By Vincent M. Antenucci
Center for Applied Research in Dementia
Professionals who work in memory care often are asked questions that are difficult or uncomfortable to answer truthfully. These questions require us to make a choice. While opinions are plentiful, there is a lack of consensus on the topic of deception in dementia care. Some believe deception is a perfectly acceptable intervention, which can even have therapeutic benefits. Typically, however, deception in memory care is not a result of some absurd “therapeutic” intervention. It is a convenient and comfortable response.
Why we lie
We recommend asking two very straightforward questions when making choices that affect the lives of people with cognitive disabilities: “What is its purpose?” and “Who is it for?” We tell ourselves we want to spare a person’s feelings or make them happy. In reality, the reason for deception often is to avoid unpleasant or inconvenient consequences of the truth. The benefit of the deception to the recipient will be very short-lived, and it may lead to bigger problems (anxiety, mistrust, resistance to care, apathy, and various responsive behaviors.) Recognizing that the choices we make will have consequences for ourselves and others, it is helpful to be guided by empathy. We must view the person with dementia as a person first. How would you act if the person did not have dementia?
Why we shouldn’t
I recently encountered a situation in which a man living in memory care was continually asking when his wife would come to visit. The man’s wife was alive and well and living in another part of the building. A staff person was overheard telling the man, “Your wife has an appointment now. She will visit you this afternoon.” The truth was that she had been avoiding her husband and would not be visiting that day. While the lie may have satisfied the man (and the staff person) in the moment—there would be a reckoning. The man likely would forget the episode of the lie, but he would feel the disappointment when his wife didn’t come to visit. Over time, and with repetition, similar incidents would lead to frustration, agitation, anxiety, aggression, and other negative outcomes. Unfortunately, these outcomes may falsely be attributed to his dementia diagnosis rather than his sense of betrayal.
A better way
Combining the use of external aids with procedural learning techniques provides an effective alternative to deception. For example, we would recommend working with the husband and wife to create a mutually-agreeable visit schedule. The schedule would be written on a calendar or journal and kept in a location that the man could learn to access whenever he wanted to know when his wife would visit.
What should you do if the man’s wife refused to visit altogether? In this case, the situation could be treated like a separation or divorce. Though painful, at least this would provide an opportunity for closure. I believe it’s better than constantly wondering. What would you prefer?
Can there be good reasons to lie? There’s a simple way to know: ask yourself how you would like to be treated. Would you prefer to be told a comfortable/happy lie or a potentially painful/hurtful truth? Certainly, a white lie or omission often is a kinder option. The type of lie that is most destructive, however, is the one that violates our basic right to our personal information. We deserve the dignity of truth, and no diagnosis should take that away.
Vincent M. Antenucci is Research & Training Manager / COO at the Center for Applied Research in Dementia, where he develops therapeutic dementia and memory disorder interventions, activity products, books, and Montessori training programs to benefit persons with dementia. As an experienced speaker and trainer, he has given testimony for the Ohio Speaker’s Task Force on Alzheimer’s and Dementia, and enabled hundreds of caregivers to empower people with dementia to live more fulfilling lives.
Contact him by email at firstname.lastname@example.org for more information on bringing Montessori dementia training to your care community, products to support dementia caregivers, or other support options for your team.
You may also be interested in reading Vince’s article, “Confidence, Crises & Change”, on the reality of culture change in long-term care.