by Steve Raymond and Jill Wallace
We shared dinner with a friend whose cognitively impaired mother just went into a memory care unit. She is upset because every time she visits she thinks the visit was great, but after she gets home, the staff calls her because her mother is upset… really upset. So much so, that professional staff asked her not to visit for a whole month. “Not visit at all,” she said.”
“Not visiting” is advice that is very difficult for family members to understand. Not everyone needs this therapeutic intervention, but some do. This is because of the way that each person’s brain is uniquely damaged by the disease.
Human beings love to remember our past. It is natural for us to want to share our memories with our loved ones. If our loved one is cognitively impaired, it is easy to think that we are helping them by reminding them of the past and keeping them “reality oriented.”
Our friend thinks she is helping her mother by reminding her of the past memories that connected them. She thinks she is helping her confused mother, who is forgetting things, to hold on to her memories. She thinks she is building connection, and improving their relationship by sharing the good times.
The trouble is that her mother does not remember, and no amount of reminding will make her mother’s brain function again. Her brain is working differently than it used to, and differently from her daughter’s. We don’t really know how it is working differently, but we see the effects. We can see that Mom becomes agitated and anxious after her daughter leaves.
Her mother feels even more confused when her daughter talks about things she should remember, but doesn’t. The daughter was talking about fun summers at the cottage. Happy memories. But the mother is now walking around, agitated and anxious, looking for her children. She has remembered the summer cottage, but for her it is not in the past. In her mind, she is right back there; back in the memory of having small children she is responsible for and she cannot find them. She experiences those memories as if they are Now.
“Where’s my little boy? I have to put him to bed. Where’s the dog? I just let him out and he’s not back yet. Does he need to go out? Has he made a mess somewhere?” These feelings create stress and anxiety and send her thoughts spinning. Rather than an act of kindness in reminding a cognitively impaired person of the past, it can actually be an inadvertent act of cruelty. This can be a hard pill for family members to swallow.
People who work in assisted living homes and memory care units know that confused people do best when they can live in the present. We learn to help our residents be comfortable in their own skins by focusing upon the positive and redirecting conversations from the stressful and anxious. We want families to learn these therapeutic communication skills because it is the most loving way to connect with your spouse or parent who is cognitively impaired.
This is why memory care communities will ask for limited or no visits for some new residents in the first few weeks. It is to provide an adjustment period for the resident. It is loving empathy for the person whose thoughts become disordered and fearful. It is a way to create the feeling of safety without the overuse of medications. It is not just the cognitively impaired who must adjust to a new reality… it is also the family members, and the professionals are there to help.