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When do we owe people the full truth about their lives?

What happens when people cannot understand the truth or cannot accept the truth, so insisting on it only causes them repeated pain?

The streetscape at the Lantern, the home at Chagrin Valley, is particularly encompassing and detailed, but comforting fictions—scenery, props, and other simulations—are employed in many homes for people with dementia.

People with dementia often ask to go home. Some ask even if they’re still in the house they’ve lived in for years

And so we lie. We distract. We employ a fascinating array of creative untruths.

All these fantasies are conceived of as a means of soothing the misery, panic, and rage that sometimes accompany dementia: to convey to people in later stages of the disease the impression that life is still as it was once, with children to take care of, and holidays at the seashore, and familiar homes to return to.

Once the caregiver masters the art of being a good liar and understands that the act of being dishonest is an ethical way of being, he or she can control the patient’s behaviors in a way that promotes security and peace of mind.” 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. To ease this “deception guilt,” lying in dementia care has been given euphemistic names, such as “therapeutic fibbing,” or “brief reassurances,” or “stepping into their reality.”

Garner’s method allowed many people with dementia to avoid panic and misery and to live out their last years in a state of happy delusion—how could that be wrong?

What does it mean to have quality of life? Can someone with dementia live a good life?

Some people in the dementia field, notably members of the Bradford Dementia Group founded, in 1992, by the late psychologist Tom Kitwood, believe that to think of the disease as a terrible harm is to think slightingly of people who are living with it. They argue that, with proper care, a person can live as good a life with dementia as without—in some ways and in some cases even better.

People feel immense guilt putting someone in residential care and often delay it far longer than is safe or rational, but some people find the opportunity to develop a new relationship with their loved one once they’re in care.

Many people said this: that while they were taking care of their wife or their father at home they were no longer a husband or a child—just a nurse.

Read more on The New Yorker.

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