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My client is a bit more strong physically than he was a few weeks ago, but his Vascular Dementia is progressing. He has been obsessed with something from day one (back in late summer) and some days it gets to be very detailed and scares him. The gist of the story is that, while he was in the hospital (sometimes he says this was a few weeks ago, sometimes a year, sometimes days), the "city" moved his house, and his neighbor's house, to their current location.

Sometimes the story gets very lengthy and complicated, and the house isn't his at all, but was moved there by the city and now they have to live there, but it was free. He doesn't know why it was free, and what scares him sometimes is that it could be taken away again as easily as it was given.

How I've handled it so far is to take him for a walk around the house and inspect the foundation. It looks great. I also take him for walks through the neighborhood to talk to neighbors on both of the days I'm there. He converses with them all. While he's lucid I engage him in conversation about the benefits of living in the same place for so long. He agrees and is "present". Then, all of a sudden, he will start in on that house moving thing again.

One day, when he was getting agitated, I took his arm and I said "Do you feel safe here?"
He said "Yes!"
I said," then, maybe that's what's important."
He instantly calmed down. Immediately I pointed out something else, and that conversation was dismissed.

Here's my real question. What if I got the plans from the City - showing his home being built where it is? I know not to argue with Dementia, I know how to join a person in the journey. But because this comes up every single day, and seems to be causing him distress, should I try to correct his thinking?

He accepts it when I tell him that the stroke he had stole some of the words he wants to say. He seems comforted by that. I tell him that, when he had the stroke, some parts of his brain were hurt, and those parts were where some words are reached. He understands this, and now he talks to me and lets the missing words just go missing. He lets me figure it out! Like yesterday - "We went to that place where we............ get everything." "Lowe's?" "YES!!!!!"

Yesterday I drove my truck and let him take me on a tour of the entire town where they live. He never missed a turn. Described everything.

So, I'm baffled. And obviously long-winded.

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My mother has mixed dementia - Alz and vascular - and has these same types of major, complex delusions. It has always amazed me that with all the loss of memory that comes with the disease, that a 'new' memory (the delusion) can take hold for weeks upon weeks. Why don't the go away quickly if short term memory is an issue.

Thank you all though for validating that I'm doing the right thing. I too have created faux documents, thank goodness for the computer, printer and all the things you can copy and paste! Right now I'm dealing with babies that are supposedly in her care and living somewhere in the house. Don't think a baby doll will work - she's still very 'there'. Hmmm
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damn liz,
your experience is impressive. of course schitzo would be another ball game entirely ( in addition to dementia ) . disputing a delusion versus acknowleging and modifying it. i think were all on the same page here your opinions just seem to pack more punch.. bottom line, disputing a delusion is just going to piss off the situation.. does not work.
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Sounds like you are handling it just fine. Good for you! My mom is just moving into this stage, so I was glad to read the advice from others. If I could just help my Dad remember not to argue with her :)
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Pstegman, that is so funny because she did move on to Elvis after that. And absolutely refused to believe he was dead:-)
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My last post - sorry for being so wordy. The reason getting city plans probably wouldn't work is that it disputes his delusion, and a delusion will always win. The reason a 'letter' from the city might work is that it acknowledges his delusion, and then builds upon it in a direction that is positive for him. I at first really resisted the idea of using deception in dealing with mentally ill people, but then realized I wasn't actually lying, which made me feel a little better. My client really would have preferred to have fresh breath if Brad Paisley came to marry her, and the city will almost certainly never move your client's house.
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LIz, then tell her Elvis will be stopping by. Maybe Garth Brooks.
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One thing I learned when working in a program that took care of people with severe schizophrenia (and there are so many similarities with dementia, IMO) is that there is absolutely no way to prove to someone that their delusion is wrong. At best, they will learn to just quit talking about it, something people with dementia will not usually be able to do because of memory problems. At worst, they will become more secretive and paranoid and come to believe the caregiver is complicit in whatever they feel is being done to them.

If you obtained the city plans, your client would almost certainly not change his belief, because it is fixed. The rational part of him is not in control of it. We had several schizophrenic women with ongoing delusions that they were pregnant, and no amount of pregnancy tests, doctor's examinations, or years-long gestations could convince them that they were not actually pregnant. Another woman was convinced she was engaged to Brad Paisley and would wait daily for him to show up and marry her. We gave up trying to convince her that this was not true and started to use it to motivate her, such as with personal hygeine. "What if Brad comes today? Wouldn't you want to have fresh breath?" This strategy worked great until the day she informed us that she and Brad had broken up so she no longer needed to brush her teeth:-).
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Hey, captain, that's a great idea! My mom is not very mobile, so there are lots of places I could hang things.

For stuff that I want her to have access to, I finally started putting things in page protectors in a binder with 'Anne's Notebook' on the front. She hasn't yet figured out the page protectors have an opening at the top, the binder spring is too stiff for her to work it, and the binder is big enough so that it's usually pretty easy to find.
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pretty innovative liza. re losing documents. i just could not keep my moms current med list in the house because shed demand to see it and then squirrel it away -- till i got smart and hung one over a piece of furniture out of her sight and reach. innovation is what it takes to be an effective carer imo..
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Just an idea... What if you mocked up some 'city' letterhead on Word (tip: using a different color for the letterhead and then black for the text of the document makes it look more official) and then wrote him a letter on it stating that his house is never to be moved again and that he has the right to live in it for the rest of his life? As a last resort, I did something similar for my mom, and it comforted her greatly. An added benefit was that I didn't have to keep having the same maddening conversation. If it came up again, I just handed her the 'letter' and let her read it. Just keep it brief and simple, don't include working phone numbers, and print plenty of copies because he'll probably lose the ones you give him.

And yes, I know I'm going to hell for lying to my mother:-)
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an imposter !! i was talking to a nurse on the phone as this hallucination was unfolding. i said " oh s**t, let me go get my bandana on" . the bandana resolved it. not only funny in hindsight but funny in a sad, melancholic way at the time.
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winging it indeed. its absolutely going downhill from here and you sound like a true professional in your field. ( a rarity imo ) read up on the capgras effect. its when the care reciever decides that the carer is stealing from them, trying to kill them, and an imposter. i read about it online and then lived it to the letter during moms final weeks. i did not bat an eye as this crap unfolded. knowlege rocks..
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Thank you all. He and I get along famously. It's very endearing, the way he confides in me about the house being moved. And, yes, I have said "They did a GREAT job!" as captain suggested. It's like being in a bad movie, when he's so lucid and then *bang* there goes that whole house moving conversation again. Like Ground Hog Day. But it's so good when he feels validated and safe. I was really amazed that he told me all the streets to turn on in town and took me on a great tour of the new construction. I showed him where I used to live (just a few blocks from where they live) and he forgot immediately that I'd done that. "Weren't you going to show me where you lived?" he asked maybe 10 minutes after I did. So, I went there again. Said all the same things. Deja Vu all over again. I do well with this, but what worries me is how it seems to be escalating and getting more complicated. Yesterday he kept pointing at house after house "And THAT one! And THAT ONE!" That's when you go meeeeep. What now? :-) We'll just wing It.
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now thats the stuff thats driving you nuts jesse, not just dirty dishes at all. obssessive behavior is the straw that would break me too. im the problem solving type and when ive solved the problem my brain just sizzles if we end up back there again. my solutions are in steel and concrete and proper water control and stone , etc and never meant to be revisited as a problem again. i do not do ocd well..
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I think you are handling it just fine. He has the same concern every day. You can have the same reassurance every day.
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I go through something similar with my mother. Two years ago we had some floor work done. She got it in her mind that they put the floor up on stilts and it is making it bounce when she walks. It is also letting wind come in between the cracks. I tell her the floor is okay, but she doesn't believe. When my brothers were here, they told her it seemed fine. She seemed assured about it, hearing it from them. But she quickly forgot after they left. One time my nephew came over, jumped up and down on the floor, and said it seemed good to him. She was convinced for a while. The visual was great. I was able to revisit his jumping up and down with her for a few months when she started.

Soon that wasn't enough. So for two years now our house has been on stilts in her mind. She made up a conversation that she had with the foundation/floor workers as proof they needed to come back. Poor guys! She kept calling them until finally I hid their calling card from her and told them not to come unless I called.

Every day we have "the conversation" about the floor and how we need to call the foundation company. I tell her the floor is fine and she gets mad at me. It has been two years, so the best I can do is deaden myself to it and keep her from making phone calls that could cost a lot of money or trouble for the unfortunate foundation workers. It is just all part of dementia for some people.
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it sounds to me like your doing a great job and with a great attitude. id suggest going along with him. the home may have indeed been moved ( lie ) but its sitting on a good foundation and " they " really done a great job. ( half truth ) .
now lets get drunk and play ping pong. ( redirection / one of my favorite homer simpson lines ) .
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Would he be able to understand the plans you would pick up from the city? From what you say it doesn't sound like it. My mom with Alzheimer's many times thinks that someone else has been living in her house. She has lived here 50+ years. All I can do is assure and reassure her that she is home and safe. She doesn't know what city she is in much of the time. She thinks she is in the city where she grew up. It is odd, you cannot explain or get in their heads to try to figure out what they are thinking. I know it gets very repetitive and it sounds like you are handling it well. Walks around the neighborhood are great, chatting with those he sees. Sometimes they just get stuck and we need to deal with it as best we can.
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