As you walk through the door of his room at the nursing home, your dementia-stricken father asks why his wife, your late mother, isn't with you. He's forgotten that she died. You don't want to upset him, so you're tempted to make up a story about her being on a trip. Should you?
The experts say you shouldn't. But that doesn't mean you have to tell him the whole truth, either.
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"If you lie, you're going to end up in a very unattractive game of Twister," says Ken Robbins, a clinical psychiatry professor at the University of Wisconsin-Madison who specializes in geriatrics. "You'll get stuck in a ton of subsequent lies. He'll ask: 'Where'd she go? Why didn't I go? Why can't we call her?'
"Instead of lying, talk about the feelings that are making him ask that question," Robbins says. "Don't say she's dead. Instead, say: 'I bet you miss her. What would she do right now?' Bring her up in a positive way and then casually move the conversation away from her."
Is honesty the best policy in every scenario? Consider these four other situations in which many of us would be tempted to bend the truth:
You just got a serious, worrisome health diagnosis. Should you tell your mother?
"It depends on the severity of the diagnosis," Robbins says. "If you think you're going to die before she does, tell her. But you might want to take it in steps."
Ashley Uhler, program strategies director of Country Meadows Retirement Communities in Pennsylvania and Maryland, says, "I think everyone deserves to hear the diagnosis once. Tell the truth, because you both might to do things differently with the possibly brief time you have left. Put the information out there and gauge the reaction. If parents don't process what this means, then there's no point rehashing it."
Your dad isn't driving safely and you know his license and car need to be taken away. Should you tell him it's all your idea?
No — and you don't have to tell him alone, either. In this case, experts say it's OK to pass the buck by enlisting an outsider. "The lead person in this conversation shouldn't be a family member," says David Solie, geriatric psychologist and author of How to Say It to Seniors: Closing the Communication Gap With Our Elders. "It's better when news like this comes from an outside person with authority, such as the parent's doctor."
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In conversations with your parent about driving, you can help frame the issue in an acceptable way. "It's important to have some guiding values," Solie says. "Start by saying, 'I've always told you the truth even when it's difficult.' Allow language and word choice to follow these value-driven reference points.
"Tell the parent," Solie advises, "that driving has become a danger and he can control his independence more if he allows someone else to drive. Otherwise, he may get in a wreck, hurt himself or others and end up with medical and legal entanglements.'"
After a hospital stay, your mother's doctors say that she can't return home, but has to move into a nursing home. Should you tell her it's "just temporary"?
"It's not necessary to say it's permanent," Robbins says. "The truth is that, if it doesn't work out at one facility, then you might move her to another facility. What you can say is, 'You're having a tough time managing and they can take care of you there.' And talk about the specific incidences that are causing concern. For example, 'You're confused when you go out. You can't make your meals." Position it as a trial: 'Let's try this and see if it will make you happier and safer.'"
While you may temper your responses to a parent's questions, it's important to express your own concerns honestly. "Sometimes, the greatest tactic is to be heartfelt about how the situation is affecting you," Uhler says. "That's when Mom or Dad may be most likely to listen. This stops a lot of the power struggles."
It might help you to know that you're not the only one tempted to fudge the truth in these difficult conversations. "You might think the answers to challenges like these are obvious, but they're not generally obvious to people," Robbins says. "Often caregivers feel very alone with these dilemmas. In general, these difficult decisions – should a parent go to an assisted living home, should someone drive – work better when children aren't in the position of laying down the law. You can let a doctor be the bad guy so you're able to express empathy to your parents for whatever they perceive they're losing."
Your father has received a tough medical diagnosis. How much do you reveal to him?
"If I'm meeting with family members and laying out the situation with regard to someone with dementia," Robbins says, "I don't necessarily include the person with dementia.
"But if the father has his full cognitive capability, answer his direct questions honestly. You can also honestly say: 'Prognoses are highly variable. Some people live a short time, some live a long time. There are some things that can be done to prolong your life.'"
Keep in mind it's not always what you say, it's how you say it. For a talk like this, or one of any of the stressful discussions on this list, you should always prepare ahead of time, set the right tone, follow your parent's cues and, above all, listen.
This article was written by Caring.com contributor Dave Singleton
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Copyright Caring.com, 2013.