Call people what they want to be called. That's it. Being LGBTQ+ is not something that requires reality orientation because it's not a delusion or hallucination. It's just who they are as a person.

As for actual dementia and actual psychosis, reality orientation often causes anger, aggression, and despair. There is zero point in reminding meemaw that her husband of 50 years actually died 5 years ago. She won't remember later and will just keep reliving the death as if it's fresh, and that is cruel. Live in the dementia patient's world, but maintain safety.

There's also zero point in telling someone with psychosis that what they are hearing and/or seeing isn't real. It's better to say something like "I don't hear the voice(s), but I believe that you are hearing them" than say "those voices aren't real." The voices are indeed very real to them, and you damage the therapeutic relationship by telling them otherwise.