The first time I walked into a secured dementia unit, I wanted to slither away. Each resident seemed to be babbling, staring, or trying to remove clothing. Some of them drifted toward me, strange smiles pasted across their faces.
As a young pastor, I tended to avoid the old and the cognitively impaired. When I later became a retirement home chaplain, I had to care for the people I had feared and neglected.
At my first visit, I was rescued by a sympathetic staff person. She explained that these people were glad to see anyone, especially a minister. She introduced me to each person, helping me to see the faces of individuals behind the masks of dementia. She showed me how gently and eagerly they responded to simple questions and directions.
That started my learning. Here’s how I now visit in such settings.
Check atmospheric signs
When I entered the dementia unit that first time, I felt overwhelmed by the unfamiliar (persons with dementia often feel the same way!). Now when I enter, I aim to sense what the resident feels.
What can I learn about the person I’m visiting, even before she notices me? I notice the atmosphere, the noise, activity, and the mood of the staff and visitors. I observe how rapidly she’s breathing and the emotion in her eyes. I want to enter her world as an empathetic friend.
Too often, I’ve walked up behind an individual with dementia, loudly called his name, and scared him out of his wits. When I did this to Paul, he asked, “What did you have to scare me like that for?”
I had entered his world too abruptly. He felt disturbed and dishonored, and rightly so.
When I approached Eleanor the same way, she jumped sideways, put on an angry expression, and withdrew her arm from my touch.
Now I try to slow down to match Eleanor’s pace. I calmly approach from the front, bend or kneel just below her eye level, and catch her visual attention. As her eyes meet mine, I say, “Hello, Mrs. Miller. I’m Rev. Steve Klotz, the pastor at Country Meadows. May I visit with you a little while?”
If I sense intense but muddled emotions, I try to help the resident verbalize them. As I sat and talked with Paul, his voice was loud and abrasive and his arms were flailing. I asked, “Are you angry or sad, Paul?”
He replied, “Both. My son doesn’t come to see me.”
By helping him to express his feelings and identify the causes, I relieve his anxiety and build a relational connection that enables me to truly minister.
Bridge the time gaps
Dementia-affected persons typically live in a world where time shifts between present and past. Recent memories are clouded by neuron damage, leaving only distant recollections.
The person with dementia who stands at the locked entrance displays this time-confused state. He knocks on the door and shouts, “I want to go home! How do I get out of here?”
In the past I said, “This is your home now,” or, “You’ll be going soon. How about us getting something to drink first?” Both allayed my anxieties but missed how the resident was feeling.
The dementia-afflicted person knows that he isn’t really at home. He deeply misses it, but is confused about where his is. Now I try to discover his view of reality by saying, “You must really miss your home. What makes it important for you to go home?”
He might answer, “I’ve got to get home to take care of the animals,” or “My wife will be looking for me after work.” His confused mind is expressing his present feelings of displacement and loneliness by trying to leave the secured unit and get back to how things used to be.
Visiting pastors often meet individuals with dementia who are glad to talk, but don’t know what to talk about. Unwittingly, the visitors ask memory questions like “Do you remember who I am?” or, “When was your family last here to see you?” If we give them a memory quiz, they almost always fail and they know it. They became anxious and frustrated.
Now I ask present-focused questions like “How are you?” and “What have you been doing today?” They can then tell me how they’re feeling and what they perceive to be their activities.
I stick with familiar, universal topics. And I use broad terms and phrases:
“How are things with your family?”
“Do you like living here?”
“What are some of your favorite parts of going to church?” I pay particular attention to this answer and incorporate their responses into my visits.
Invoke the familiar
In my early visits to parishioners with dementia, I made small talk, spoke a little prayer, and moved on. It seemed incomplete and unsatisfying.
I now offer several spiritual encouragements. Depending on what aspect of church life they were receptive to before, I ask if I may read from the Bible, tell a Bible story, pray the Lord’s Prayer, sing a hymn, or give a blessing.
Sometimes as I recite the Lord’s Prayer or Psalm 23, the memory-impaired person joins me in unison, all the way through. Residents who were formerly silent sing old familiar hymns with me—from memory. Men and women who can’t remember their children’s names tell me Goliath was struck down by David with a slingshot, and that Jesus said, “Peace, be still!” to the storm.
When I’ve asked the question “Do you ever feel like those disciples?” several people have said, “Yes, sometimes it feels like my boat is going under.”
Objects also work well. I invite the person to look at, touch, and tell me about a symbol of the faith. I might bring a cross, Bible, hymnal, prayer book, worship bulletin, or seasonal items, like palm leaves or nativity figures. These remind her of sacred times and places in her life. Her room becomes a momentary sanctuary.
I recently visited Emily, a retired art teacher. As I entered her living room, I stopped at the doorway to gauge her mood.
She looked drowsy, with eyes half open and head tilting back. Perhaps she was daydreaming about a more peaceful, productive time of her life, or maybe she was under-stimulated by the lack of company.
I stooped and approached slowly, eventually getting on my knees. I took her hands in mine, looked up into her eyes, and softly said, “Hello, Mrs. Cole.” Her eyes opened fully. She started to smile.
“I’m Pastor Klotz, and I’m here to visit for a little while. May I sit and talk with you?”
“Yes,” she responded. “I’d be glad—for—to have me visit.”
She attempted to answer my questions about her health, her activities that day, and her daughter Sandy.
Then I asked, “What are your favorite parts of going to church?” Her halting answer included music, choir, and children. So I asked, “May I sing a couple of hymns with you?”
She nodded, then said, “But I can’t sing too well.”
“Well, no one else is here to listen to us right now.” I started singing, “I come to the garden alone … ” and she quickly joined in, most of the words intact. I reminded her that Jesus is not only her savior, but also her friend who walks with her each day. Then we sang “Jesus Loves Me” and prayed the Lord’s Prayer together, again with her near perfect participation.
As I stood to leave, I offered a blessing and told her how much I enjoyed our visit. She said, “I enjoyed it, too, and God bless you.” I promised to return next week, and in my heart I looked forward to it.
On my way out, I made a note to call Sandy about the visit; she always appreciates encouraging news of her mother.
Stephen Klotz oversees 30 chaplains at 11 campuses of Country Meadows Retirement Commun-ities based in Hershey, Pennsylvania.
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