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Would you like someone to tell you what to do all day, every day? What would it feel like to have your ability to choose taken away from you?

“Time to get up!” But I’m tired.
“Eat your breakfast.” But I don’t want eggs. My stomach hurts.
“Take your medicine.” All of them? Why? What are these?
“Go brush your teeth.” I thought I already did that.
“Change your clothes. Not those pants, these pants.” But I like these other ones.
“Put your shoes on.” Those hurt my feet.
“Here is your chicken salad.” That’s not what I wanted to order.

Every person makes countless decisions in a day without even thinking about it. We all like being able to make choices about how we spend our day, what we eat, what we do, what we wear, etc. This starts at an early age when we are just toddlers learning to say, “No!” or, “I will do it myself!” This doesn’t change as we age, and this doesn’t change with memory impairment.

Those with memory impairment still want to make their own choices and not have a taskmaster. It is important for caregivers to remember: your loved one still wants to make choices. Because of their memory impairment, there are many cases where it may be unsafe or overwhelming for your loved one to choose. But there are ways that you help preserve the dignity of choice for them.

Open-Ended Choices

These are choices with “limitless” options. Individuals with a healthy brain and those in the beginning stages of memory impairment can answer some of these questions.

Examples:

• What do you want for dinner?
• What do you want to wear?
• What do you want to do today?

Multiple Choice

When open-ended choices are too overwhelming, but your loved one still has some good decision-making abilities, multiple choice is a good option.

Examples:

• For supper, would you like ham sliders, pizza, or spaghetti?
• Today do you want to go to the movies, Target, or out to lunch?
• Do you want to go to a sit-down restaurant, go home to eat, or grab some fast food?
• Which of these four shirts do you want to wear?

Two Options

As your loved one progresses through their disease, multiple choices may be overwhelming, but they still can make decisions with less options. Also, it is important that as we limit choices, we make sure that all options are good choices.

Examples:

• Would you like hamburgers or pizza for supper?
• Do you want to go on a walk or sit on the porch?
• Which shirt do you want to wear – this one or that one?

Limited Choice with the Same Outcome

With limited choice, the individual still gets to make a choice, but there is no “wrong” answer. Either answer is okay, and the results are the same.

Examples:

• Would you like to take shower before or after breakfast?
• Do you want your medicine with coffee or water?
• Do you want to put on the sweater now or before we leave?

No Choice (Sounds Like Their Idea)

With this method, you aren’t really giving a choice, but you are giving your loved one the feeling that they made a choice.

Examples:

• You wanted me to remind you to take your medicine this morning. (Really, they didn’t ask you to remind them, but it sounds like their choice.)
• Here is your blue shirt that you said you wanted to wear today. (Really, you didn’t ask her what she wanted to wear, but you know she struggles to pick out her clothes.)
• I got the shower ready for you like you asked me to. (Your loved one did not and would not ask you to do this, but you know they need a shower.)
• You said you wanted to go to see your friends today, and they are waiting for you. Let’s go!

Even those with broken brains want to be in charge of their own days. It’s up to those of us with healthy brains to give choices in a way that helps our loved ones feel independent and not overwhelmed.

Giving choices will take more time for you, as the caregiver. But it’s worth the time! If you can help your loved one feel dignified, competent, and in charge of their day, you can save yourself more work down the road. The less choice your loved one feels they have, the more they will be prone to arguing and the more work you will have to do to bend their will to yours.

Ultimately, your loved one is an adult. It is so very important to honor their personhood, their history, and their preferences. Every choice you take the time to offer them is a gift they can’t thank you for, but a gift that makes their days so much better.

Written by Sheri Wammack, LBSW