Remaining Relationally Present – Spiritual Care for Patients with Dementia

During my time as both a hospice and hospital chaplain, I provided care to many patients with dementia. When I am providing care to people who may struggle to share their own life stories, any information I can learn about the patient from the family is incredibly beneficial. More broadly, I ask about their faith or religious tradition, but I also ask about specifics: their favorite songs or prayers, people or pets they are likely to mention during a visit, recurring stories or talking points of which I should be aware. I have witnessed folks who could barely put together a sentence have the ability to sing a hymn or recite the Lord’s Prayer. Ultimately, my goal is to be relationally present with the person no matter what the subject matter of our conversation may be. Eye contact, a soft smile, and a friendly tone are often met with warm regard for whatever level of conversation the patient is able to hold.

One patient – we’ll call him Jim – would speak to me about his days working on a garbage truck. Though he was in his mid-70’s and retired, his mind would slip between recounting memories to me in the hospital room and living directly in those moments, talking to me as though I were a neighbor on his route who was offering him a piece of chocolate cake during the holiday season. During these conversations, I would not challenge his experience of reality, but instead I would lean into the relational connection.

When Jim thanked me for the chocolate cake, I did not tell him I hadn’t offered him food, but I also did not play up a false persona. Instead, I asked him how his route was treating him. Jim talked about his gratitude for his route, how kindly people treat him, how cold it was in the truck, and his family’s holiday plans. I then asked about his family and who would be gathering for Christmas. I would stay with his emotions and his story, inviting him to share more deeply, and validating any strong emotions that arose during the telling. 

Another patient (we’ll name her Sue) was a resident at a private care home. Her daughter lived less than 10 minutes away and visited most days. However, due to her dementia, some days she would wake up in this care home, an unfamiliar setting, and feel unsafe. She would wonder how she got there and about the intentions of the staff. She was also aware enough that her disorientation caused her more concern and agitation.

While I was caring for Sue, it was important to remind her of where she was, and that her daughter lived nearby and visited her often. Her confusion was a source of major distress. Thanks to her daughter’s guidance, we knew that her Catholic faith was a source of peace. If I recited the Lord's Prayer or sang certain hymns she knew from her childhood in the parish, she would stop what she was doing and join along. Her face would relax, and her posture would loosen. Her mind would move off the track it was on earlier. Her memory took her somewhere comfortable, familiar, and safe – church. 

I am a professional spiritual care giver, and it is an honor to provide that relational presence to folks whose condition often leaves them vulnerable and isolated. I have learned to honor family members' choices about how best to interact with their loved one. And occasionally, I have provided emotional support to those trying to cope with the grief that comes with having a family member suffering from dementia. Jim’s daughter struggled herself to see him as his dementia progressed. She was already grieving his loss. Sue’s daughter was committed to visiting her regularly, and while on some days these visits were purely a source of joy for her daughter, on others it was a source of mixed-up joy and heartbreak. I learned to hold space for whatever relational dynamics might be at play. Regardless, the focus of my care was to recognize and honor the sacred dignity of the individual suffering from dementia by remaining relationally present.