When someone asks for mum: Navigating truth and connection

“I need to get home. Mum will be worried.”

People ask me about this all the time. Support workers, nurses, family members. At home, in the community, in residential care.

“What do I say when someone asks for their mum, and their mum died years ago?”

It’s a question that sits at the intersection of ethics, emotion, and human connection. And the reason it keeps coming up isn’t because we lack answers.

It’s because it asks us to confront something deeply uncomfortable: the idea that sometimes, to truly care for someone, we might need to step away from our own truth and enter theirs.

The tension we sit with
The debate around telling lies in care has continued for many years. Professional codes explicitly instruct practitioners to act with honesty and integrity at all times, but they also instruct us to do good and to do no harm.

With dementia mate wareware, these can pull in different directions.

We know that telling the full truth can sometimes cause deep distress. If a person believes their mother is still alive, and we say: “She died years ago”, we may cause fresh grief over and over again.

And yet, lying feels wrong. Practitioners tell me they don’t want to do it. It conflicts with their values.

“It goes against everything I was taught.”

“I don’t want to be a liar.”

That discomfort is not a bad thing. It shows we care about doing the right thing.

Ethics matter, but don’t get bound up in them
The ethical dimensions of this are genuinely complex.

We can tie ourselves in knots debating whether lying is always wrong in principle, or whether it’s okay if it reduces harm weighing autonomy against beneficence, parsing the difference between deception and therapeutic fibbing.

These debates have their place they’ve generated important scholarship and pushed the sector to take this issue seriously.

But here’s what I’ve come to believe after more than thirty years in dementia care: if we get too bound up in the ethics, we can lose sight of what this is really about.

This is about connection. It’s about being with another person in their world. It’s about relationship, presence, and what it means to truly see someone.

The ethical frameworks can help us reflect, but they shouldn’t paralyse us.

When someone is distressed and asking for their mum, they don’t need us to resolve a philosophical dilemma. They need us to be present, to be kind, and to respond in a way that meets them where they are.

So, I often say this is less about getting the facts right, and more about staying connected.

Whose truth are we working with?
Dr Jane Murray, a nurse and researcher whose work has shaped so much of our current understanding, puts it beautifully:

“When someone with dementia has their own truth that is different to mine, I am not sure that I have the power or will, to force my truth onto them. As a nurse, I am happy to enter their (often time shifted) world and respond to their truth.”

For me, this changes the main question. Instead of only asking: “Is it right or wrong to lie?”

We can also ask: “Whose reality am I working with right now?”

Sometimes the kindest thing is to step into the person’s reality for a while.

Dr Murray suggests that by engaging in another person’s truth, we can support the true meaning of personhood helping to maintain relationships that may, in our world, be lost, but for the person with dementia mate wareware, are still very much alive.

This moves us beyond functional communication the kind that centres on tasks and caregiving processes and toward something richer: genuine human connection.

A turning point: the Truth-Lies Axis
The first substantive piece of work to address this came from the Mental Health Foundation in 2016, with their inquiry What is Truth?

It remains a brilliant piece of work, not least because of how it was developed collaboratively, with practitioners, family carers, and people living with dementia from across community and residential settings.

What emerged was the Truth-Lies Axis. In simple terms, it’s a line of options:

• Tell the whole truth
• Look for another meaning (What are they really asking for?)
• Distract (move to another topic or activity, kindly)
• Go along with their reality
• Lie (say something you know is untrue)

The key messages were clear. Start as close to the whole truth as you can. Move away from it only if the truth is causing distress.

Keep kindness and respect at the centre. Use clear lies only as a last resort, and only to avoid real harm.

I’ve used this framework in my own work ever since. It showed us that defaulting to lying is not the best approach and can, in some cases, cause real harm. But it also acknowledged that rigid truth-telling isn’t always in a person’s best interest either.

New insights: the taxonomy of lies
Dr Murray’s ethnographic research has taken our understanding further still. Her work is unique in that she observed lies being told in real time not relying on practitioners recalling what they had said, but documenting interactions as they happened and their impact on the person with dementia.

She spent hours observing staff working with people who had moderate to severe dementia. She documented many examples of things staff said that were not the full truth.

What she found challenges some assumptions. Lying in dementia care, she writes, is “a common if controversial practice which presents complex dilemmas for professional caregivers”.

But perhaps more striking was her discovery that much of this lying is spontaneous almost unconscious.

Earlier research suggested that decisions about lie-telling were conscious, triggered by specific dilemmas. Dr Murray’s observations revealed something different: carers often respond with untruths automatically, as part of the natural flow of interaction, without deliberate intent.

She found six common types of untruths:

• Blatant lies – saying something untrue as if it is a fact
• Avoidance – not answering the question directly
• Familiarity – using words like “Boss” or “Pet” that fit the person’s past roles
• Props – using things like fake money, soft toys, or paperwork as if they are real
• Banter – joking or playful comments where everyone knows it’s not literally true
• Going along with – stepping into the person’s reality for a while

But what emerged as most significant was not the category of lie. It was how it was delivered.

Banter: connection without deception
One category that stands out is banter. Murray describes it as a mode of conversation essential for building and maintaining relationships a way for people to belong, to share understanding, to connect.

What makes banter unique is that both parties know what’s being said isn’t literally true, and both are happy to engage anyway. It’s lying without deception, because no one is being fooled.

In one observation, a patient announced she was leaving: “Goodbye everyone!” A nurse responded warmly: “See you later, alligator”. The patient laughed and continued walking.

You see the same thing at home: “You again! I’ll have to start charging you rent.”

“Careful, you’ll wear that carpet out!”

This kind of talk uses old sayings stored in long-term memory. It feels familiar and safe. It builds the relationship.

It’s not about information. It’s about warmth, rhythm, and being together.

Genuineness and motivation: what really matters
Across all her observations, Dr Murray found that the impact of a lie depended not on its content, but on two things: the genuineness with which it was said, and the motivation behind it.

This might seem paradoxical genuineness and lying appearing to sit in tension. But Dr Murray argues that a practitioner can be genuine in their affective domain, in their empathy and care, even when what they’re saying doesn’t represent their own truth.

It’s that genuine empathy that makes the lie therapeutic. If someone interacts with indifference, it won’t have a positive effect, no matter what words are used.

She saw that lies could be:

• Helpful, when they were said with warmth, respect and a clear wish to help the person with dementia
• Unhelpful, when they were said to make life easier for staff, without much care or feeling

So, she suggests we move away from the question “Should I lie?” and towards “If I move away from the full truth here, am I being genuine and whose needs am I meeting?”.

A systems lens: we can’t separate words from the bigger picture
Here’s where I want to push our thinking further. These communication approaches whether we call them therapeutic lies, compassionate untruths, or simply skilled connection are powerful.

They can reduce distress, maintain relationships, and support personhood. But they cannot sit in isolation. We cannot look at these interactions outside of a systems lens.

If genuineness and motivation are what determine whether an interaction is therapeutic, then we have to ask: what shapes a carer’s capacity to be genuine? What influences their motivation in any given moment?

The answer, often, is everything else going on around them.

Things that get in the way
Staff shortages and rota gaps. Fifteen-minute home visits with three tasks to get through. Constant rushing and paperwork. Family carers up half the night, with little sleep and little support.

In these conditions, it is much harder to:

• sit down, listen and explore what “Mum” really means
• stay gentle and patient when someone asks the same question twenty times
• think through where you are on that truth-to-lie line

Staff wellbeing directly interacts with this. A carer who is exhausted, stressed, or feeling unsupported will find it harder to bring genuine warmth to an interaction.

Workload pressures influence intent and motivation when someone is rushing between tasks, trying to get through an impossible list, their motivation shifts from “How can I connect with this person?” to “How can I get this done?”.

That’s not a personal failing. That’s a system problem.

And then there are the missed opportunities. The relationships that never get built because there simply isn’t time.

When we don’t have the chance to know someone to understand their history, their rhythms, what makes them laugh we lose the foundation on which genuine, person-centred communication is built.

This applies across all settings.

If we only teach truth-telling and “therapeutic fibbing” as a personal skill, and we don’t address the conditions people are working and caring in, we are being unfair.

Frameworks like the Truth-Lies Axis, taxonomies like Dr Murray’s, and reflective tools like the Lie ARM give us structured ways to think through these moments.

But they only work if they’re embedded in organisational culture and supported by realistic working conditions if teams have time to learn, space to reflect, and permission to talk openly about the uncomfortable realities of their work.

Supporting reflection in practice
To help with this, we’ve produced a reflective practice prompt sheet that you can use after interactions where you’ve moved away from literal truth-telling. Check it out.

Moving forward, together
The question of how to respond when someone is looking for Mum will probably never have a neat, single answer.

But we know more now than we did.

Truth should be our starting place, not a weapon. When we move away from the full truth, our intent and the way we speak make a huge difference. And this is not only about “right or wrong words” – it’s about connection, safety, and personhood. In aged care, in the community, and at home.

So perhaps our next conversation – in teams, in services, in families – is not just: “What should I say?”, but also: “What help do I need and what needs to change around me so I can say it with calm, kindness and real care?”.

References

• Murray, J. (2023). Is it ever ethical for nurses to lie to patients? In Nursing Ethics (Vol. 30, Issue 1, pp. 3–4). SAGE Publications Ltd. https://doi.org/10.1177/09697330221135711
• Murray, J., Thompson, J., Hill, M., & James, I. (2025). An ethnographic study to develop a taxonomy of lies for communicating with people with moderate to severe dementia. Nursing Ethics, 32(1), 272–287. https://doi.org/10.1177/09697330241246087
• Mental Health Foundation (2016). Dementia Truth Inquiry: Review of Evidence. A supplement to the report: “What is Truth?” An inquiry about truth and lying in dementia care. Mental Health Foundation.