By Abbi Laushine, Executive Director at Bridges® by EPOCH at Westford
When I consider fiblets, there’s a story we share at Bridges. There was a resident who was always stressed about getting the bus. Every day, he would become agitated mid-afternoon, believing he needed to take the bus to some undefined place.
Every day, the caregivers faced this same distress. The resident needed to get the bus, and nothing could distract him from his task.
So, what could the team do? They set up a makeshift bus stop sign, right there in the community. They told him he could wait for the bus there. This calmed him. He sat awaiting his bus, contented.
After a while, a CNA would go over and say something like, “Oh well, looks like it’s not coming today. We’ll have to wait until tomorrow”. Resigned, he would move on to something else.
This makeshift bus stop was a lie. Some might think that lying in this way must be wrong. I would argue that this community team merely embraced his reality. To me, this was a much kinder choice than making him face their reality.
This idea, choosing kindness over facts, is at the core of the therapeutic fib. At Bridges, we use these fibs to help our residents every day.
Abbi Laushine
Executive Director at Bridges Westford
Over decades of experience in dementia care, Abbi has come to understand the value of the therapeutic fib. She helps caregivers overcome the moral complexity of telling ‘fiblets’ for compassionate reasons.
What Is a Fiblet?
In the context of dementia care, ‘fiblets’ are therapeutic ‘white lies’ or small stretches of the truth. They are a non-pharmacological approach to dealing with some of the challenging symptoms of memory loss.
We use them to reassure and calm individuals. The idea is that a therapeutic fib is kinder and avoids the agitation and distress that might come from telling the truth. With this framing, a small lie or a creative mistruth is a more compassionate choice. It reduces stress for caregivers, too, who can often prevent a harmful confrontation with a tactical white lie.
Living With Dementia
When you care for a person with dementia, you begin to realize that they live in a different reality to you. Their sense of time, and themselves, is completely different to yours. This is how they wind up saying and believing things that aren’t true.
We’ve all come across the typical examples:
- Believing a deceased family member is still alive.
- Believing they need to get to work.
- Believing they need food when they only just ate.
- Believing they have a home elsewhere – that they don’t belong in the memory care community.
This distortion of reality is one of the challenging symptoms of Alzheimer’s Disease and other forms of dementia.
The key thing to remember is that, while we see this as a “distortion”, we must understand that their reality is valid. This 81-year-old individual with dementia is, for the moment, their former 32-year-old self who needs to put the kids to bed.
They are living it. It is true for them, and no amount of arguing will convince them otherwise. Forcing them to face your reality will likely cause frustration and even sorrow.
For example, let’s say you force the individual with dementia to come to terms with the death of a long-gone spouse or relative.
Think about what this means to them.
The loved one is alive in their mind. Their existence is a solid, dependable truth to the person experiencing memory loss. In making them consider your reality, you are asking them to confront a terrible loss, possibly forcing them to go through a process of grief.
We are brought up to think lying is wrong. But ask yourself this: isn’t it kinder, in this situation, to enter their reality? What is the more harmful path to take as a caregiver? To tell them their mother is dead, or to tell them their mother will visit soon… in the meantime, tell me about her!
Let’s discuss the evolution of thought on the topic:
Naomi Feil’s Validation Therapy
When I first started working in dementia care, I became familiar with the fundamentals of positive dementia communication.
These mainly stemmed from the work of Naomi Feil and her concept of validation therapy. In a nutshell, when someone with dementia states something that isn’t true or asks you a question that puts you in a challenging position, you should opt for one or a mix of three approaches.
These techniques are simple yet important.
- You can try to redirect the conversation to something more positive.
- You can acknowledge the statement or question but then try to distract the person with something different – more “safe” or “comfortable” ground for you as a caregiver.
- You should always validate the person with dementia’s feelings in any interaction. A simple acknowledgment of their emotion can go a long way to building a trusting relationship.
These techniques are still valid today; any caregiver worth their salt will use them every day in a memory care community.
Yet, any caregiver with any experience in dementia care will also know that these techniques won’t always suffice.
Problems with Validation Therapy
I care for a resident who is a big coffee drinker. No sooner than she finishes a coffee, she wants another. She can have four or five in the morning without realizing how many she’s had!
Caregivers are unsure what to do, worried about the potential jittery side effects of so much caffeine, but no amount of redirection or distraction can sway her from what she wants.
These attempts irritate the resident. She is fully aware of the intention to obstruct, to deter her from her desire – a simple cup of coffee. As an adult, she feels she has every right to drink a cup of coffee whenever she wants.
And, of course, she is right!
This example shows us that, while Feil’s validation therapy fundamentals are decent guiding principles, they simply won’t always cut it in the real world.
We know this intuitively, too.
When we are angry, there’s often nothing worse than an obvious attempt to calm us down. Those with dementia are the same. Just because they are experiencing memory loss doesn’t mean they have lost their other faculties; they can often sense a trick from a mile away and resent the attempt.
So, what is the alternative?
I’m a big believer in embracing their reality, a concept linked to Rachael Wonderlin. If you embrace their reality, you will naturally have to engage in some light fibbing as you sacrifice your own reality in the process. But, as we will see, this step is almost always the path of least resistance, and therefore the kindest route to take.
Rachael Wonderlin: Embracing Their Reality™
Rachael Wonderlin’s concept of “Embracing Their Reality™” is a dementia care approach that encourages caregivers to enter the world of the person with dementia, rather than trying to correct or reorient them to reality.
Instead of arguing or causing distress by insisting on facts (e.g., “Your mother passed away years ago”), caregivers validate the person’s emotions and engage with their perspective, promoting comfort and reducing anxiety.
This whole approach is about building a connection and minimizing frustration for both of you.
So, let’s return to my simple coffee example. What would I do for the resident demanding coffee? I’d let her have it. It’s not harming her. She might say “Ooh, it’s my first coffee of the day – I need it!” And, of course, I would agree: “I’m sure it will make you feel better, I need a pick-me-up, too.”
I will not refer to her previous coffees. I will not confuse or stress her with alarmist comments about her health or caffeine intake.
We in dementia care often like to refer to the famous Maya Angelou quote:
“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
I like to think of this quote as underpinning the philosophy behind embracing their reality.
The caregivers who were preventing access to coffee were creating a negative experience. They were agitating the resident in their care. It came from a good place, for sure, but they were building up bad vibes through the interaction.
And, trust me, those with dementia remember how you made them feel. They may not know who you are, remember your name, or the time you spent on an activity that morning, but those positive or negative associations with your aura tend to stick around.
With my approach – the simple act of meeting her where she was, giving her what she wanted, and recognizing her needs – I took a simple step toward building a positive relationship.
And, you know what? Caregiving is all about building that credit. Perhaps later, I may have a better chance of helping her avoid more harmful behaviors because she remembers how I made her feel in that moment.
Putting Fiblets into Practice
A word of warning: this isn’t easy. You won’t always get it right. And it can still be difficult for both family caregivers and healthcare professionals to know what the best course of action is when it comes to navigating these fiblets.
However, there are a few key principles that can help guide you to Embrace Their Reality.
1. Understand Their Baseline
Before you can effectively use therapeutic fiblets, you need to understand the person’s cognitive and emotional baseline.
Knowing their level of awareness and memory retention is crucial because it helps you gauge how much gentle reality-bending is appropriate.
If they retain some short-term memory and can be easily redirected, fiblets may not be necessary. But if they repeatedly return to a distressing belief, embracing their reality can be the most compassionate choice.
2. Assess What They Believe to Be True
To successfully engage a person’s reality, you need to determine what they already believe.
If a resident believes they need to pick up their children from school, it won’t help to argue that their children are now adults. Instead, understanding their perspective allows you to craft a reassuring response that fits within their world.
3. Identify Their Emotional State
Equally important is assessing their emotions around a given topic. Are they anxious? Excited? Fearful? The goal is not just to validate what they say but to ease the underlying emotion.
If someone is upset about missing a loved one, telling them their relative will visit soon (even if untrue) provides comfort and prevents unnecessary distress.
Examples of Fiblets in Action
Let’s look at a couple of practical examples of how embracing their reality can be used in real-life situations:
Example 1: “You Can Go Home When You’re Stronger”
A resident insists they need to go home. They don’t recognize that the memory care community is their current home. Instead of telling them, “This is your home now,” which may cause agitation, you might say:
“I understand. Your home is a wonderful place. Right now, let’s focus on getting you stronger, and then we’ll see about going home.”
This provides reassurance without creating distress and offers a sense of progress rather than a hard “no.”
Example 2: “I Just Talked to Your Son”
A resident anxiously asks when their son is coming to visit. You know their son isn’t coming today, but you also know that telling them so will only cause repeated distress. Instead, you could say:
“I just talked to your son. He’s busy today, but he said he’ll come tomorrow.”
This small fib provides relief and prevents repeated cycles of disappointment. The goal isn’t deception for deception’s sake—it’s about prioritizing their emotional well-being.
The Art of Gentle, Compassionate Care
When using fiblets, always consider the balance between truth and kindness. If a resident can be redirected or soothed without fibbing, that’s always a great first option. But when their reality conflicts with ours in a way that causes them distress, embracing their reality is the most compassionate approach.
At the heart of dementia care is the understanding that emotions and well-being matter more than rigid truth.
If we can ease anxiety, prevent unnecessary grief, and create a sense of peace with a small act of therapeutic fibbing, then we are truly providing the best possible care.
Because, in the end, it’s not about the words we say; it’s about how we make them feel.
Key Takeaways
Let’s round off with three key takeaways for you to apply as you navigate your caregiving journey:
Embracing their reality is an act of kindness – People with dementia experience a different reality. Forcing them to confront the truth can cause unnecessary distress. Entering their world, rather than correcting them, is often the most compassionate approach.
Therapeutic fiblets reduce anxiety and strengthen trust – Small, well-intentioned fibs can prevent agitation and grief, allowing caregivers to soothe rather than upset an individual with dementia. With this approach, we prioritize well-being over sticking to a rigid truth.
Positive emotional connections matter more than facts – People with dementia may forget what you say, but they remember how you make them feel. Caregivers who validate emotions and provide reassurance build trust and create a more peaceful environment.
Explore Bridges® Memory Care
Bridges memory care communities have been purposefully designed as a safe place that those with dementia can call home.
Taking a personalized approach to care, we offer residents an environment where they can thrive, with a life enrichment schedule that promotes physical and mental activity, social interaction, and creative endeavors seven days a week.
We’re here to exceed the expectations of residents and their families with the services we provide, and our efforts haven’t gone unnoticed. With Purple Flag™ accreditation across all our communities, we‘re proud to offer the highest standards of dementia care.
Many of our communities were also rated BEST MEMORY CARE by the prestigious U.S. News & World Report. This puts us among the best senior living communities nationwide, based on survey results from families and industry experts.
Contact the community nearest you to learn more or arrange a tour. You can also check out our upcoming supportive and educational events.