Redirection (aka Happy Lies)

# 4 Redirection (aka Happy Lies)      

Beverly has raised the name of her close first cousin and of her Mother nearly a million times (it seems like). It was easy at first to simply be honest that they both were dead; her Mother has been gone more than 20 years and her cousin died 6 years ago.   Of course, she once knew they were gone.  Telling her the truth now is always wrong; sadness and crying follow as she grieves the loss of her Mother/cousin.  Of course, she does not remember what she knew before or that I recently told her that her Mother/cousin died.  So she talks about her Mother again, sometimes very soon.  And though I vowed to never again say “She is dead,” I was caught when she asked if her Mother had died.  I said, “Yes.”  Same mistake on my part as she had a big cry again.  

 Redirection/happy lying developed into telling her that her Mother is in the home town. I learned to say: “We will call” or “We will go visit her.”   and that we will call her sister to talk about their Mother.  Raising the issue of her Mother was often followed by saying that she would save her plate of food to give to her Mother.  I had to say that we would buy food for her Mother when we got there.    “Fried catfish & hush puppies.”  

 She was not told about other deaths and serious illnesses since such reports would not be remembered.  Sadness would only be repeated.  Her close sister died a few months ago, but she has not been told.  Various friends have died, including one she was close to.  She will never know.  Another sister had a serious cancer, but she never knew.  In the pre-Alzheimer’s days, she would have gone to her sister to help with treatment and recovery.  That could not be now.

 With normal folks, we can be truthful; and they are not likely to ask If their Mother died since they know.  But, with her, the death is forgotten.  It is best to respond with a redirection/comfort lie that keeps the person in a better emotional place. 

 Redirection is the common terms for the lies that we tell dementia folks all the time.  We could call them “happy” lies, as they are often used to prevent unhappiness.  Redirection is critical for managing anyone with dementia; the responses to these folks can be very laughable, even in context.  It is worth thinking in advance of new ways of responding to some of the various situations that happen often, even some of them very unique to our loved one. 

 The experts at managing those with dementia have an amazing supply of, and can be very skilled at creating on the spot, some kind of redirection/comfort lie.  Such lies must be created to prevent more serious problems.  So the issue raised will result in anger, sadness, or some other negative emotion and response, even a physical confrontation if nothing is said/done or they are simply told “No.”  A good redirection will typically prevent all of that.  A good redirection must address the present issue and must make a positive emotional connection while “solving” the issue.  These redirections are generally verbal. We know that those with dementia (especially advanced) do not understand much of what is said.  So it is often unclear what the recipient of redirection understands; yet the emotional/social connection is there and that matters as long as the issue is addressed.

 And the understanding of, and memory for, the whole interaction will go away in seconds, which has both positive and negative consequences.  The person with dementia typically does not have the capacity to realize that often the redirection cannot be true.  We would all know that it was not sensible.  But redirections usually work.  The negative aspect of a redirection is that the redirection may be forgotten while the resident’s original purpose continues.  So the whole process may be repeated, sometimes over and over.  It is often true that the redirection should get the person to think about something else.

 A resident comes to the front desk, saying that he cannot afford to stay here as he has no money.  The usual response is “It is all paid for” which may be enough.  If he or she wants to know who paid for it, any person could be named, like “John here took care of it as a special favor.”  While this is implausible, it is generally accepted by residents.  

 A critical and common redirection situation is getting someone to move away from exit doors when someone else is coming or leaving, so as to prevent escape.  Similarly, it may be critical to get someone out of a room where something is taking place that is not for them.  How?  “Let’s go to this other room where there is a party.”  Or “Let’s go down the hall where there is food for you.” “I think somebody was looking for you in the lobby.”  “Your sister is looking for you.”   ”Jane was looking for you; she just went down that hall.”  “The nurse wants to see you.” 

Often when someone requests strongly that they want to leave the facility, a plausible redirection is that the doctor will check “your” blood pressure in the morning before releasing you or that the doctor is adjusting “your” medicines so you can leave tomorrow.  Or, if the person is demanding to get someone to release them, that person may be told to go to the nurse’s station and ask the nurse, as “I” do not have the authority to release you.  That may be an imposition on the nurse who may then have to refer that person to see the doctor later.  On the other hand, the person who is sent to see the nurse about getting released is likely to totally forget the whole matter by the time they reach the nurse’s station in a minute or two. 

 A similar situation arises when the resident wants to know which door they can exit by.  They are told that this (the actual exit door) is locked right now, but they should go down this hall to the other exit door.   This is a lie since there is no door down that hall that is an exit.

 There is one resident who always wanted to contact a relative, indicating that her sister will call or will “pick me up.”  Staff tell the resident that her sister was called and a message  was left, so we are now just waiting to hear back from her.  Sometimes this person is told repeatedly that we have called and left a message and are just waiting for her to call back or to come get her.  This process repeats itself so many times in a short period that I marvel that anyone can have so much patience with this repetition.  The resident hears the answer, walks away, then reappears in a minute or two with the same request, and does so over and over and over.

Notable was the response to “What is this place?” The response from a caregiver was that this is a fancy resort with wonderful rooms to stay in with a TV and private bathroom, exercise rooms, entertainment, a swimming pool, great food, and whatever you want.  I have heard something like this several times and it does reassure the resident. 

One person moved himself in on the pretense that he was going to a fantastic retreat with training and education.  Within a couple of weeks or so, the realization came that this was not a retreat.  In this case, the lie backfired in that there was great anger that he was not getting what he expected.  He was certainly earlier in the dementia process.  Many residents would not remember the pretense for moving in.  Still, getting him moved in was a major achievement managed without resistance.

 And redirection can be nonverbal.  Just as with a child, one can substitute something the person wants as a redirection of the current problem.  One resident was pushing the wheel chair of another and it was time to get the one in the wheelchair up to a table to eat lunch.  But the one pushing the wheelchair had a very tight grip on the bar at the back of the wheel chair.  He would not release that grip to verbal instruction or to attempts to pry the hands off.  Quickly the caregiver grabbed a cream puff that was handy and offered it to the recalcitrant pusher.  He immediately let go of the wheelchair to get the cream puff and everything was smooth after that.  Maybe we cannot think of nonverbal in the same way, but this was certainly a redirection.

Of course, it may be troublesome to some, as it was to me, to engage in such “lying.”  Yet these lies are effective at serving a significant social purpose, namely making the target person comforted, more relaxed or happy.  And definitely these “lies” often save bigger difficulties, including sadness, anger, aggression, efforts to escape, etc.  So in most cases these lies are positive functional responses to difficult circumstances.

 Even in more extreme cases, the redirection can be effective.  One evening a resident was on the rampage, striking another person in the face, then beating on the wall.  Everyone was keeping a distance and doors were being locked to prevent any access to others.  A wise skilled caregiver simply took him by the arm and said, “Come on, it is time to go to your room.”  So he went calmly.  While not much of a lie, it still did not quite make sense.  But it was said kindly and it worked very effectively.

 One should not never forget that the “lies” should have the right emotionality.  In many cases, the verbalized reason given may not be understood,   As we said,  why would it have been necessary to call her sister in order to contact their Mother?  The key is that the issue is addressed with some level of empathy toward the loved one.  The redirection (promising to call the sister) was still supportive of Beverly’s emotional need to find some contact.

Let’s use our imaginations to create effective redirections.  At the front desk wanting out:  “That bus just pulled up in back to take you.” (By the time they reach the back door, they have forgotten why they went there.).  In a room and needing to get them out:  “The cat really needs some water.  Would you go get some water in that dish.”  (Close the door behind them.)

Or wanting to move them away from some place.  “There is great country music; they just started playing in the big room down there.”  He wants to find the doctor:  “I just saw him go down that hall.  You can find him if you hurry.”  (In the wrong direction for the doctor.). “The airplane is landing in the back parking lot to take you back to California.”  “The hot tub is ready for you.”  “Pick up your award in the room down the hall for the most creative work.” 

Redirection is central to maintaining the comfort of someone with dementia.  For those, like me, who were not good at lying, one needs to learn to do so effectively.  Again, it has to address the problem, even if not quite making sense.  And it has to have the right emotional tone, namely being sympathetic to the other person.

So it is essential to learn to make all types of comfort lies/redirection.  Most of us do not automatically want to lie, even feel it is wrong to do so.  Yet redirection is unavoidable with dementia loved ones.  Learn how to do it effectively.  Remember that it does not quite have to make sense from the normal point of view.  The problem needs to be addressed, of course.  Most critically there has to be emotional support or sympathy in the response.