It Ain’t Necessarily So – 12: Is honesty always the best policy and should we always tell residents the truth?
Caring Times, January 2014
With JOHN BURTON
“Mrs Smith, your husband isn’t coming to get you; he died three years ago. You can’t go home; your house has been sold and you live here now.”
But Mrs Smith repeats her insistent, mournful demand: “When’s my husband coming to take me home? I want to go home. I want to go home.
If the care worker doesn’t listen for what’s behind Mrs Smith’s words, fails to put herself in Mrs Smith’s situation and understand Mrs Smith’s “truth”, the old lady will continue to be searching fruitlessly for love, home, connection and relationship. If Mrs Smith said “It’s cold in here,” it would obviously be wrong to tell her that it isn’t cold because the heating is on and the temperature is 70ºF. She feels cold and we need to find out why and help her to feel warm and comfortable. She may feel cold for some physical reason or she may be saying something about her state of mind and emotions.
It is equally wrong to deny Mrs Smith’s yearning for her lost partner and home. It’s common for staff to be told not to “correct” what residents are saying, but to attempt to divert them from the subject and soothe them. Often it’s a question of time: can you stop to listen and talk? So, should the response to Mrs Smith be something like “Your husband’s coming soon and then you’ll be able to go home, but in the meantime come and have your tea”? Probably not because, while possibly diverting Mrs Smith for a few minutes, this answer may reinforce her conviction that her husband is alive and coming to take her home and does nothing to attend to Mrs Smith’s feelings.
These feelings may sweep over people at particular times of day. In Mrs Smith’s case, it’s just before teatime or when someone else’s visitor arrives that she has this sense of loss, anxiety and disorientation. If everyone knows that, it’s not so hard to think ahead and be ready to give her attention at that time.
You may notice the signs: she looks expectantly at the door; she seems agitated. You sit by her and hold her hand. “My husband’s coming to take me home.” You know she’s thinking about her husband: “He used to collect you from work, didn’t he?” And, surprisingly quickly, Mrs Smith knows that her husband won’t be coming here today because . . . yes . . . now she remembers sadly that he died several years ago, and then she moved here . . . to be with people who love her and understand her . . . and she’s looking forward to sitting down to tea . . . what is for tea?
Of course it’s not always as easy as that, but it’s rarely an either/or – true or untrue. There is no formula, no one right way. It will all depend on listening and responding, and empathy. And to use empathy, you must be able to imagine how the other person is feeling.
We found a different way: Caring Times readers tell their stories
Care home manager, Scotland: At the last home I worked in (as deputy), the manager was stuck with a very old-fashioned idea of “reality orientation”. She told staff to always tell the truth and gently challenge their delusions.
To go along with this she encouraged us to use sweets as rewards. This meant that everyone carried sweets in their overall pockets and if for instance you were trying to get someone up in the morning or into breakfast, you gave them a sweet at each stage.
Of course, some of the residents didn’t respond to this and hear only that they are wrong, deluded, mad. The residents never got a chance to talk about what was worrying them, and they expected their “rewards”. We were like kindly dog trainers. It was awful.
Now in my new place, I’m trying to get a large staff team to listen and talk, and it’s very hard going because they say they don’t have the time, even though I explain in the long run it takes less time if you listen. I think they need listening to first, and they’re not used to that.
Mike Farmer, home manager, Cedar Court, Oxfordshire: A distressed resident may not benefit from being reminded of very sad events and may not fully comprehend in a meaningful time frame. But would we be acting in their best interests to tell 100% of the truth all the time? This may lead to further distress.
Conversely, I doubt that it would it be right to mislead. It is far more important for us to be open and honest with each other, so that we plan to deal with issues when truth or not may be a necessary way forward for an individual. This means knowing our residents and understanding what may be the consequences of truth (or not entirely the truth). It’s not what we would wish or prefer, it is what our resident would wish that really matters. Conflict and/or criticism is inevitable at some time.
Senior care worker, Devon: Honesty is always the best policy, but honesty is not necessarily “the truth”. This is something I learned from residents with Alzheimer’s Disease.