting the care they truly need. Necessary activities like bathing, changing one’s clothes, going to a doctor’s appointment, or taking blood pressure medication can be postponed indefinitely if we take explanations such as, “I showered this morning” or “I don’t need medication; I feel fine!” at face value.
Let’s take bathing, one of the more common challenging tasks that caregivers struggle to accomplish with their clients who have dementia. The following exchange between the resolute caregiver and the unbending patient is all too familiar a scenario for those in the world of dementia care (taken from the Alzheimer’s Association):
Caregiver, determined: “It’s time to shower.”
Patient, not moving: “I’ve showered already today.”
Caregiver, frustrated: “No you didn’t. You haven’t showered in two days.”
Patient, not moving: “I am fine. I don’t need a shower.”
Caregiver, exasperated: “Yes you do, you smell bad.”
Patient, not moving, offended and angry: “YOU smell bad. Leave me alone.”
To the person with dementia, there’s a lack of awareness around having not bathed, including acknowledging any odor or discomfort. Instead of trying to convince them that they haven’t bathed, often times employing the use of therapeutic storytelling can achieve the desired outcome and minimize agitation and upset for both caregiver and person with dementia.
Therapeutic lying (or therapeutic storytelling), a concept that is currently seeping into the medical literature, is the practice of deliberately deceiving patients for reasons considered in their best interest. Telling your client, patient or loved one with dementia that they have a social engagement such as lunch with a friend, or a doctor’s appointment to attend, may often be just the nudge they need to decide that they’ll agree to bathe in preparation for the event. Another tactic like putting the shower on a visual calendar they can see, or telling them that they asked to be reminded about showering at a particular time, can also be useful therapeutic lies.
Another common challenge we often encounter is when we’re trying to initiate care with a new client. Most of the time, there’s some degree of resistance from the person who needs help (see our blog post on anosognosia), so coming up with plausible reasons as to why we’re coming to someone’s home is critical to our success. Using explanations such as, “your doctor asked that we stop by to take your blood pressure twice each day”, or “You had asked for some help with housekeeping (or pet care, garden maintenance, etc.)” will usually produce a more favorable response, rather than telling them that we’re there because the doctor said they can no longer live alone and need a caregiver.
In most cases, telling the truth is the reasonable, moral, and ethical thing to do for all parties involved. The main challenge is that patients who are in the middle and late stages of dementia cannot be reasoned with. When someone is acting in ways that don't make sense, we tend to carefully explain the situation, calling on his or her sense of appropriateness to get compliance. However, the person with dementia has lost this sense of logic. Therapeutic lying works in situations where validating feelings, trying to reason and turning to logic all fail.