The Need for Care Home Safe Holding Training
Care Home Safe Holding can help your staff to have a pre-planned and practiced response to aggressive or distressed behaviours in your service.
The following is an actual story reported to our training team during sessions we deliver for staff who look after older people in care. Stories like this are representative of the kinds of conflict and violent incidents which occur with largely un-recognised frequency in care homes for older people.
A Real Scenario from the Front Line
A 70+ year-old resident who had been exhibiting combative behaviour for many weeks was in the home’s severe dementia unit. Her behaviour was becoming more and more ‘confused’ as time went by. One evening, the woman insisted on wearing her bra over her dress. On discovering this, the home’s manager asked the staff on duty to remove the woman back to her bedroom and “dress her properly” in order to preserve the resident’s dignity.
The team approached the woman and she became combative, lashing out at staff. The report describes the woman’s subsequent behaviour as “like a wild animal” and “like nothing I had ever seen before.”
The two staff who retreated from the scene were in-date for their restraint training, but took the decision that the training they received did not prepare them for the level of violence they faced that evening.
Four staff were present. One senior member of staff who was trying to de-escalate the situation was assaulted and attempted to physically hold the resident. The incident was happening in the day-room and many other residents were in the vicinity.
Two other staff — care assistants on an apprenticeship scheme — refused to assist the senior carer, fled the scene, and locked themselves in the staff toilet. One other member of staff on-scene had not had their physical intervention training and so declined to intervene. The single member of staff who engaged in the restraint suffered minor injuries — bruising to her arm, strained muscles — as the resident used her free arm to punch her in the face.
During the resolution of the incident, the manager assisted the carer to hold the woman and escort her, under resistance, to her room. The manager suffered a bruised cheekbone and black eye during the struggle. The resident was subsequently removed to a psychiatric unit.
What Went Wrong: Three Critical Issues
1. Person-Directed Care
If the woman who is wearing her bra outside her clothes is perfectly happy and content, and the other residents don’t mind or don’t notice, and the staff who know her and look after her are satisfied that she is safe and secure — then why would a manager demand an intervention to re-dress her?
Fear of relatives? Fear of CQC inspection? Personal standards of ‘appropriate’ dress? Are any of these reasons sufficient to warrant an intervention?
Her behaviour was ‘created’ here. The woman, who was content at the beginning of the incident, had to be removed from the home because of “her behaviour.”
💡 Key takeaway: Before intervening, ask: is the resident content and safe? An unnecessary intervention can create the very crisis you’re trying to avoid.
2. Duty of Care
Staff who are trained in physical interventions should be under no illusion that, if circumstances warrant the use of restrictive interventions to prevent harm to their residents or to their colleagues, they are duty-bound to make the situation safer by their presence, their communication skills, or their physical actions.
⚠️ Warning: Where staff fail to act, there may be serious legal consequences if their omission results in injury to another.
3. Recruitment, Selection, and Training
Staff in care homes for older people must be recruited, selected, and then trained to deal professionally and competently with the full spectrum of behaviours they are likely to face in their role.
Caregiving for the elderly — especially in the increasingly complex world of dementia care and later life — is becoming increasingly dependent on skills more akin to those of the qualified and well-trained care workers in learning disability services, which is years ahead.
Carers should be under no illusion that the days when giving cups of tea and tucking people into bed as core tasks are long in the past. They can be called on to do far more demanding inter-personal work, including managing conflict and using physical force.
The Solution: Pre-Planned Safe Holding
Care Home Safe Holding training can help your staff to have a pre-planned and practiced response to aggressive or distressed behaviours in your service — bringing about pre-planned outcomes which are more positive and safer for all involved.
✅ Action: Equip your team with Safe Holding training. When staff have a practiced, pre-planned response, they act with confidence rather than retreating in fear. Learn more about Safe Holding →
Gerard O’Dea is a conflict management, personal safety and physical interventions training consultant. He is the training director for Dynamis, a specialist provider of personal safety and violence management programmes and the European Adviser for ‘Verbal Defense and Influence’, a global programme which addresses the spectrum of human conflict. www.dynamis.training