I once got in a tense argument about whether a stuffed cat was a real cat. For the record, it was a stuffed cat but really it was a real cat.
About ten years ago, I was visiting with a hospice patient on a weekly basis. Linda-not her real name-had vascular dementia (as well as multiple other health conditions) and lived at an assisted living. She was reserved when I first started stopping by, and I had trouble connecting with her.
One day, I notice a stuffed cat sitting on her bed. She sees me looking at it and asks if I like cats. I tell her that I do. She smiles.
“Well,” she says. “You’ll love my Tiger. He is quite a cat.”
I’m not sure if she thinks Tiger was a real cat or not, so I walk over to pet him.
“Be careful,” she warns. “Tiger still has his claws.”
Yep. Linda thinks Tiger is a real cat. I shift gears and start interacting with Tiger as if he is a real cat. In other words, I step into her reality. Linda perks up some, and suddenly we have a connection. I figure out that Tiger is the key to engaging her.
Every time I stop by, I ask about Tiger right after I come in. He’s usually on her bed. Sometimes I pick him up and put him on the windowsill so he can watch the birds. A few times we find a nice sun puddle on the floor for him. One day she mentions that Tiger looks chunkier and accuses me of sneaking him tuna. I confess, and she smiles. I even buy Tiger a toy. Yes, I spend $5 on a toy for a stuffed cat. And Linda is beside herself with excitement, and I’ve forgotten that Tiger isn’t a real, living, breathing feline.
I come by one summer day while her son is visiting. When I ask Linda about Tiger, he rolls his eyes.
He tells me, “I’ve told her time and time again that Tiger has been dead for five years. He got hit by a car on the highway.” Linda looks at him, and then at me. I’m really not sure what to say.
“Actually, Tiger’s okay. He’s right here,” I say tentatively. The son takes a long look at me as I pet Tiger. I’m pretty sure he’s wondering if I’m the biggest idiot he’s ever met.
“You are petting a stuffed cat,” he says. “That’s not a live cat. It’s stuffed.” Let’s just say Linda’s son and I are not on the same page here, and I’m not about to let him break his mother’s heart.
“No, Tiger is a real. Alive and well,” I say. This is awkward. The son is not going to relent, and neither am I. I have now decided I am not going to admit to the son that the cat is stuffed. And once I pick a battle, I’m all in. He glares at me.
“Do you really not know this cat is stuffed? We bought him at Walmart,” he responds. “This is a stuffed cat.” At this point I should take this guy out in the hallway and explain why I am set on insisting Tiger is a real cat, but I don’t think of that at the time.
“Well, Linda knows that Tiger is real, so Tiger is real,” I say. At this point, I have Tiger cradled in my arms. I’m squeezing him tighter and tighter as I get more and more frustrated. If Tiger were alive, I might have suffocated him.
The son stares me down. It’s intense. Linda looks at me, and then at her son. He sighs and walks into the other room. I consider it a victory.
When Dementia Knocks 
Great tale…reminds me of a local elder who, if I am recalling the story correctly, it was her parents who were instrumental in what was then a local nursing home here in Cleveland, Montefiore. She grew up in the field, and eventually created something called Validation Therapy…the crux of it was not to contradict or argue with people, because to what end? To cause pain? There was something to it. But it also points to what comfort real creatures can be. More effort needs to be put in that direction, to assure people can have access to pets, even if a caregiver in a setting has to be hired to help tend to them.
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Yep! You are correct that it is called validation therapy. We used to recommend what was called reality orientation, but then we realized it only causes pain and individuals did not remember what we tried to orientate them to anyway. The type of care that focuses on living creatures is called the Eden alternative.
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You are a Slurpee-drinking angel. So glad you were able to comfort Opal in her final days.
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I gave my mom a stuffed cat after her cat died and she named it “Mouse” after the real cat. She used to think it was real, but now she thinks the “real” Mouse is living outside and she tries to come through the window sometimes and the nice man feeds her.
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Great job on the Tiger,the poor lady and the son! You had to have made an impression on him after he thought it all over. I have learned a lot from your blogs about the patients and what they go through. A little imagination and play along can sure brighten their days. After all, in the end what’s the difference to the normal person if the patient can have a good day out of it. Too bad the tiger didn’t nip him! Keep em coming Elaine!
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