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November 11, 2015

Case Study: Care Homes for Older People


Older people care home training:  Care homes are often required by a care inspection to carry out appropriate training in managing challenging behaviour with their clients and in particular the issues of restraint with older people in care.   This often follows an incident in which a staff member or resident at the older people care home was involved in a high-risk incident.

Why Dynamis was asked to help:

  1. Managers are concerned that staff are not dealing with incidents in the most professional or effective way and hope to improve the staff team’s decision-making.
  2. Restraint of residents is taking place on a number of levels (physical, mechanical, psychological) but staf lack a ‘global’ definition of restraint to guide their practice.
  3.   Incidents where the residents are ‘lashing out’ at staff are occurring and the staff are ‘dealing’ with the behaviours, but they have no common approach or rule-set for making the interventions.
  4. A ‘no-restraint’  policy exists in a care home for older people environment where nevertheless restrictive practices are occurring frequently.

Key Issues declared by staff at this care home for older people:

  • a need for deeper understanding of the roots of challenging behaviour in dementia
  • a need for approaches to restraint-reduction and managing challenging behaviour
  • almost 100% of staff experienced physical aggression within their work with their dementia or EMI clients
  • grabbing, pinching and scratching by dementia or EMI service users very common during personal care
  • bathing and personal care a major flashpoint for physical aggression

Training Delivery:

Our training for every older people care home is enhanced by the work of the various guiding bodies such as the Royal College of Nursing, the Mental Welfare Commission for Scotland and the care inspectorates.   Their guidance, offered within the context of the Mental Capacity Act (and the Adults with Incapacity Scotland Act) provides a vital set of rules which staff can and must use to make good decisions about the restriction of their clients’ liberty.   Once staff have been equipped with these rule-sets, we then proceed to work on skills and tactics the staff can use to work in safety with their clients.  Our training narrative is always mindful that a person-centred caring approach by the staff should preclude the use of any intrusion on a client’s liberty.


Staff at this care home for older people report a greater level of awareness of the ‘rules’ which attend the use of restrictive practices and restraint with older people in care, assisting them to exercise their judgement more clearly in day-to-day interactions and problem-solving.

Increased confidence and awareness from staff in moving around in close proximity to an older person, for example when carrying out intimate personal care tasks such as when assisting dressing, washing and toileting.

Managers and unit-supervisors are enabled with a set of tools for debriefing staff post-incident in a structured and relevant way, using the ‘rule-set’ as a template for discussions about improving care-planning and risk-management.

Learn More about our training designed for your older people care home:




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Gerard O'Dea

Gerard O'Dea is the Director of Training for Dynamis. Training Advisor, Speaker, Author and Expert Witness on Personal Safety, Conflict Management and Physical Interventions, he is the European Advisor for Vistelar Conflict Management, a global programme focussing on the spectrum of human conflict.

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