Whenever I can, I give Mom a choice. That may not seem like a big gift, but when so many others at the nursing home just tell her what to do, it is a heartfelt gift of dignity, control and respect.
 
The choices are always simple to me, but in her world, even the simplest choices are often challenging.
 
When walking, I ask, “Do you want to go left, or right?”  When she responds, “I don’t care” (her automatic, easy answer), I say, “Mom, it is your choice. Your decision. Which way do you want to go?”
 
That encourages her brain to actually make a decision. Takes her off auto pilot. Exercises her brain. Challenges her. (Serves as therapy, when Medicare-paid therapy has expired.) She regains a little control in her life.
 
“Do you want to walk some more, or rest for a minute? It is your choice.”
 
While eating, I point to items on her tray and ask, “Do you want more to drink, or eat? It is your choice.”
 
At a restaurant, “Do you want the soup or the salad with the turkey dinner? What do you want? It is your choice.”
 
The choices may seem limited, but they make her sit and stand up a little straighter. More choices, more pressure, would just overwhelm her: make her freeze. 
 
Mom helps decide what we do during my visits. “Do you want to walk or sing? It is your choice. Which one do you want to do?” Sometimes, when she is less alert, I have to also mimic the action of walking and show her a songbook. And repeat it again slowly. “Mom, there is no wrong choice. Let’s do what you really want to do.”  Typically, I patiently repeat the choices three times.

The other day, I purposely gave Mom our choices while in front of the charge nurse. Mom just shrugged, and the nurse said, “Looks like you’ll have to make the decision today.” At that, I asked Mom, “Mom, would you prefer to read out loud instead?”  Swiftly, Mom emphatically said with a big smile, “Yes!”  My eyes locked with the nurse’s, we smiled together and I was sure my point was made: Mom clearly is still here, and she does have her strong preferences.
 
I love when Mom looks me in the eyes and repeats the choices: We are connecting. Often, I see an extra sparkle in her eyes. Whatever her choice, I confirm that she made a good decision, “Wonderful! Let’s read today.”  I empowered her, and she succeeded.
 
“Do you want to read the 'Sneetches,' 'The Giving Tree?' or the weekly paper?" 
 
“Do you want me to read to you, or do you want to read out loud with me?”
 
"Do you want to do a puzzle of the United States, or read?”
 
“Do you want to stay up a little bit longer, or take a nap?”

Before the Big Stroke of 2005 at age 84, decisions already had become difficult for Mom. Whether it was because of mini strokes or oncoming dementia, or mini strokes causing dementia, we’ll never know. It really doesn’t matter.
 
Today, there are no intense, high-pressure, frustration-inducing moments of earlier years when I didn’t know better: when I, the (then) long-distance daughter, didn’t comprehend her evolving changes in abilities and comprehension.
 
Today, it is just a mini, optional gift of choices, which she periodically accepts with a smile, with a little prompting. Yes, when she is tired, I often end up making the final decision. Either way, I accept that my real gift to Mom is that I always try.
 
Mom has stroke-caused aphasia, which makes it extremely difficult for her to retrieve the right words. I understand that she often knows what she wants to say. (Many around her do not understand that she is “still there.”)  Most often, she can’t retrieve the correct words to translate her thoughts to us. Add a smattering of dementia on top of that, and communication ends up being limited. Sometimes she cannot communicate because of aphasia, sometimes because of dementia. 

Together, we keep on trying. Giving her everyday choices and control helps.