When a Loved One Sees or Believes Things That Aren’t There: Clear, Practical Steps for Families in New Jersey
When a family member tells you there are strangers in the room, pests on the wall, or that someone in the house has been replaced, it can feel like the world has shifted overnight. These experiences are very real to the person living with Lewy body dementia or Alzheimer’s, and they can leave caregivers frightened, exhausted, and unsure what to do next. Start here: calm reassurance, thoughtful environment changes, and measured medical input usually help most. You do not have to manage this alone.
What Hallucinations and Delusions Look Like and Why They Happen
A short explanation helps guide what to do. Hallucinations are perceptions without an external source. In Lewy body dementia visual hallucinations are especially common and often detailed. Someone may describe people, animals, or movement in the room. Delusions are firm beliefs that are not grounded in current reality, such as believing someone is stealing or that a spouse has been replaced.
Different brain changes produce these experiences. In Lewy body dementia, visual processing and attention are affected, so the eyes and brain can misinterpret shapes, shadows, and patterns. In Alzheimer’s disease, memory gaps and confusion can cause the mind to fill in missing information with stories that feel true. For the person experiencing them these events are real in that moment. Respecting the emotion behind the experience is more helpful than arguing about facts.
How Lewy Body Dementia and Alzheimer’s Tend to Differ
Recognizing patterns can reduce anxiety and help you plan care. With Lewy body dementia hallucinations often appear earlier and are vivid. Alertness can shift throughout the day and movement symptoms similar to Parkinson’s may be present. In Alzheimer’s hallucinations and delusions can occur but often later in the illness and may be linked to memory gaps or confusion about people and places.
Immediate Steps You Can Take Right Now
When a hallucination or delusion appears, follow a calm, consistent approach that keeps safety and dignity front and center.
1. Reassure first
Use a calm voice and simple phrases. Say things like I am here with you or You are safe. A gentle touch can comfort if the person usually likes touch. If touch is not welcome, sit nearby and keep your tone steady. The aim is to address the fear, not to debate the detail.
2. Avoid arguing about facts
Corrections can make the person feel dismissed or more frightened. Instead acknowledge feelings. Say I can see that upsets you or That sounds very scary. This validates their emotion while lowering tension.
3. Redirect and distract
After reassurance, gently shift attention to something familiar and pleasant. Offer a warm drink, a simple activity like folding towels, a favorite song, or a walk to a well-lit room. Music from an earlier era, photos that trigger positive memories, or a snack often work. These techniques are part of the SPARK engagement approach used in our homes and they help patients move away from the hallucination without conflict.
4. Assess safety
Decide whether the person or others might be in danger. Are they trying to leave to go to a non-existent place? Are they refusing needed medication because they believe it is harmful? If behavior becomes aggressive or dangerous, call your doctor for urgent advice and do not hesitate to call 911 in an emergency. Always tell responders that your loved one has dementia so they understand the context.
Change the Environment to Reduce Triggers
Many hallucinations come from misinterpreted visual or auditory cues. Small adjustments at home can reduce their frequency.
- Lighting: Avoid dim corners and harsh glare that create shadows. Use steady, soft lighting and night lights in hallways and bathrooms.
- Reflections and mirrors: Cover or remove mirrors that surprise or confuse, especially in bedrooms and hallways.
- Clutter and patterns: Keep rooms tidy and avoid bold patterns on rugs or upholstery that can be mistaken for movement. Store coats and bags out of sight so they do not look like people.
- Background noise: Lower competing sounds. A television in another room or a running fan can be misheard as voices. Gentle music or nature sounds may be more soothing.
In Fox Trail homes these design choices are intentional. Smaller residential settings limit confusing stimuli and staff watch for individual triggers so care plans can be adjusted quickly.
Keep a Simple Hallucination Diary
Patterns often emerge when you write things down. After each episode note the time of day, what the person saw or believed, what happened just before, what helped, and how long it lasted. Over several weeks you may see that certain rooms, times of day, or activities increase the chance of hallucinations. Bring this diary to medical appointments. It helps clinicians make better recommendations.
When Medications May Help and What Families Should Know
Non-drug methods are first line. Medication is considered when hallucinations or delusions cause distress or safety risks and non-drug strategies are not enough. Some medicines used in dementia can reduce hallucinations and help thinking, while other drugs carry real risks for people with Lewy body dementia.
- Cholinesterase inhibitors: Drugs like donepezil and rivastigmine support brain chemicals tied to attention and thinking. They are commonly used for cognitive symptoms and can lessen hallucinations and confusion for some people.
- Memantine: This medicine can help certain aspects of thinking and daily tasks for some patients.
- Antipsychotic medicines: These are used only when necessary because people with Lewy body dementia are especially sensitive and can develop stiffness, falls, or sudden decline after exposure. If an antipsychotic is considered a doctor should start at the lowest effective dose and review effects often.
Always discuss medication choices with a clinician experienced in Lewy body dementia and Alzheimer’s. Bring your diary and ask how you will monitor benefits and side effects. In our HOPE medical services program on-site physicians and psychiatric directors work with families to weigh risks and benefits and to adjust treatment quickly when needed.
Caregiver Support and Safety Planning
Caring for someone who experiences hallucinations can be emotionally heavy. You may feel accused, frightened, or constantly on alert. Ask for help before you reach burnout. Options include adult day programs, respite stays at a memory care community, local caregiver support groups, and counseling.
Create simple safety plans. For example, keep important documents and keys in one secure place, lock medications, and make sure caregivers and neighbors know how to contact you and your medical team. When possible, have an emergency information sheet that notes diagnoses, medications, and preferred hospital or specialist.
New Jersey Resources That Can Help
Families in New Jersey have options to reduce financial and practical burdens. Ask a social worker or elder law attorney about Medicaid long-term services and supports which can cover memory care for eligible adults. New Jersey’s Alzheimer’s Adult Day Services subsidy helps families access structured daytime supervision. Veterans and surviving spouses may qualify for Aid and Attendance benefits to help cover care costs. Local memory care communities offer assessment, short stays, and educational support so families can make informed choices before a crisis.
For practical strategies and caregiver stories consider resources like the Alzheimer’s Research Alliance blog which shares approaches families find useful https://www.alzra.org/blog/strategies-to-cope-with-hallucinations-delusions-in-alzheimers-dementia/.
How Specialized Memory Care Can Change Daily Life
Many families wait too long before asking about memory care and arrive at a point of crisis. Earlier conversations are often calmer and more productive. A specialized memory care community provides predictable routines, trained staff, structured engagement, and on-site medical guidance. In smaller residential homes staff can respond quickly to changes in hallucinations and adjust activities and environment in real time. Families often report that after a move they can once again enjoy time with their loved one because staff handle the daily management and safety tasks that previously consumed visits.
When to Talk to a Doctor or Seek a Specialist
Contact your loved one’s doctor if hallucinations or delusions are new, worsening, happening daily, causing distress, or leading to dangerous behavior. Also seek medical input if there are sudden changes in alertness, a fever, falls, or changes in medication. Bring your diary and describe patterns you have observed. A neurologist or psychiatrist who knows Lewy body dementia and Alzheimer’s can offer tailored recommendations.
Final Practical Checklist for Families
- Respond with calm reassurance and validate feelings.
- Do not argue about what the person saw or believes.
- Use gentle distraction and familiar activities to redirect attention.
- Adjust lighting, reduce clutter, and cover mirrors where needed.
- Keep a simple diary to track patterns and triggers.
- Talk with a clinician before starting or changing medications.
- Use local supports such as adult day services, Medicaid programs, and veterans benefits if eligible.
- Consider whether specialized memory care could offer a safer, more supportive setting for your loved one and relief for your family.
We Are Here to Help Families in North and Central New Jersey
At Fox Trail Memory Care Living we support families facing hallucinations and delusions with trained teams, small residential homes, the SPARK engagement program, and HOPE on-site medical services. If you are managing these symptoms right now, start with a behavior diary and a phone conversation. Call 1-855-5MEMORY to speak with our team. We will listen, share what we are seeing in our homes, and help you weigh next steps without pressure.
Take Care of Yourself Too
You cannot give steady care if you are depleted. Reach out for help, accept respite, and join a caregiver support group. Your well-being matters for your loved one’s safety and peace of mind.
These moments are hard, but they do not have to be managed alone. Practical steps, a calm presence, and the right supports can reduce fear and improve daily life for both the person living with dementia and their family. If you want to talk through options for your loved one in North or Central New Jersey call 1-855-5MEMORY today.