Author: Heidi Hickethier

I watch a lot of detective shows.  I know I’m not alone, because it seems like every time I open Netflix or Amazon Video, I have more options to choose from.  Lately, I’ve been noticing that a lot of these series show their main characters—usually police detectives or other crime-solving types—caring for aging family members.  I don’t know whether this is a recent trend sparked by increasing public conversations around issues of aging and caregiving or whether I’m simply noticing it more because of where I now work.

In this post, I’ll break down how three shows address what happens when a character’s job responsibilities come up against his or her role as a caregiver.  All three of these shows are British crime series.  This reflects only my own taste in television; I tend to watch quite a few British shows.  None of the shows is current.  The oldest started airing over two decades ago and the most recent came to Netflix in 2016.

In this post, I’m primarily interested in how popular culture treats family caregiving.  I analyze three series: The BBC’s Silent Witness, Netflix’s The Five, and ITV’s Inspector Lewis.  What’s particularly interesting about the three series I analyze here is that aging family members are simply part of the characters’ lives.  All of these shows center around crime solving, not around family relationships, but the shows’ creators all choose to spotlight caregiving for aging parents as a central to their main character’s personal lives.

Silent Witness

The BBC’s Silent Witness aired its first season in 1996.  It’s still on and aired its twenty-first season in 2018.  I’ve only recently started watching it (via Amazon Prime), so I’ve only seen the first two and half seasons.  The show focuses on forensic pathologists who help detectives solve crimes by looking closely at remains—and sometimes by getting more involved in investigations than the detectives would like.  The first seasons follow Dr. Sam Ryan, a pathologist of Irish descent who moves to Cambridge to work as a professor and police consultant and to be nearer to her sister and aging mother.

Mrs. Ryan has dementia.  Sam’s sister, Wyn, lives with her and is her primary caregiver.  Ever since their father was killed by an IRA bomb when they were teenagers, the two sisters have had a contentious relationship.  Wyn blames Sam for their father’s death and holds her responsible for their mother’s decline.  By the last episode of the first season, Mrs. Ryan cannot remember that her husband is dead and often does not recognize Sam.  When she starts wandering away from home, Sam decides it’s probably time to find a nursing home where Mrs. Ryan will be safe.  Wyn disagrees.  Though she is their mother’s primary caregiver and bears most of the brunt of her care, she refuses to seriously consider the idea and fails to turn up for a tour of a possible community.  At one point, she tells Sam, “I will not put my mother in some bloody awful home so that you don’t have to look at what you’ve done.”

Silent Witness offers a compelling and realistic portrayal of the conflict between siblings over caring for an aging parent.  Wyn wants help, but she doesn’t want help from professionals.  She wants help from her sister.  The fact that she’s been away for a long time gives Sam some distance and perspective that Wyn doesn’t have, but it also makes it hard for Wyn to take her seriously.  At the same time, Sam’s intense job as a medical examiner and teacher (who spends the majority of the episode in question investigating the death of her student’s fiancé) means she doesn’t have time to do much hands-on caregiving.  To her, a nursing home is the best solution for everybody.  A nice nursing home would keep Mrs. Ryan safe and relieve the burden on Wyn.  But to Wyn, whether the home is “bloody awful” or perfectly pleasant is actually immaterial, because the conflict is less about caring for Mrs. Ryan than about getting her sister to live up to her responsibilities.

By the end of season one, the show has set up a real tension between Sam’s career and her caregiving responsibilities.  When Sam leaves a family dinner citing a work emergency, Wyn says, “I am an emergency.  Mummy is an emergency.”  Sam chooses work, believing that the family “emergencies” can be worked out later.  The show ends its first season letting viewers, too, believe that this is the case.  The question of where Mrs. Ryan will live is not resolved; all we really know is that she has not moved in to a nursing home.  But by the first episode of season two, Mrs. Ryan has died.  Sam and Wyn never have to come to an agreement, and Sam never has to confront the choice between career and caregiving.  Ultimately, Silent Witness acknowledges the conflict but chooses not to resolve it on screen.

The Five

Twenty years after the first season of Silent Witness aired, Netflix’s The Five explored a different kind of family conflict over caregiving and offered a unique twist on the topic.  The Five follows a group of friends, one of whom is a police detective, as they try to figure out why the fingerprints of Jesse, a murdered boy, have turned up at a crime scene two decades after he was allegedly killed.  Detective Danny Kenwood’s father has Alzheimer’s disease, and one of the opening shots in the first episode shows Danny examining, and then discarding, a brochure for a Memory Support community.

As the series continues, viewers learn more Danny’s father, Ray, and his place in Danny’s household.  Ray lives with Danny and his family, and because of Danny’s busy life as a police detective, his wife Jennifer does most of the day-to-day caretaking.  We also learn that Ray was the detective who investigated Jesse’s disappearance and murder.  When Danny first shows Ray a picture of Jesse and asks him about the case, Ray responds by blowing raspberries.  As Danny pursues the case, he learns that Ray altered files relating to the case, and this fact helps confirm that Jesse wasn’t actually dead.

Perhaps because he’s trying to get information related to his work, we see Danny do a lot more hands-on caregiving than, say, Sam of Silent Witness.  He feeds his father meals and spends time with him in spite of his busyness.  But it’s not just the demands of caregiving that make Ray’s presence in their house difficult for Jennifer.  Because of his disease, Ray is frequently disruptive during family time, and it’s difficult for Jennifer and Danny to get time alone together.  Danny sees that his wife is struggling, but he’s devoted to his father, to whom he looks up both personally and professionally.

It’s not until Jennifer leaves and threatens not to return that Danny sees just how much of a toll his father’s needs have taken on his marriage.  When he realizes that he might have to choose between his marriage and having his father in his house, Danny decides to move his father into a specialized Memory Support Community.  This is a happy ending for the Kenwood family.  As Danny tells Jennifer about his decision, he promises to take the family on vacation and to prioritize their needs over work as well as his father.  Unlike Sam and Wyn of Silent Witness, Danny of The Five does have to make a decision, and that decision plays out as a resolution.

Inspector Lewis

In the eighth and final season of ITV’s Inspector Lewis (2016), however, we see that moving a parent with dementia into a Memory Support community does not always mark the end of family conflict over caregiving responsibilities.  Over the course of its eight seasons, Inspector Lewis subtly but definitely emphasizes the personal costs of detectives’ jobs.  The title character misses milestones in his children’s and grandchildren’s lives, and his partner, Detective Sargent—and by the eighth season, Inspector—Hathaway at several points has to choose between his personal and professional loyalties.

In the final season, Hathaway’s sister, Nell, decides that the time has come to move their father into a Memory Support Community.  After an early visit goes poorly, Hathaway refuses to engage with his father.  Throughout the rest of the season’s first episode, Nell repeatedly leaves Hathaway messages reminding him of his responsibilities.  Viewers get the sense that Hathaway hasn’t been a particularly involved son.  This is the first we’ve heard of his father’s dementia, and Nell says, “It’s easier to pretend nothing’s wrong, isn’t it?  And leave it to me to pick up the pieces yet again.”  There’s a lot of back-and-forth between Hathaway and Nell, all with the implication that Hathaway has failed his family responsibilities because he prioritizes work.

The senior Mr. Hathaway goes to live in the Memory Support community because caring for him is too much for Nell and Hathaway doesn’t help, but that’s not the end of the conflict.  In fact, it’s only the beginning.  Nell wants Hathaway to be involved and visit, and he resists.  Finding the right community for a loved one can ease the day-to-day burdens of caregiving, but family members don’t stop being family members just because they don’t live with you anymore.  As The Five suggests, the right community can make a big difference in the lives of caregivers.  But Inspector Lewis reminds us that how to divide the various responsibilities of caring for an aging family member is an ongoing concern.

Time is hardly the only reason Hathaway avoids seeing his father.  In his first visit, the older Mr. Hathaway doesn’t recognize his son and doesn’t remember that his wife is dead.  Hathaway struggles to accept that he can no longer interact with his father in the ways that he used to, over books and intellectual pursuits.  Nell’s exasperation comes as much from her brother’s refusal to accept their changed parent as from the burden he places on her. Eventually, with Lewis’s help, Hathaway reconnects with his father over fishing.  Mr. Hathaway’s dementia is not going to get better, and once he accepts that, Hathaway finds a way to enjoy his company.  His acceptance of his father’s condition also helps him reconcile with Nell.

Taken together, Silent Witness, The Five, and Inspector Lewis portray a range of possible responses to family conflict over caregiving.  The ways the three shows resolve (or not) the conflicts in question show that careers and caregiving can coexist.  Some time in the twenty years between the first season of Silent Witness and the final season of Inspector Lewis, the subject of caring for aging family members came to the forefront of public discourse.  Also during that time, options for dementia care increased in both range and reputation, so Hathaway and Nell have choices that Sam and Wyn don’t.  Overall, these three shows offer a compelling narrative of the conflict between career and caregiving—and the way that conflict both has and hasn’t changed over time.

In the final week leading up to Christmas, groups that celebrate advent focus on love.  If you look up the word “love” in the Merriam-Webster dictionary, you get a lot of different definitions.  For starters, because it’s both a noun and a verb, love has two different entries.  The first (noun) entry alone boasts nine different definitions, and the second (verb) has five.*

Usually, we think of love as either romantic or familial, but those aren’t the only ways to use to word.  As I walk the halls of Immanuel, I see many different expressions of love.  Not every definition in the dictionary is appropriate, of course, but several are.  Here are just a few examples, organized by the dictionary definitions they meet:

1: Strong affection for another arising out of kinship or personal ties (noun)

• This one is personal; my Grandpa lives at Buffalo Hill Terrace, so I get to see him, and tell him I love him, more often than I would otherwise. In general, Immanuel is great at involving families in resident activities and milestones.  In recent weeks, for example, at the various Christmas dinners held on campus, families and friends came to enjoy gourmet dinners with residents.  As residents and their guests ate and chatted, the atmosphere was full of love.**
• I’ve also seen staff express love for residents by residents by learning their likes, dislikes, and histories. A few months ago, I heard a great story.  A CNA in the Assisted Living department learned that a resident was of German descent and spoke German.  She was born in Germany and also spoke the language, so she began speaking to him in German.  As a result, they developed a special bond.

2: Warm attachment, enthusiasm, or devotion (noun); to like or desire actively: take pleasure in (verb)

• There’s a resident at the Skilled Care Center who loves music. Whenever I see her while music is playing, she has her eyes closed and is listening intently, maybe a swaying a little bit in time to it.  Live music is a common feature of recreation calendars across campus, so she has many opportunities to enjoy it.  When she expressed a desire to meet a band playing at an event, the Recreation staff made it possible.  Immanuel staff care that she has what she loves.
• My Grandpa loves playing games. Almost every Thursday, he meets a group of other residents in a common space to play a card game called Hand and Foot.  All of them love engaging in this activity that brings them pleasure, made possible by the fact that they live in community togheter.
• A couple of months ago, Passions Project participant and popular canine Terrace resident Toby Maurer turned ten years old. For his birthday, the Recreation and Wellness staff took him a large treat.  Toby’s owners David and Martha love him very much, of course, and they appreciated the recognition by the staff of their beloved pet.

3: Unselfish loyal and benevolent concern for the good of another (noun)

• I see this one every day because it’s embedded in Immanuel’s culture. The examples below are the tip of a lovely iceberg.
• Recently, a resident wasn’t feeling well. He went to the dining room anyway, and the waitstaff noticed that he wasn’t himself.  They made sure a staff member brought a wheelchair to get him safely back to his apartment.  This is part of a larger pattern where dining staff know the residents well enough to know what their “normal” is—as an expression of their loving hearts.
• Every year, one of the churches in our region takes the time to find out what each resident in the Skilled Care Center would like for Christmas. Volunteers from the church then purchase and deliver the gifts, so all residents get a present tailored specifically for their wants.  This church is some distance away, and most members of the congregation have never met the residents.  They purchase and deliver these gifts out of unselfish love.

*For the grammar nerds out there, there are four definitions for “love” as a transitive verb and one as an intransitive verb.  This is a word with many properties.

**Of course, love of the food was also a commonly-expressed emotion.  See also definition 2.

As we approach the ends of our lives, I think most of us desire some form of peace.  What that looks like will be different for everyone, of course.  For some people, peace genuinely means an absence of conflict.  They want to be surrounded by harmony and, perhaps (though not necessarily) quiet.  Others don’t mind a little conflict.  What they mean by peace has to do with relative financial security and the ability and freedom to spend their time as they choose.  Still others think of peace primarily in terms of physical comfort; they want to be in a place where their needs are attended to and to not spend their final years in pain or worrying about day-to-day necessities.

At Immanuel, we strive to help our residents find peace in whatever way is most important to them.  At the Immanuel Skilled Care Center, this means offering private rooms with private bathrooms to the majority of residents, regardless of who pays their bills.  This allows residents the peace of their own private space to use how they need and want to, whether that’s reading a book in silence or watching a TV show that others around them don’t enjoy.  It also allows them to entertain their visitors on their own schedules without worrying about disturbing someone else’s peace.

Residents move into Immanuel Lutheran Communities for all kinds of reasons.  Especially for independent residents, one of those reasons is that they want the peace of knowing that someone else is taking care of day-to-day maintenance tasks.  Snow and ice is always a possibility during Flathead Valley winters, and when it inevitably arrives, the maintenance team does a great job of keeping sidewalks and parking lots clear and safe.  And when they can’t quite keep pace with the winter weather (because in the Flathead, it can be relentless), they and other team members let residents know what areas are safe and which ones will be soon.  Residents have both the peace of not having to shovel or arrange for someone else to do it and the peace of knowing they’ll be as safe as possible when they do choose to go outside.

Of course, peace might also mean having people around you who care that you have ways to spend your time that are pleasant and enjoyable for you.  Across campus, our recreation teams plan full calendars of activities.  Many residents find peace in knowing that, by the first day of a new month, they will have the schedule for the whole month.  That way, they can plan their days and make sure they don’t miss out on their favorite fun events.  They have the peace of knowing that that staff care not only about their physical wellbeing but also about their emotional wellbeing, happiness, and pleasure.  For many residents, the spiritual services and pastoral care available every day at Immanuel contribute significantly toward their experience of peace.

No matter what kind of peace a resident desires, at Immanuel, we strive to help them find it.  When you give to the resident care fund, you too help residents find peace.  You also help Immanuel find peace by helping to close the gap between what Medicaid pays and what it costs to offer services like private rooms.  By becoming part of our community of donors, you, too can give the gift of peace this holiday season.

Last fall, I shared Megan’s story with you.  Megan, who began as a CNA, is currently an LPN, and is pursuing her RN credential, is only one of many employees who have received assistance from Immanuel’s Employee Education fund.  I’ve recently begun serving on the committee that helps decide how to distribute these funds.  That means that each semester, I will look at applications from employees who have asked for funds from Immanuel to help them reach their educational goals.  While I haven’t yet seen any applications, through conversations with colleagues I’ve learned that these are some of the reasons people apply for assistance from our fund:

• They never had a chance to finish college as traditional-aged students and are going back now that they have the time and some financial assistance
• They want to gain an additional credential in their work area (i.e. an LPN studying to be an RN)
• They are traditional-aged students who work part-time at Immanuel and/or work full time during school breaks
• They want to learn a skill or explore a subject they’re interested in but never had a chance to pursue before (i.e. art)

All of these reasons for going back to school suggest that the applicant has hope.  The student returning as a working adult to a degree program he or she started some years before, or to a new degree program that’s a bitter fit with their life now, hopes that their learning will enrich their life.  That enrichment might be financial or simply personal, but almost everyone embarking on a degree does so out of hope.  The student returning for an additional job credential does so because they believe that it will better equip them to serve current and future residents.  Even the non-degree-seeking student who takes an art class simply because they’re interested does so because they believe it will make a positive difference in their life.

Each of these reasons for applying for education funding implies hope for a future that is both different and better than the present.  I’d also like to point out that taking action implying hope for a better future doesn’t imply that a person’s current situation is bad.  Employees who seek additional education do so because they want something different, and they are willing to give what it takes to achieve their goals.  An LPN studying to be an RN is probably doing so because she enjoys nursing and wants to do it at a higher level.  She hopes that by obtaining another credential, she will be to provide a different level of service to both the residents she serves and the organization.  She also likely hopes that she will increase her earning potential to create more opportunities for herself and her family.

Hope is a powerful motivator.  It keeps us going even when things are difficult.  When you give to the employee education fund, you give the gift of hope to employees who want to make both their own lives and this organization stronger.  Your gifts contribute to the culture of hope we’re creating here at Immanuel.  Thank you for being part of it.

This time of year, the Thanksgiving holiday encourages us all to consider what we’re thankful for.  For this week’s post, I asked my colleagues here at Immanuel Lutheran Communities to share what they’re grateful for.  Here are some of the responses:

 

“I am grateful for a lot of things, especially my family.”

-Nicole Normandy, HR Assistant

 

“I am thankful for family.”

-Christie Brown, RN, Director of Nursing, Immanuel Skilled Care Center

 

“I am grateful for the friends God has blessed me with, both coworkers and friends outside of work.  I am thankful for the Lord who is always with me.”

-Pam Andrews, Life Enrichment Coordinator, Immanuel Skilled Care Center

 

“I am thankful for my family and friends I have in my life.  I wouldn’t be where I am today without them.  I am also thankful for my job and the residents.  I love my job and my residents—they put a smile on my face when I get to work.”

-Shirley Pate, PCA/CNA Trainee

 

“I am thankful to still have my grandfather her with us.  I am thankful for the home health aids that go out and care for him when my parents and me cannot be there.  I am thankful for the amazing Unit Council team; I’m glad we could get some amazing leaders for the team I’m part of.”

-Lacie Jo Curtin, CNA

 

“I am grateful for the unending love and effort I see everyone who works here put toward our guests, and to each other, day after day after day.  It is inspiring and while it may not happen to every single person every single day, it happens often enough to make my heart happy.  In this season of beauty and thanksgiving, let’s count each of us working here in whatever amazing job we do, and count most of all, our guests as our blessings.”

-Kitt Adams, RN, Retreat West

 

“I am thankful for my boyfriend Reza, the opportunity to see him in Paris, and crépes!”

-Charlotte Vaillancourt, Executive Development Assistant

 

“I am grateful that I work in a community that celebrates Christmas.  I also love working on a team that’s small enough to feel like a family.”

-Dave Garnett, RN, MDS Coordinator

 

“I am thankful for the awesome teamwork we’re growing at Buffalo Hill Terrace.  Departments are working together.  Even with growing pains as new spaces open, everyone is coordinating very well.”

-Subrina Hanson, LPN, Assisted Living Nurse Coordinator

 

“I am thankful for my job.  I have the best job in the world.”

-Bo Diaz, Transportation Coordinator

 

As for me, I’m thankful that I get to spend Thanksgiving with my family.  From the time I started college until I moved to Kalispell in 2015, I spent Thanksgiving far away from my loved ones.  While I created many great memories with friends during those years, I missed our family dinners, and I’m so glad to be with them.  I’m also grateful for the team I work with here at Immanuel.  It’s lovely to have colleagues who are always willing to pitch in and help out.  We all want to make life joyful for the residents, and it shows, every day.

 

And the Immanuel Foundation and Immanuel Lutheran Communities are grateful for you, our donors, volunteers, and supporters, who join us in our efforts to provide safe homes in vibrant communities for Montana’s seniors.

 

Happy Thanksgiving to all of you from all of us!

This somewhat lengthy essay is a response to an article in a national publication.  Your friendly blogger is not a memory support professional; my training in the area is extremely limited. This is a piece about ideas.  Some of them are ideas that come from observation and from my limited training, but I’m not recommending any action to anyone, and neither is Immanuel Lutheran Communities or the Immanuel Foundation

The October 8, 2018 issue of The New Yorker features an article by Larissa MacFarquhar called “The Comforting Fictions of Dementia Care.”  In it, MacFarquhar relates what she learned on a visit to The Lantern, a specialized memory support community in Chagrin Falls, Ohio, just east of Cleveland.  The Chagrin Valley community features an interior that is decorated to look “much like the town outside.”  The common spaces feature “facades of what looked like clapboard houses, with wooden shutters and shingled pitched roofs and porches that extended into the room.  Two long hallways… looked like streets in the same town, with more clapboard facades and porches on either side.”  Each “front door” opens onto a resident suite, offering the illusion that residents living in a locked community actually go outside every time they leave their suites.

The idea of illusion troubles MacFarquhar throughout the piece.  As she traces the history of dementia care from the days of physical restraints and Haldol (an antipsychotic) to “Reality Orientation” treatments to current, kinder practices, she talks a lot about lying.  By using that word, with all the value judgments it implies, and by making strong statements like “Family members and care staff lie all the time, and can’t imagine getting through the day without doing so, but, at the same time, lying makes many of them uncomfortable,” she poses a dichotomy between truth and lying that doesn’t necessarily exist where people with dementia are concerned.

Most memory support communities don’t take the illusion of external reality to the extent that The Lantern does (The Lodge at Buffalo Hill certainly doesn’t).  However, many communities encourage staff and caregivers to “live in the reality” of the person with dementia.  That means accepting their version of the world.  If a family member talks about her deceased husband as if he’s still living, then, a lot of professionals would recommend talking about why he’s away rather than insisting that he’s dead.  For professionals who recommend this course of action, these kinds of untruths are both kind and pragmatic.  If your family member believes her husband to be alive, news of his death will alarm her—and likely, she’ll soon forget it again, requiring you to tell her over and over that her husband is no longer alive.  This is likely to be extremely exhausting and unpleasant for both of you, so it’s something you might reasonably choose to avoid by going along with the fiction that her husband is simply absent.

The question, then—and MacFarquhar’s main concern—is whether going along with this fiction is lying.  Admittedly, this is a tricky question.  As MacFarquhar chronicles, people with dementia don’t necessarily want their family members and caregivers to tell them comfortable fictions.  She includes a summary by British researcher Graham Stokes of a panel convened a few years ago to discuss ethical issues in dementia care.  Stokes included people with dementia on his panel, and “All of them said, Why do you lie to us when we are at our most vulnerable?  Would you wish your relationships with others to be based on deceit?”  This is a fair point, and one that surely gives pause to many who interact regularly with people with dementia.  Surely in determining best practices in memory support we have to take into consideration what those with dementia want.  But the question becomes, What do you do if the person you’re interacting with believes you to be telling the truth when you are lying, and vise-versa?  What is the difference between the truth—insofar as it’s possible to determine that objectively—and a truth for the person with dementia?

I don’t have the answers to these questions, and I don’t think anyone yet does.  The memory support staff I know—and they range from managers to recreation staff to CNAs—believe in making every day as positive an experience as possible.  They certainly don’t set out to deceive the residents they care for, but if a resident believes she’s on a train, they’ll play the role of conductor.  Their training and their kind hearts tell them that the best thing to do for the resident is to enter their reality.  By being a train conductor for a little while, a staff member likely helps a resident have a much better day than she would if the staff member said, “Nope, I’m a CNA and you’re not going anywhere except to the TV room.”

In his essay “On Truth and Lies in a Nonmoral Sense,” German philosopher Friedrich Nietzsche posits, “What men avoid by excluding the liar is not so much being defrauded as it is being harmed by means of fraud.  Thus… what they hate is basically not deception itself, but rather the unpleasant, hated consequences of certain sorts of deception.”  As a scholar I’m compelled to note here that this essay is mostly about metaphor and language and how we as humans construct the world, but Nietzsche’s ideas are nonetheless useful here.  When a memory support staff member takes on the role of train conductor, she might in an objective sense be deceiving the resident in question.  But the resident is probably happier in this case “being defrauded” than she would be otherwise, and she’s not harmed by the “fraud” in any concrete sense.  There aren’t really any negative consequences here, except in the most abstract sense.  In fact, I’d go so far to say that it’s not really fraud, because fraud implies intent.

MacFarquhar concludes her article with a description of a Dutch community built to look like “a modern neighborhood in a Dutch city.”  It includes a restaurant, a pub, a café, a supermarket, a small mall, and even a music performance venue.  While the residents cannot leave, some parts of the community, like the restaurant, are open to the public.  MacFarquhar never says out right that this community lies, and she even seems to admire its homelike atmosphere and philosophy of public engagement.  However, her description immediately follows dire warnings about the consequences of lying.  Just before embarking on her description of the Dutch community, she quotes philosopher Sissela Bok: “The veneer of social trust is often thin… As lies spread… trust is damaged.  Yet trust is a social good to be protected just as much as the air we breathe or the water we drink… When it is destroyed, societies falter and collapse.”  In many senses, everything about the Dutch community is a lie.  Residents do not actually purchase things at the supermarket, and their homes are not in a normal neighborhood.  But could such deception really lead to the collapse of society?

I don’t think so, and as you can probably tell, I was, well, bugged by this article.  I value honesty in my interactions, but I can’t honestly say that if I were to develop dementia I would want everyone around me to tell the objective truth, regardless of the consequences for my well-being on any given day.  It should be up to every individual to make that decision, but as MacFarquhar rightly notes, it can be very hard to know with regard to dementia whether an individual’s desires remain the same.  What we do know is that while people with dementia might not experience what we would consider the objective truth, they have experiences that are real to them.  By watching and listening to them, we can get a little bit of access to their truths, and that’s probably more than they can get to ours.

All of my colleagues want to be ethical (as do I), and “tell the truth” seems like the most basic part of ethical practice as a professional and as a human being.  But maybe in memory support, ethics mean something else.  Maybe they mean respecting the truth of the person you’re working with, whatever it happens to be on the day.  Maybe it simply means, as I know my colleagues over in memory support do every day, creating a here-and-now for people with dementia that respects who they are at this particular moment.  I think this is what MacFarquhar is struggling with throughout the article, and again, I don’t have the answers.  But I don’t think it’s as simple as truth and lies.