This post is about managing challenging behaviours in. In dementia care, behaviour is often communication.
A person may shout, refuse care, hit out, grip, walk repeatedly, resist washing, become distressed at mealtimes, or try to leave. To staff under pressure, this can look like “challenging behaviour”. To the person, it may be fear, pain, confusion, frustration, sensory overload, shame, or an attempt to make sense of a world that has become difficult to navigate.
That distinction matters.
The aim is not to excuse behaviour that causes harm. Staff, residents and families all need to be safe. But if training treats behaviour only as a problem to manage, it can miss what the person is trying to communicate.
Good dementia training helps staff understand distress, adjust care, reduce escalation and use physical intervention only as a carefully justified last resort.
Start with the person, not the behaviour
The same behaviour can mean different things in different people.
One resident may shout during personal care because they are in pain. Another may resist because they no longer understand why someone is helping them undress. Another may become distressed because the room is noisy, the carer is unfamiliar, or the routine has changed.
Training should help staff ask:
- What is the person experiencing?
- What happened just before the behaviour?
- Is pain, hunger, thirst, infection, fatigue or medication involved?
- Is the person frightened or embarrassed?
- Does the environment feel overwhelming?
- Is the task being done too quickly?
- Is this a known pattern?
- What usually helps this person feel safe?
This is not abstract person-centred language. It is practical risk reduction.
A carer who understands the person is less likely to rely on force, argument or rushed care.
The routine is where most prevention happens
Dementia care is built around daily routines: waking, washing, dressing, eating, medication, activities, visitors, evening settling, and sleep.
These are also common flashpoints.
A person may resist a shower because they are cold, exposed, confused, or unable to understand the sequence. They may become agitated before meals because the dining room is loud. They may walk at night because they are looking for somewhere familiar. They may hit out because a carer has moved too quickly into personal space.
Prevention means designing routines that reduce distress.
That may involve:
- Slowing the pace
- Explaining one step at a time
- Using familiar carers where possible
- Offering choices
- Preserving privacy
- Reducing noise
- Using meaningful objects or cues
- Adjusting timing
- Checking for pain
- Supporting transitions gently
Small changes can prevent significant incidents.
Communication is a care intervention
The way staff communicate can either regulate or escalate.
People with dementia may need more time, fewer words, visual cues, reassurance, and a tone that communicates safety even when the words are not fully understood.
Helpful communication includes:
- Approaching from the front
- Using the person’s name
- Speaking slowly and simply
- Offering one idea at a time
- Avoiding correction where it is unnecessary
- Not arguing with the person’s reality
- Using reassurance rather than repeated instruction
- Watching body language closely
- Pausing when distress rises
A person may not remember what was said, but they may respond to how the interaction felt.
Staff need to practise this. Under time pressure, it is easy to rush, repeat instructions, or become task-focused. Training should help carers stay person-focused even when the shift is busy.
Physical contact and safe holding
Some dementia care involves physical support: helping someone stand, guiding movement, supporting personal care, preventing a fall, or keeping someone safe during distress.
Touch can reassure. It can also frighten.
Safe physical support should be:
- Explained before it happens
- Gentle
- Brief
- Necessary
- Responsive to distress
- Stopped if it is no longer helping
- Recorded where appropriate
If a person is resisting strongly, staff need to pause and reassess. Is the care needed immediately? Can it be delayed? Would another carer help? Is there pain? Is the environment wrong? Is the person saying “no” in the only way available to them?
Physical intervention should never become a routine shortcut for completing care.
When behaviour becomes unsafe
There are times when staff must act quickly to prevent harm.
A person may be striking another resident, attempting to leave into danger, grabbing staff, pulling at medical equipment, or placing themselves at immediate risk.
In those moments, staff need practical, low-force options and clear decision-making.
They should understand:
- What harm they are trying to prevent
- Whether less restrictive options are available
- How to protect dignity and breathing
- How to avoid pain or punishment
- How to call support
- How to stop as soon as the immediate risk reduces
- How to record and review the incident
The fact that someone has dementia does not remove the need for accountability. It increases the need for thoughtful, well-trained practice.
Families are part of the picture
Families often know the person’s history, preferences, fears, routines and earlier life.
They may know that the person always disliked showers, that a particular song calms them, that they worked night shifts for decades, that they become frightened by uniforms, or that certain words have meaning.
This knowledge can prevent incidents.
Services should involve families respectfully, especially when behaviour changes or physical interventions are being considered. Families also need honest communication after incidents. Vague phrases such as “challenging behaviour” may not help them understand what happened.
Supporting staff
Dementia care can be emotionally demanding.
Staff may be hit, scratched, insulted or rejected by people they are trying to help. They may feel guilty after an incident or frustrated when the same pattern repeats. If the service simply expects them to carry on, staff may become task-focused, defensive or burnt out.
Good training should be linked to supervision, debrief and team learning.
After difficult incidents, teams should ask:
- What was the person communicating?
- What might we have missed?
- What helped?
- What made distress worse?
- What should change in the care plan?
- Do staff need support?
This protects both residents and carers.
Common weaknesses in dementia behaviour training
The first weakness is focusing too much on managing the behaviour rather than understanding the distress behind it.
The second is over-reliance on generic breakaway or physical skills training. Staff may need personal safety skills, but the larger need is usually communication, routine design and person-specific support.
The third is separating behaviour from physical health. Pain, infection, constipation, dehydration, medication changes and fatigue can all affect behaviour.
The fourth is poor learning after incidents. If the same behaviour repeats and the plan does not change, the service is not yet learning.
A practical first step
Choose one repeated behaviour pattern.
For example: resistance to personal care, distress at mealtimes, attempts to leave, night-time agitation, aggression during medication, or conflict between residents.
Review:
- When does it happen?
- Who is present?
- What happened immediately before?
- What does the person appear to need?
- What has changed recently?
- What helps?
- What makes it worse?
- What does the family know?
- What should staff try differently?
Then build training around that real pattern.
Managing challenging behaviours in: What good looks like
Good dementia behaviour training helps staff see the person before the behaviour.
They become better at reading distress, adjusting routines, communicating gently, using touch carefully, protecting safety, and learning after incidents. Families feel listened to. Staff feel supported. The person receives care that is safer and more dignified.
If you would like to strengthen dementia behaviour training in your service, we can help you review patterns, listen to staff and families, and build practical training around the situations your carers face every day.
This guide on managing challenging behaviours in is part of our ongoing work with schools and academies.