As an elder care columnist, I get questions by the boatload. The following question intrigued me because it is so hard to answer.

"My grandmother complains that her nurse leaves early and shows up late, but her nurse says it's not true. My mother and her siblings are concerned, on the one hand, that my grandmother is not getting the care that they are paying an arm and a leg for. If this is true, what can they do when the nurse blames the "lies" on the patient's illness? My grandmother is also convinced that someone is coming into her bathroom at night and urinating on the floor. Same deal: false? What if it's actually true and no one is doing anything about it?"

I wish I could give this person a definite answer, but like so many things about caregiving, there isn't one. People with dementia are vulnerable, and we need to take the greatest care to make sure that they aren't being abused. That said, the "reality" of those with dementia is often very different than the reality of the rest of us, including their caregivers.

An elderly friend went through a time where she had a bowel infection, and couldn't control her bowels. A visit to her was part of my daily rounds, I'd sometimes walk in and see that she'd made a huge mess of her carpet and tracked it around. I'd try not to react, but she would look at her carpet and see the mess, then complain about the person who "made that mess all over the floor." Her mind couldn't grasp (and likely wouldn't have wanted to grasp) the fact that she was the person who had made that mess. Therefore, someone else must have been in her apartment.

My dad, his brain demented due to surgery, would go through streaks of talking about an aide who was rough and mean spirited. It was so scary, because it was always a night aide he would talk about. Dad was in a very good nursing home. I visited daily, and the staff knew me. I knew the staff. Who could this aid be? And was his or her abusive behavior real? Do I report that someone on the night staff is being rough and scaring Dad? Should I accuse someone, when I knew Dad had a voice in his head since the surgery that told him all kinds of other things I knew were not true?

And there's this one. My mom wore pretty, decorated sweatshirts and polyester stretch pants in the winter. In the summer, she wore decorated short sleeved shirts and lighter colored pants. She had a winter and summer wardrobe - necessary in North Dakota. Her closet in the nursing home wasn't large, so I would take home the clothes from the season past, and bring in the ones for the new season. It was a ritual. Even kind of fun for the first few years.

However, as her dementia got worse, it wasn't so fun. One day, as I was leaving, one of the housekeepers pulled me aside. She was struggling to keep from laughing. She told me that my mom had told her that I was taking her clothes and wearing them to my new job!