I used to work as a CNA in the dementia unit of a long-term care home, located in a small town in Iowa. 

I haven’t worked as a nurses aide for many years now, but have continued to be around people with dementia both personally and professionally. 

If you are reading this, you probably already know that having a conversation with someone in the later stages of dementia can be completely nonsensical. In the moment, inside their mind, they are often in a completely different time and place than you. 

The fact that I sort of delight in having these wacky conversations feels like something I must confess (as opposed to simply telling you), because I am fully aware that the confusion and distress that someone may be experiencing in their mind is real and concerning. It is sad when someone endures the loss of their memory and grows increasingly disoriented from reality. There is no doubt about that. There is a time and place for indulging in illogical chat and there is a time and place for redirecting. One has to know when to make that judgement call. 

But, why not meet people where they’re at? That’s all I’m saying. It can be refreshing. Even fun. Especially if you have a flair for the dramatic arts. 

Scene I

Case in point…one time working as a CNA, I passed by the TV room where Lois beckoned me to come over. 

When will the valet bring the car around?

The valet? You see, this is like being in an improv scene where the situation and your identity is provided only through prompts. 

You car should be here shortly, ma’am. 

Oh, wonderful. Thank you, sweetie. And the luggage? Will they bring the luggage down?

Ah, it appears we are in a hotel. 

Yes, I will make sure every item is loaded in the vehicle for you. 

Even the two horse saddles?

Horse saddles?! Alright, then…

It might be a tight squeeze, but we will do our best to make it fit. 

Yes, Gerald spent a pretty penny on those, you know.

Oh, that Gerald. Has to have the best of them, doesn’t he? 

She touches my arm. 

Isn’t that the truth? 

Then Lois chuckled and turned toward the TV, seemingly happy to know everything was in order and would be just fine. 

Scene II

Another time, a different resident approached me. 

Excuse me, could I ask you something?

Sure, what can I do for you? 

She brings my head down so that she can whisper in my ear. 

Do you happen to have any sanitary pads? You see, I’ve just gotten my period. 

There is absolutely no way this 82 year-old woman is still getting a visit from Aunt Flo, but I go along with it.  

Don’t worry, dear. I have some in my purse. I’ll just go grab you one. Would you like some ibuprofen as well?  

She nods and winks at me, mouthing a silent “thank you”. Sisterhood.

I come back with a pad and she stuffs it in her cardigan pocket with the stealth of covert ops mission. 

Later, when I went into her room to start the bedtime routine, I found the pad open and stuck to her nightstand with an oatmeal raisin cookie lying on top. Well, you know, I’m glad she found a use for it. 

A New Perspective 

Sure, these exchanges are illogical. However, at the time, I was invited into someone else’s present reality. Even though it involved being a bit off the wall on my part, the result is that these women stopped worrying. Their demeanors shifted. All was right once again. Who wouldn’t find a little joy in that? 

Building up life stories is such a large part of what care staff focus on in senior homes. When the opportunity presents itself, perhaps you can be part of a resident’s life story by acting out a scene with them. You both might like it.

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AuthorBio: Taylor Vander Well heads up Best Practice + Communication for StoriiCare. She lives in Edinburgh, UK with her partner and son.