I enter the living room in a locked dementia facility through white, six-panel alarmed double doors. Rounding the corner, I see 90 year old Elsie sitting in a wing-back chair.
Seeing me, she shouts in her strong German accent, “Girl! You come over here right now!” I flash an innocent look on my face that says, “Me? I’m always good.” In other words, I think I’m about to get in trouble….again.
“You come over to me! I own this building and I’m your boss! Today I am firing you! I want you to go home! Now!”
“Miss Elsie, I didn’t do anything wrong,” I refute. But instead of forgiveness, Elsie starts shooing me away with the fanning of her hand. “Go! Go! You don’t work for me anymore! I saw you push that woman down and now I’m telling you to go! You know I’m an honest woman. I’ll write out your final check and mail it to you later today.”
Surrendering to her reality, I extend my hand to shake hers. “Thank you Elsie. I appreciate the years I have had with you. You are an honest woman and you have always treated me fairly.” At that I turn and leave… to take the elevator to my office on the second floor.
Elsie felt she had accomplished her task. She fired me using this same scenario at least twice a week, depending on what was happening in her reality. By echoing her own words back to her, I validated her sense of self-worth.
Elsie’s back at work
Above all, the highlight in Elsie’s life was being an office manager. Never married. No husband. Elsie never experienced raising children. She was a business woman through and through. She grew up during a time when women were not encouraged to succeed professionally. Her career rose to uncharted heights despite the impeding taboos that could have blocked her dreams.
Those were the years she felt accomplished and successful. Self-worth and value, two important psychosocial needs in all of us, were packed full of successes. She was a highly respected, proficient business woman who could manage an entire company almost singlehandedly. Elsie was a decision maker and was willing to take on difficult situations with guts and fortitude. And now she was reliving it all over again.
My reality said she was state funded. Completely broke. Unbeknownst to her, she had dementia. Elsie would never be capable of efficiently running anything anymore. For her there is no freedom to go places other women only dream of going. Unable to create and carry out new goals, Miss Elsie needed constant guidance and assistance just to function throughout her day. But remember, that’s my reality.
Value and self-worth
Really all Elsie had left after a lifetime of living was her sense others respected her which strengthened her self-worth. She flourished in that respect. No way would I ever believe it would be better for her if I took that away. Just to have her walk a few steps in my reality? That simply can’t be justified.
Besides, Elsie’s reality told her the daily assistance she received was a symbol of her status. Her maids. The hired help. Her reality far outshined mine.
Our realities were completely opposite each other. At any rate, I deliberately chose to go with hers and play the situation out totally within her version of reality. Result was Elsie once again soared and overflowed with self-worth and value. She sat tall and proud and her quality of life ascended to heights that have otherwise long since been forgotten.
Bringing Elsie to our reality
Let’s switch things around a bit. You and I will be two regular people interacting with Elsie from our side of reality. This is the most common way family members, friends, and even many healthcare professionals interact with their loved ones. I can easily imagine the outcome because I have seen similar situations played out over and over again. That is to say, it’s almost completely predictable.
Elsie’s shouting could be heard up and down the halls. “You come over here right now! You come over to me! I own this building and I’m your boss! Today I am firing you! I want you to go home! Now!”
To catch her up to speed, we would have said, “No, Elsie, that’s not right. You’re retired now. It’s your time to enjoy doing whatever you would like to do. You don’t have to work anymore. This isn’t your place of work. You live here now. You don’t own the building, you rent an apartment.”
Laughingly we further correct her. “And we never pushed a lady down. That just didn’t happen. We’re heading upstairs right now. Later if you like we can come back to visit for a bit.” At that we turn and start for the second floor, ignoring any further comments Elsie may have made.
Get the meds ready, we just destroyed Elsie…
Feeling completely invalidated, Elsie shouts out, “You’re not listening to me! You’re fired! I told you that already. Now go home! Do it!” We didn’t leave Elsie “caught up to speed.” Not even close. Instead we left behind an angered, scared, and very confused woman.
Elsie probably thought we saw her as a nothing, a nobody. Now this, after all her years of sacrificing and fighting for values that gave strength to her identity. She doesn’t want to be seen as worthless. Her every thought, action, and very reason for being is surrounded in her life’s accomplishments and status. They’re everything she LIVES for.
Elsie’s not “appreciating” the benefits of our reality
Our reality just toppled her world. We psychologically shredded her to pieces. Elsie’s new mood-state is going to reflect anger. Specifically, anger is the knee-jerk reaction to sudden fear. It is a survival tool we all use.
To help eliminate Elsie’s “unwanted behaviors,” we will need a nurse. She’s going to need a psychotropic-type medication to “numb” Elsie’s behaviors. Her psychological needs will remain just that. Still needing attention. Eventually the head nurse would be called because, “She needs her medication. She’s delusional or something and very agitated. We’re concerned she may harm herself or others in this state.”
Consequently, a mood altering med would have been administered. Later, when we came back downstairs, we would have found Elsie sitting in the same chair. But this time we find tea dripping down the front of her suit jacket as she rests her arm against her chest while sleeping off the medication.
Psychosocial Encouragement
- Echo back their words to validate.
- Even if reported events sound nonsensical, validate their feelings rather than the content.
- Find tasks the loved one can successfully accomplish that contribute to their community.
- Dance and sing together.
