Dear Family Advisor

The family of a recent widower is glad that he's transferred affection to me, his nurse -- but I'm not!

Last updated: Feb 16, 2009

I'm a licensed practical nurse who used to care for a couple. Since the wife died two months ago, the husband has transferred his feelings to me. His family thinks this is helpful for him, but I don't like it.

This couple was together for 60 years and very close. The husband, who has dementia, transferred his feelings to me. He wants to kiss me, hold hands, lie down together. He says "I love you," stares at me, and wants me to sit next to him. I fend him off and try to redirect his attention. But the real problem is the family: They don't mind. They understand it's difficult, but they say I'm naturally nurturing and a safe haven for the man.

You've been a valuable asset to this gentleman, his wife, and their family, and I'm sorry that the family is nudging you into an unprofessional role, one you're not interested in.

Some families push off their responsibilities for their elders onto others. They may do this because they'd rather "throw money at the problem" than go through that uncomfortable first phase of learning how to be in an elder's life when the person has health and memory disorder problems.

You're right to talk about transferring affection, because that's exactly what this gentleman did. He's received a devastating blow, losing his wife, and due to his dementia, he's confused you with her. But sadly, you can't be that person for him.

Many family members don't realize that "going along" with an elder's misperception isn't always a good thing to do. While it may keep the patient entertained and avoid a "scene," it can lead to trouble. For example, my mom, who had Alzheimer's, insisted that I call her a taxi to take her home and that she would meet it at the end of our driveway. I could have played along, but what if she slipped out the door to meet that taxi and got hit by a car?

Professionals like you, while extremely valuable, shouldn't take the place of family interaction. You can help his family by letting them know his transference of affection is primarily due to his disease and has to be handled in a matter-of-fact manner with no shame. But the solution is not what they think it is.

If you decide to continue giving care to this gentleman, you need to sit down and explain to his family, in a gentle, nonaccusatory way that validating his confusion of you with his wife isn't healthy for him or for you. Tell them that it would be best if he could continue in your care, since consistency and structure is helpful in people with memory disorders -- but that you simply can't pretend to have a romantic relationship with him. State clearly that you will not stay if they want you to play that role.

You might also want to find some acceptable outlets for this gentleman's affections. Encourage his family to hug him, sit with him, and hold his hand and talk. People who are lonely often also respond to a pet's love or even the company of a doll. 

Many adult daycares accept seniors and elders with memory disorder diseases. If he's ambulatory, he might enjoy meeting other peers, and he might even find a girlfriend or a platonic friend who expresses warmth physically. It doesn't have to be sexual -- all of us long to be touched, and many elders respond to a warm hand or a stroke of their hair.

While he may get a bit "inappropriate" at times due to his dementia, try to teach his family how to handle this -- distract him, laugh it off, give him an alternative such as petting a family dog.

After these efforts, if you do have to leave, you'll know that you really tried. Most families simply don't know how to handle the nuances of dementia or Alzheimer's, and with your firm yet gentle guidance, I hope that you can continue to enjoy this family and patient you've grown to care about.