Nobody likes to be manipulated. But the family and caregivers of people who have dementia spend a lot of time trying to encourage them to do things they don’t want to do. When we find a way to entice our loved ones or clients into eating a healthy meal or taking medications or a much-needed shower, are we manipulating them?

It depends entirely on our intentions. When we convince someone to do something for our own benefit, we are being manipulative. We are using them. However, when we convince people to take an action beneficial to themselves, we are motivating them. Think of the elementary school teacher who must find ways to encourage her charges to sit still and absorb math or history lessons when they would much rather be outside on the playground.

Determining what qualifies as being in someone else’s benefit brings up a deeper consideration, a concept that we refer to in the law as a person’s “interests” and “best interests.”

If you hire a lawyer to represent you in a divorce, she has accepted the responsibility of representing your interests, nothing more or less. She cannot take it upon herself to file motions or go to trial unless you agree, even if she knows there are other rights she could pursue that you could claim. Her responsibility is to protect and act upon your interests (your desires or wants).

At other times lawyers are appointed by the court to represent a child in a divorce. However, what the child wants may not be in his best interests (what he truly needs). So, when representing a child, the lawyer’s duty is different. It is to represent to the court the child’s best interests. In essence, depending upon whom she represents, a lawyer may have a duty to protect a person’s interests (wants) or best interests (needs), depending upon whether her client has capacity.

I believe that when we care for a loved one or client experiencing dementia – someone who has become, through memory loss and rational thought loss, unable to perceive reality and safely care for himself – we have assumed the responsibility of protecting both that person’s interests and best interests.

Every day our clients act in ways that harm their best interests. One is determined to go for a walk in the arboretum wearing two sweaters and wool pants, because she cannot recall that it is July or comprehend the thermometer outside her door that reads over 90. Another is positive that he showered this morning, just like he always did in younger years. Another is sure that she can live at home alone without assistance, another that her back will hurt less if she moves less.

Our clients also act against what we know were their lifelong interests. A once-fastidious woman refuses to wash her hair, a renowned professor heads for the door without pants, a former athlete and outdoor enthusiast refuses to go outside or get exercise. We know these clients would be terribly embarrassed and concerned, and would choose to behave differently, if they still had healthy thinking and memory skills.

Providing person-directed care means protecting both our charges’ interests and best interests. When they cannot join us in reality, we meet them where they are and work within their personal realities to motivate them to do what we know they would choose to do if they still had fully functioning memory and rational thinking skills.

Being a dementia caregiver means becoming a caring motivator.


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