Dad thinks he has to go to work. Dementia, and what do I say?

It is ten to six on a Tuesday evening and your father is looking for his keys because he has to get to work. He retired from the plant in 2004. If you searched "dad thinks he has to go to work dementia what do I say," you have probably already tried the obvious answer, which is the truth, and watched it make things worse. This page is about why that happens and what the people who study dementia communication suggest saying instead. It is written to daughters, and it is written about fathers and mothers both, because the conversation in the front hall is the same.

Where he is right now

The Family Caregiver Alliance has the clearest description of the thing you are looking at: many people with dementia may not remember what happened 45 minutes ago, but they can clearly recall their lives 45 years earlier. Forty-five years ago your father had a shift, a lunch pail, a foreman, and a family that depended on the paycheck. In the late afternoon, when the light changes and the day's tiredness lands, that is often the year he is standing in. From inside that year, the sensible thing to do is go to work.

So he is not confused about work. He is exactly right about work, in the year he is in. What he is missing is the forty intervening years, and no sentence from you can hand them back to him at six o'clock.

Why correcting hurts and does not help

The Alzheimer's Association's guidance for the middle stages is two short instructions. Avoid arguing. If the person says something you don't agree with, let it be. And: avoid criticizing or correcting; instead, listen and try to find the meaning in what the person says. The NIA's page on behavior changes says the same in its own words: be patient, try not to show frustration, and avoid arguing, and reassure the person that you are there to help.

Think about what "Dad, you retired twenty years ago" does inside the year he is in. Either he does not believe you, and now the person in front of him is lying to him about his own life, or he does believe you, for a moment, and has to absorb twenty lost years and a job that no longer exists while standing in his own hallway. Then the moment passes and he has to get to work again, and you are one sentence further from him. The Family Caregiver Alliance says it is important to connect with the person on a feeling level, before you redirect. The feeling is duty. Start there.

What to say instead

We are not going to tell you to lie to him. We are going to tell you to answer the feeling instead of the fact, which is what the Alzheimer's Association means when it says to consider the feelings behind words or sounds, because sometimes the emotions being expressed are more important than what is being said. These are scripts, not magic. Say them in your own words.

The clock says six in the evening and he says it is morning

Very often this conversation lives inside the late-day window, the stretch the NIA describes as restlessness, agitation, irritability, and confusion as daylight begins to fade. Your father's sense that it is time to leave for work is sundowning wearing a familiar coat. The same daytime changes that ease the window help here: morning appointments, daylight at midday, less caffeine late, lamps on before dusk. That routine is on the sundowning page.

When he heads for the door anyway

Sometimes he is out of the chair before you have said a word. The physical rules from the doorway page apply: the Alzheimer's Association says to approach the person from the front and identify yourself; the NIA says to make eye contact and call the person by name, and to be aware of your tone, volume, facial expressions, and body language. Do not stand in the door. Stand beside him. And make the errand longer by keeping the props out of reach: the NIA says to keep shoes, keys, suitcases, coats, hats, and other signs of departure out of sight. A man who cannot find his work boots is a man with time to hear "have some coffee with me first."

If he does get out, the first fifteen minutes page is the plan, and the old workplace is the first place to look.

What not to say

• "You don't work anymore." A correction, and a demotion.
• "The plant closed years ago." News he will have to hear fresh every evening.
• "We talked about this yesterday." He does not have yesterday. You do. Carry it for him.
• "Fine, go then." Said in exhaustion, and understandable, and he may take you up on it.

The Family Caregiver Alliance's last tip is to maintain your sense of humor, though never at the person's expense. "They'll dock your pay if you're late, so drink the coffee fast" is the kind of thing that can work, if it is said the way you would have said it to him thirty years ago.