Q. My mother has dementia and lives in an assisted living facility. Nearly every time I visit with her she asks me repeatedly when she will be going home. I’ve spoken with my friends who have parents with dementia who either live with them or who live in a facilty and they have the same experience with their parent. What do we say to them?
A. Your question brings up an important issue that many family caregivers face: what is the best way to communicate with a parent who has dementia or Alzheimer’s? No one wants to lie to a parent, but if a truthful response to a question asked over and over will cause emotional distress, is it better to reply in an incomplete manner, or ignore the question altogether?
For professional advice, I turned to Rebecca Mandler, a licensed clinical social worker in South Miami, who told me that “communicating with a person with dementia necessitates simple, direct and non-confrontational responses to questions.”
“An honest response to this question might be along the lines of ‘when your doctor and the other people who care so much about you feel that it would be healthy and safe for you to return home.’ This is honest, factual, and provides the message that your mother is cared for and loved. I would not elaborate on the answer, and if or when the question is posed again, I would offer the same answer.”
Still, there may be times when a family caregiver is at a loss as to how to respond to a parent’s persistent question when they know the response will cause emotional pain or make them unnecessarily agitated. In these cases, many geriatric experts believe that telling a “fiblet” — aka “white lie” — can actually be therapeutic for someone who is cognitively impaired.
In a recent survey of professional geriatric care managers, more than 90 percent of respondents said they recommended this strategy to relieve stress and anxiety and protect the self-esteem of an elderly person. The situation cited most often as an appropriate and helpful use of a fiblet is when a senior is refusing clearly needed care or assistance at their home.
“Telling an aging parent with Alzheimer’s that a paid caregiver is coming to their home for their spouse’s benefit, or for another concrete role, can help them maintain pride and reduce anxiety,” reported the caregivers in the survey, whose findings were summarized in this press release.
“A therapeutic fiblet is just that — it is therapeutic because it calms and reassures, reduces and anxiety and protects self-esteem,” said Emily Saltz, president of the National Association of Professional Geriatric Care Managers.
Telling a “fiblet” to a beloved parent can be uncomfortable and painful for family members. For guidance on dealing with these and other kinds of sensitive and challenging issues, I have always found the advice from experienced geriatric care managers to be very helpful.
I also recommend reading “Caregiver’s Guide to Understanding Dementia Behaviors,” an article offered on the website of The Family Caregiving Alliance. It provides 10 tips for communicating with a person with dementia and how to handle repetitive questions.
Have you found fiblets to be a helpful strategy? I’d love to hear about your experiences.
Nancy Stein, Ph.D., is the founder of SeniorityMatters.com, a local caregiver advisory and referral service for South Florida seniors and their families. You can contact her at firstname.lastname@example.org.