“There is no place like home; there is no place
like home.” We can all relate to Dorothy’s
sentiments. She was surrounded with
enchantment—talking animals and vivid colors—yet she
still longed for black and white Kansas. In Kansas
lived the people she knew and loved; things were
familiar and predictable, and Dorothy knew where she
fit in. Her eyes were filled with joy and
relief when she saw Auntie Em, Uncle Harry, Hank and
Now consider this scenario: Dorothy’s shoes
suffered a technical difficulty and she had to stay
in Oz for 40 or 50 years before she is able to
return home. When she opens her eyes, she discovers
that the farm was repossessed by the bank in the
Dust Bowl, and the house has been moved to town. Oh,
and by the way, her body was repossessed as well and
was replaced with a smaller, weaker version.
Auntie Em and Uncle Henry are dead and the farmhands
are long gone. Dorothy recognizes the house, and
yet, nothing is the same. She longs for the
familiar—the smell of Auntie Em’s cooking, the sound
of pigs grunting in the yard, and the voices of the
farmhands talking and laughing. She wants to go sit
on the fence and watch Zeek feed the pigs, but there
is no fence, no pigs and no Zeek. And she couldn’t
climb a fence if she tried. Dorothy is lost
once again and she cries to go home to Kansas.
She is told over and over again, “This is your home,
Dorothy.” But she knows in her heart that she
is not home.
MGM would never have ended a movie on such a
hopeless note. But life is a different story.
Alzheimer’s and other forms of dementia play a cruel
trick on their victims. The memories of rich,
full lives are slowly and insidiously stolen from
them. Alzheimer’s attacks the short-term
memory first. An individual may, in the
process of driving to the bank to make a deposit,
forget halfway there why they are going. She may go
to the grocery store and see a friend of many years
and be unable to call her name. He may ask the
same question over and over again.
Entire passages of time may be erased in the last
stages of Alzheimer’s. “Joe” lives in a
nursing home and worked as an accountant for many
years, yet he tells people he is a mechanic.
His family wonders, “Where did that come from?” and
Joe receives the label “confused.” Yet,
looking into his history would have revealed that he
worked his way through college as a mechanic. He
really isn’t confused; he is just living within the
confines of his own memory. The disease has
eroded the past 45 years of his life and he does not
remember being an accountant or getting married or
having children. Thus, when his son Tom comes
to see him, he decides this familiar looking man
must be his younger brother Jimmy. When his
wife comes to see him later, Joe tells her that
Jimmy came to see him today. His wife knows
that Jimmy died in an accident several years ago and
she tells the nurse that Joe is having another bad
day. The nurse then tries to explain to Joe that it
was his son Tom that was here to see him earlier.
Joe argues angrily with the nurse; he does not
remember having a son, so the nurse must be either
stupid or a liar, and he proceeds to call her both.
The scenario above explains why it is fruitless to
try “reality therapy” on an Alzheimer’s patient in
this stage of the disease.
A more successful approach in dealing with Joe is
to go into his reality. If he gets up and is
ready to go to his job as a mechanic, go with it.
Talk to him about his job, what he does, who he
works with, and what he likes about it. If he
tries to leave his home or the facility, explain
that his boss called and said they didn’t need him
to come in today. This explanation will make
more sense to him than the truth of him not having
worked in 10 years.
Let’s revisit Dorothy in Kansas, crying to her
caregiver to go home. She is told repeatedly that
she is home, and Dorothy retorts that she indeed is
not. She and her caregiver are exasperated with one
another and the exhausted caregiver places Dorothy
in a nursing home. Dorothy continually cries that
she wants to go home and the guilt-ridden caregiver
takes her back to the old house. But still she says,
“I want to go home.” What now?
The caregiver tries to tell Dorothy that she is
old and frail and can no longer take care of
herself. But she cannot get through to her
because in Dorothy’s mind, she is still skipping
down the yellow brick road with Toto close behind.
If you want to relate to her, you had better start
skipping. Talk about things in the past that she
remembers—Auntie Em and Henry, or even mean Miss
Gulch. Let her tell you how much she misses
them. Bring food or fix things she enjoyed in
her childhood. Bring pictures from the old
family scrapbook or picture books of that era. There
are numerous books with vivid pictures of the Dust
Bowl and the Depression, of the first Ford assembly
lines and electric appliances. Let her be the expert
on things of the past. Encourage her to talk
about what she did and what she was proud of.
Part of wanting to go home is a desire to go back to
a time when we were young, vigorous, and productive;
a time when we felt loved and needed. Allow
her to grieve for the loss of those times. Tell
Dorothy she is still loved and help her feel needed.
Let her know she is valued for her wisdom and her
There are days when ordinary, healthy people want
things to be the way they used to be. There is no
solution except to spend some time grieving the loss
of these things. Children have grown and moved away,
careers are over, and friends are gone. People
with dementia need the opportunity to grieve just as
we all do; they just need more guidance. Affirm and
validate their feelings of sadness. Allow them
to be sad. Then do the best you can to make
them comfortable in the here and now. And if
all else fails, try skipping. It is very good
for the heart!
Shelly Osborn Moss is the
Executive Director at King’s Manor Methodist Home in
Hereford, Texas where she has been employed for many
years. She has worked with Alzheimer’s residents and
leads Alzheimer’s and caregiver support groups. She
is married and has two children.
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