Helping a parent with dementia

Two weeks ago, I presented a shiur on halachic issues involved in caring for a patient who is experiencing a level of dementia. Along the way, I cited responsa addressed to people who felt they could manage their parents' physical needs, but who were concerned that they would violate the mitzvot of honouring and revering their parents by losing their temper with them.

One of the attendees asked me: What if one's mother has advanced dementia, and she asks for her deceased husband? Clearly, one should not upset her by telling her the truth - but even if the falsehood is appropriate, isn't it still a violation of the mitzvot of honouring and/or revering one's parents?

I wasn't sure how to respond to this. I suspect that there would be no violation of kavod (honour), but one could contend that this violated mora, reverence, a category of behaviours which includes not sitting in a parent's place or contradicting him/her. So I put the question to a group of rabbis, and received an interesting response from a veteran chaplain.

The chaplain stated that in his work, they tell facility staff to practice "validation therapy". When a resident asks after a particular relative, or says something like, "I need to be here, my children are coming home from school soon," she is clearly interested in turning the conversation in a particular direction. This direction may be good for her, especially since her long-term memory will be far more reliable than her short-term memory. So others who are present should not shut down the conversation; rather, they should embrace it, expressing interest in the subject and so validating her interest in it, and helping her to continue the thread to the extent she can. Asking appropriate questions - questions which won't frustrate her in her dementia, presumably - is a positive way to go.

I hadn't thought of this at all, but once I heard it, it made so much sense! And, it solved the halachic problem.

Parenting from the Torah, Week 5: The Sandwich Generation

This Shabbos, Gd-willing, I'll be leading the fifth class in our "Parenting from the Torah" series. The topic will be "The Sandwich Generation", and I hope to address some of the big questions that arise when people have the opportunity to care for their parents while raising children.

Here are the vignettes I plan to use:
1. Janet and Jim have three children in yeshiva, at a total cost of $45,000 per year. They are also paying for 24-hour care for Jim's parents, and they are finding that between these two costs, they cannot make ends meet. From a halachic perspective: If they need to cut one of these, which do they cut?

2. Jill moved her mother Susan into her home two years ago, when Susan's dementia began to worsen. She reasoned that the home environment and a daughter's care would be better than Susan would receive in a nursing home. Now, though, Jill is finding that her mother's presence is causing great strain on Jill's marriage, difficulty for Jill's work in her home office, and bitterness between Jill and her siblings. May Jill move her mother into a nursing home?

3. James (age 38), John (35) and Julie (30), all married, are sharing the tasks of looking after their parents. James and Julie are raising children; John and his wife are childless. Although their relationships with each other have historically been strong, they find themselves quarreling over the specifics of who does what for their parents. Is there halachic basis for assigning certain responsibilities to a particular child? If not, how can they reduce their disagreements?

Your thoughts on these vignettes would be most welcome.