There was some pretty horrible screaming coming from the shower room in the nursing home that day. On investigation I found that Beverly was the elder showering and the caregiver was ignoring the screams while she scrubbed and rinsed Beverly down with the shower hose. It made me wonder if every elder this nursing assistant showered, yelled this way.

After talking to the nursing assistant for a few seconds, I soon realized that she didn’t know Beverly’s name. No wonder Beverly was so distraught; a perfect stranger had taken off her clothes and now was squirting water all over the place, while Beverly knew for a fact that she only took baths. This had to be a bad mistake, all her life she had taken baths, never showers.

Despite Beverly’s protests the nursing assistant was continuing with what the caregiver understood her job was, her “assignment”, to shower the person in 205 bed 1. Such an easy and necessary step was missed, communication.
Beverly uses a wheelchair, the assistant needed to squat down in front of Beverly so they could communicate at eye level. She needed to smile at Beverly, tell Beverly her name as she continued to use Beverly’s name in her conversation. Explain to Beverly what was going to happen, using words like “I am going to help you take a shower,” not “give you a shower.”

When the caregiver doesn’t know the elder she needs to check the facilities resident information and ask her co-workers if there is anything special she should know about Beverly. Learning that Beverly always takes a bath and becomes frightened in the shower is an important piece of information.

Using Beverly’s name often when talking to her during her bath makes the caregiver more of a friend than a stranger. If there is anything we all have in common, is we love the sound of our own name.

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing


Elders with Alzheimer’s disease have trouble adjusting to changes in activities and the environment. When the confused elder is uncertain as to what will happen next, this will cause unnecessary anxiety. Many a caregiver will tell you that their elder resists leaving home for this very reason.  Helping the elder adjust can be accomplished using a transitional space in the environment or by creating a routine before or after an activity.

Before an activity, speak in a very matter of fact quiet tone not in a questioning or insisting tone. Simply state what is going to occur before it happens. This is the time to put into place some positive and pleasurable traditions. Maybe remind the elder that after you go shopping you will be stopping for an ice cream cone. My father-in-law never got over the pleasure of having a dish of peppermint ice cream, maybe enjoying it even more when he was in his eighties, and confused.

A simple yet effective transitional activity can be as easy as a wash cloth wrung out in warm water and a little lemon juice.  Offer the wash cloth to the elder, encourage him to take a deep breath and enjoy the lemon. Suggest the elder wash his face and hands with the wash cloth to “freshen up.”  In warm weather the wash cloth can be very refreshing using cold water, and lemon. When you are transitioning from one activity to another, taking the “warm wash cloth break” can offer the confused elder a small moment in time to change gears for something new or different.

Make use of transitional spaces when you go away. A hotel has a lobby and often a place to have a beverage when you enter. Bookstores and even libraries have coffee areas where you can sit and get your bearings before you transition into the bookshelves. Think of those places that have natural transition areas; a doctor’s office, the dentist, the veterinarian.  Those environments immediately cue the confused elder to where they are. Seek out transitional spaces or create that transitional space when possible.

Virginia Garberding RN

Certified in Restorative Nursing and Gerontology


Lois was just leaving the shower room of the nursing home, bundled up in her brown and blue bathrobe. She was talking to her caregiver about what a fine shower she had just enjoyed. Then she saw the family standing together in the hallway of the nursing home. “She is crying” Lois said pointing at one of the women. “And she is too,” Lois continued, “They all are crying.”

Because Lois has been affected by her Alzheimer’s disease, she no longer follows social conventions when speaking. If something occurs to her, she just says it. The mother of these young adults had just died, and Lois could clearly read their body language. As they stood there with arms around each other, supporting each other and crying, Lois could tell something was very wrong.

The ability to read a caregiver’s expression and body language remains long after the person can no longer speak to you. A look of anger or disgust is rarely missed by the confused person. That caregiver who is given to smiling, singing, whistling and always has a pleasant expression is the caregiver worth their weight in gold.  Because the confused elder, he or she is caring for, is in the moment and can be made happy by a happy caregiver.

This was a great reminder for all of us working in the Nursing community. Lois spoke for all of the residents who couldn’t that morning. All of the residents could read the body language of those family members. They could see the grief and recognize their pain. Because they can’t tell us what they see doesn’t mean they don’t see it and understand. The person with advanced Alzheimer’s disease just needs a Lois sometimes to remind us.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


Book Excerpt

At some point, most long-term caregivers ask the why question. It’s either “Why me, God? Or Why her?”

Isobel is typical. It took a long time before she realized her mother was suffering from a form of dementia similar to Alzheimer’s disease. Once the doctor’s named it, her question became, “Why my mother?” She cried and wept over the painful situation. Her mother had suffered so much that it just didn’t seem fair.

Eventually, it became obvious that her mother could no longer live alone. Isobel and Paul took care of her for the next four and a half years. Isobel’s mother became increasingly difficult to care for. Although she was demanding and manipulative, there was no question of not keeping her or of putting her in a nursing facility.

During this time, Isobel often asked, “Why me, God?”

Isobel isn’t alone. At some point in the midst of their pain and deep agony, most caregivers ask, “Why, God? “Why?’

As a former pastor, I realized long ago that Why? May not be the real question.

The worst response I ever heard came from a man at a funeral home. A thirty-nine-year-old mother had died. Her husband couldn’t stop weeping. I was there when he asked, “Why? Why did it have to be her? Why couldn’t it have been me?”

The husband’s friend resorted to reason and explained that life isn’t always fair, and that sometimes good people have to suffer as much or more than the wicked. He droned on and even talked about his slain buddies in the Vietnam War.

The bereaved man stopped crying, but I don’t think it was because of any of his friend’s answers. The lecture-and it really was one-made him feel stupid and selfish for wanting his wife.

Why? May need to be asked-and even encouraged-but it doesn’t have to be answered. Even if we had an answer, would it make a difference? Even if god whispered the reason behind the illness, would it change anything? Probably not.

The long-term caregiver still has the burden. The parent is still ill, and the child is still caring.

If Why? isn’t the real question we need answered, what are we really seeking? For each person, the pain behind the question may be quite different.

For one, the inner voice may be pleading, “God, assure me that you’re with me. Help me know you care.” To another, the question may be prompted by fears of inadequacy to cope.

Some find the question difficult to ask, as if they are demanding God to become accountable. Others are ashamed for being weak enough to ask.

I’ve learned one thing from this question. It’s wonderfully freeing to ask. Those who have wept and asked repeatedly have told me that they often found relief-perhaps not peace, but some rest from the turmoil-by simply asking the question aloud and allowing their hearts to speak the anguish they feel.

Book excerpt from: my parents, my children – Spiritual Help for Caregivers by Cecil Murphey

Published: Westminster John Knox Press, Louisville, Kentucky

Virginia Garberding, R.N

Certified in Gerontology and Restorative Nursing


When Shirley moved into the nursing community, her daughter casually mentioned that Shirley “Liked to wash things out.” No problem, we had had several residents who spent long amounts of time in the bathroom. A man came to mind who had been a very well-known surgeon and he liked to continually wash his hands as though he was once again going into surgery. Little did we know what those “things” would be that Shirley would be washing.

By her second day with us, Shirley had stripped her bed and washed her bedding. Somehow she had brought with her some clothes line and now her room was strung with the line, and her bed sheets, pillow cases and blankets were hung to dry. Once dried, Shirley would start all over again. Washing sheets in a small bathroom sink wasn’t an easy job, but despite Shirley’s advancing years, she proved to be more than up to this task.

Now some would have liked to see Shirley enjoying the many programs and activities available in this very nice facility. One staff member commented that her room looked as though one of our residents was taking in laundry. Maybe so, well yes, that was so. But what would be the point of trying to stop this very happy, energetic old woman from doing this job that she felt she needed to do?

Just as with the surgeon, this behavior was so much more than a behavior. For Shirley it was a task, a job, an activity that needed to be done. It was her personality all her life when she saw a job that needed to be done, to roll up her sleeves and get it done.

Not everyone in a nursing community is sitting in a circle, playing a word game. Some are pedaling away in rehab because they always enjoyed working out or loved to bicycle. Some are sticking their heads into the kitchen several times a day because they just so love the atmosphere of the kitchen. Then there are those who are spending their days, washing out a few things. It is all activity, therapy and good Alzheimer’s care.

Virginia Garberding RN

Certified in Restorative Nursing and Gerontology


We have all met or known people who appear to have little ability to take facts, and then think through what is practical and possible. Not a difference of opinion, but a real lack of the ability to think about a situation and come up with a logical conclusion. Not brain surgery, but everyday simple decisions we all make, the inability to reason.

I think of Myrtle, her husband Phil had Alzheimer’s disease and still very much wanted to “help.”  Phil had never been involved in the kitchen for the 45 years of their marriage. Now, since he was home all the time, he had evidently decided to get involved in what had always been Myrtle’s territory. His “help” was making Myrtle feel on guard all the time – guarding her kitchen.

Since Phil became involved, kitchen items Myrtle had had all their married life were disappearing at a frightening rate. Myrtle’s favorite spatula she had for 40 years was gone. She knew Phil, in his confusion was throwing things away; she had found enough things in the garbage to know that.

Phil really liked to run water and took every opportunity to get to the sink and run water. If Myrtle didn’t immediately clear the table after meals and rinse dishes, she could expect hamburger, pieces of fish, paper towel just about anything to be floating in the sink. Phil was fast! Once Phil got the water running, he would get easily distracted and leave the kitchen, only to have Myrtle later find water overflowing.

Phil was no longer able to reason that he would forget about the water, as he had in the past. He never thought, maybe it isn’t a good idea to leave running water. He no longer learned from past experiences.

Myrtle’s solution was to try as best she could to stay one step ahead of Phil. In the kitchen her policy was to simplify-simplify. Although she would like to make the traditional meals Phil so much enjoyed. It now was too hard for Myrtle to keep that up and still monitor Phil. Simpler meals, less ingredients and preparation time cut down on the time she needed to focus on being one step ahead.

Myrtle and Phil started eating out more often at their local café. This gave Phil the socialization he needed and the rest from meal preparation Myrtle needed. Many people have found that when their spouse is in the early stages of Alzheimer’s disease, going out to eat are a normal activity that can still be successfully enjoyed.

Myrtle thought about how she could make their life run more smoothly and put these changes into place because, thank the Lord, Myrtle could still reason.

Virginia Garberding, R.N.

Certified in Gerontology and Restorative Nursing


Her mind went traveling today, it packed it’s bags and slipped away

It wanders old paths and memory lanes, and her dementia holds the reins


It travels down roads that were not taken, and desires things long forsaken

It dwells on what she should have done, and fights old battles lost and won


It re-lives talks that once she had, and remembers happy times and sad

It plays her life again and again, her dementia adds what might have been


It plays games and tricks her senses, it concocts lies and it convinces

It exaggerates her greatest fears, and gives her reasons for her tears


It jumbles memories all together, and forgets the truths that she would never

It confuses facts, people and places, yet remembers forgotten names and faces


It makes her doubt the ones she loves, it makes her question all she does

It shows her things that are not there, and makes her think that we don’t care


Her mind tries constantly to deceive her, she worries why we don’t believe her

She says things that anger and annoy us, her mind is filled up with paranoia


So, is her dementia friend or foe? That answer we may never know

It’s stolen her from us, that’s true, but protects her from her future too


But why all the anger and mistrust? Why does it make her turn on us?

Her life was grand in so many ways, What purpose does this deception play?


Does it create these stories to help her cope? Does it ‘make believe’ to give her hope?

Does it shield her from her own lost mind? That in itself, is not so unkind


 Does it help us do what we must do? Does it lessen the guilt we feel too?

Is deception dementia’s deceiving way, to get us all through this difficult day


Whatever the reason, we may never know, Let’s travel together, here we go!

Because, her mind went traveling today, (it won’t be back, at least not to stay)


This poem says it all, many thanks to Laura Ellen Eaves Ballard who wrote this in 2008 while on her way to be at her mother’s side. A printable copy can be found on poem hunter.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing



Alzheimer’s disease

The person with Alzheimer’s disease is very sensitive to being put on the spot. When someone is having a very hard time functioning, and appearing “normal,” they will try to protect themselves as best they can. If the person is asked repeated questions, the stress of trying to come up with answers will be exhausting. When the person just can’t remember the information they are being asked for, they will start making it up.

Having Alzheimer’s disease means that person will make many mistakes all day long. No one likes to be wrong all the time. The person with Alzheimer’s disease, is no longer able to reason their way out of situations, and will try very hard to make problems go away.

A symptom of Alzheimer’s is becoming stuck in a behavior, and being unable to change. This makes it very hard for the person to get along with others, and even more so if they are accused of making up stories.

Lying and Dementia related to Alcohol abuse

Persons with Korsakoff’s syndrome often will have lying as a symptom of their dementia. The person will make up a story, and after they have once said the lie they will back it up if challenged. The reason they make up a story in the first place is because they can’t remember. So this person isn’t necessarily lying, it isn’t intentional, and once said may even believe what they have heard themselves say.

His Dementia Makes Him Do It

Most people would take great pride in being thought a truthful person. Especially so, for the elder who grew up during the depression. Once someone suggests the elder is not telling the truth, the elder becomes the injured party. 

Be careful with words, when working with someone with dementia, they can’t always be taken back.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing



We have all known liars. This is still my all-time favorite definition of a liar.


“Above all, don’t lie to yourself. The man who lies to himself and listens to his own lie comes to such a pass that he cannot distinguish the truth within him or around him, and so loses all respect for himself and for others.

And having no respect he ceases to love, and in order to occupy and distract himself without love he gives way to passions and coarse pleasures, and sinks to bestiality in his vices, all from continual lying to other men and to himself.

The man who lies to himself can more easily offend than any one. You know it is sometimes very pleasant to take offense, isn’t it?

A man may know that nobody has insulted him, but that he has invented the insult himself for himself, has lied and exaggerated to make it picturesque, has caught at a word and made a mountain out of a molehill-he knows that himself, yet he will be the first to take offense, and will revel in his resentment till he feels great pleasure in it, and so pass to genuine vindictiveness”.

Still true today!

This was first published in 1879 and is as true today as it was then. Many liars believe their own lies.  We have all heard that person who tells a lie, then turns around and claims to have “heard” this. Knowing all along that they heard it from themselves, they are the one who said it, and heard themselves say it.

If someone points out to them that what they have just said is untrue, they will immediately take offense and play the injured party.

How does that apply to the person with dementia who lies?

Virginia Garberding, R.N.

Certified in Gerontology and Restorative Nursing

Author: Please Get To Know Me – Aging with Dignity and Relevance


The elder who wanders is always at increased risk. Alzheimer’s disease robs the elder of the ability to reason, causing lack of safety awareness. Loss of the ability to dress correctly for the season or weather, with reduced awareness of dangerous conditions, makes the elder vulnerable to falls on icy walks and frost bite from inappropriate clothing during times of extreme cold.

Just as using the right cues in the environment can help the confused elder better understand what is going on. The wrong cues can make life even more dangerous for the confused elder.

I recently saw a “picture perfect” entry way, it might have come right off the pages of a magazine.  It had a pretty blue door with a large window and next to the door was a bench with cubbies for shoes and boots. Added to that, was a wall storage unit holding scarves, gloves, purses, and hooks for coats.

Why wouldn’t the confused elder living there be invited to just walk out the door? All of the triggers to go outside were right there. He could see the outside, right through the window in the door. He could see all the triggers; shoes, coats, even keys hanging next to the door.

As pretty as the entry way was, all of the triggers indicating this was an exit had to be removed. Pretty as the blue door was, it was repainted the same beige as the surrounding walls. The window in the door was modified by hanging a picture over the window. More pictures were hung on the walls of the hallway, creating a small art gallery that the elder now enjoyed walking around, leading him right back into the living space.


When a confused elder wanders you need to look at the environment and see what the person might be trying to get away from. Is the environment too noisy, too stimulating, or are there just too many rules?  When talking to the elder avoid negative words like “don’t.” Change “Don’t go outside,” to “Stay here with me.” Saying “don’t” to an elder can prompt a “don’t you tell me what to do,” type of reply.   

Ask yourself if the elder is getting enough exercise.  The answer for this man came in the form of a couple of rousing games of electronic bowling with family members every day.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing