"He can do it when he wants to" — why dementia looks like stubbornness I Live and Stay

Here is a sentence that gets said in almost every family, usually in a tight voice, usually in a kitchen:

He can do it when he wants to.

And on the evidence, it looks true. Your father spent twenty minutes last Sunday telling the story about the car he drove to Reno in 1962, with the names and the weather and the punchline intact. Then on Tuesday he stood in front of the microwave he has owned for nine years and couldn't make it go.

Or it's your mother, who can't let you help her into her coat without getting sharp with you, but who went to church last week in three shirts and got herself there on time.

It looks like choosing. It looks like the good stuff comes out for company and the difficult stuff gets saved for you. Families reach that conclusion honestly, and it's one of the loneliest places to be, because it turns every hard moment into something personal.

What's actually happening

Abilities don't switch off all at once, and they don't switch off in the order you'd expect.

A story told a thousand times over sixty years is worn deep. It runs almost on its own. A microwave needs a short sequence held in mind — this button, then that one, then the number, then start — and sequences are fragile in a way that old stories are not. So the hard thing survives and the easy thing doesn't, which is precisely backwards from how ability normally works, and precisely why families read it as effort rather than capacity.

It also moves. Capacity is not a fixed level someone sits at. It shifts by the hour, with rest, noise, how the morning went, whether there are four people in the room. What he could do at ten he genuinely may not be able to do at four. From the outside that looks like inconsistency, which looks like will.

Add one more thing: most people know something is going wrong, and refusing is a good way to avoid being seen to fail. If you cannot be sure you'll manage the coat, the safest move is to want to do it yourself, sharply, before anyone finds out. What you're seeing as defiance is often self-protection.

And there is the plain fact underneath all of it, which is worth holding on to on the bad days — the person in front of you is trying at least as hard as you are, usually harder, for less result.

So arguing does nothing. Reasoning does nothing. Explaining why the coat needs to go on, patiently, in a different order, with better logic, does nothing at all, and it is the most exhausting way to spend an afternoon that has ever been invented.

What works better than reasoning

Shorten the instruction. Not louder, not more detailed — shorter. One step, then wait, then the next step. Most of us, when something isn't landing, add words. Adding words is the opposite of what helps.

Start the motion. Put the toothbrush in his hand and touch it to his mouth; hand her the sleeve rather than telling her where the sleeve is. Beginning is the part that breaks first, and once the movement is underway it often continues on its own.

Let the room do some of the work. Lay the clothes out in the order they go on. Take the four things off the counter so the one thing is obvious. A task nobody can start is often a task with too many possible starting points.

Offer two options rather than an open question. Would you like the blue one or the grey one is answerable. What do you want to wear today is a field with no edges.

And pick your battles honestly. Three shirts to church is not a safety problem. It's a laundry problem and a pride problem, and you get to decide how much of your limited patience it's worth. Families who spend their energy on the things that actually matter — the stove, the stairs, the front door at night — have more of it left for the things that matter more, which is company and good humour and getting through Tuesday.

When you do lose it

You will. The fourth time the same question arrives, or the coat, or the microwave. Everyone does — including people who've done this professionally for twenty years, which is not something the brochures tend to mention.

Two things help afterward. The first is that sharpness in the moment doesn't erase what you've been doing for months; you are allowed to be a good daughter who lost her temper on a Tuesday. The second is that the person opposite you is likely to have let it go long before you have. You'll carry it around all evening. They mostly won't. That's not a consolation prize — it's one of the few places where the odds run in your favour.

What changes things is not becoming endlessly patient, which nobody manages. It's stopping the argument earlier, because you know it can't be won, and finding the shorter way round.

The story about Reno and the trouble with the microwave are the same man, on the same day, doing his best with what's still reliably there. Once that lands, the afternoons get easier — not simple, but easier — and a lot less of the day is spent being angry at someone who was never choosing this in the first place.

Live and Stay is a licensed non-medical Home Care Organization serving Northern California since 2008. Formerly Geriatric Care Solution.