Racism: A Ticking Time Bomb in Dementia Care?

If you’re caring for loved ones with dementia, you already know that it’s hard to predict what will come out of their mouth as their social filters are lost to the disease. A senior with cognitive impairment may comment on anything, including a person’s weight, appearance, accent, race, or ethnicity.

While some comments may be off the wall or even comical, others cross the line. Comments about race or ethnicity can cause real problems, especially if your loved one interacts with people of different races or ethnicities who work for in-home care agencies, adult day care centers, or long-term care facilities.

What should you do if your loved one comments on a person’s ethnicity or uses racial slurs? Should you laugh it off? Try to interrupt and redirect? Sweep it under the rug?

There are no easy answers. Many older adults grew up in much less diverse communities than we have today. To make matters worse, dementia can cause an older adult to become fearful, angry, or agitated when confronted by a person or situation they are not completely comfortable with.

When the derogatory quip happens, you may feel the urge to rebuke your loved one for being so insensitive. This is rarely effective. As the popular mantra goes, there is no reasoning with dementia. Older adults in the moderate and severe stages of dementia are typically unable to engage in conversations about respect or political correctness, and, even if they are, they’ll likely forget the discussion shortly afterwards. You’re better off quickly putting an end to their abrasive comments, often through acknowledgement and redirection, and then ensuring that the person your loved one was talking or referring to understands that your loved one has a condition that affects judgment and behavior.

For example, if your elderly father uses a racial slur to describe a caregiver, the best course of action is to acknowledge what he has said and then shift to a different topic. If your loved one’s remark isn’t addressed, he may repeat the offensive comment. This response doesn’t mean that you agree with your father or condone his behavior. It is simply a step in the redirection process.

How might this conversation go? You might say something like this to your father: “Yes, isn’t it exciting to see so many people from different walks of life working together to help each other?” If he responds with more grumbling or even outrage, such as the refusal to let the caregiver provide assistance, it’s important to remember that this probably isn’t the professional caregiver’s first time encountering such pushback. Most elder care professionals understand how dementia affects the mind.

When these hurtful comments happen, it’s always a good idea to talk to the professional caregiver about your loved one’s remarks. An apology may be a good place to start, but opinions differ on exactly what you might apologize for. Some say not to apologize for the older adult’s behavior (because you are not responsible for it) but to apologize instead for the offense caused. The goal is to assure the person insulted that when the older adult was well, he or she wouldn’t have said those things.

It may also help if you chat with the caregiver and your loved one together. You’ll be setting an example of healthy, respectful interaction, which can help build trust and comfort among everyone involved. Eventually, your loved one may become more relaxed around the new caregiver. Who knows? They may even end up as friends.

Fortunately, most elder care professionals handle these situations with grace. They know that off the wall comments are just one of the many symptoms that dementia can present.

Perhaps what matters most is how we learn to deal with these undoubtedly difficult and potentially divisive by-products of dementia.

Dana Hentschel, Takacs McGinnis Elder Care Law’s outreach coordinator and certified dementia educator puts it this way. “People with dementia are doing the best they can,” she explains. “Their brains are dying. Dementia is brain failure, not simply memory issues. The person with dementia cannot change, so the responsibility lies with us to adjust our behaviors and responses.”

Silently squirming or seething when a person with dementia makes a derogatory racist comment won’t change anything, but an honest and open conversation just might. It’s worth a try.