The following is an actual story and scenario which was reported to our training team in the sessions that we deliver for staff who look after older people in care. Stories like this are generally representative of the kinds of conflict and violent incidents which occur with largely un-recognised frequency in care homes across the country.
A 90+ year-old resident became very agitated during a night-shift. The trigger for this resident was that he wanted a male carer to help him with personal care. The female carer in his unit attempted to de-escalate and calm him using all the methods at her disposal — but he escalated to the point of violence. The resident began pulling electrical appliances from the wall and throwing them around the unit. He was extremely upset and very violent at this point.
The carer, assessing that the risk from the resident was too great for her to deal with, left the unit and proceeded to a place of safety behind a closed door. She kept the resident in view but observed him entering other residents’ rooms as the incident unfolded. She and the other staff called the police.
The police eventually arrived, entered the unit, and began a de-escalation process which ended when a doctor administered medication to help the man calm down. A police officer remarked that they could not believe one person could have caused so much damage to the unit — “like a tsunami.”
Five Critical Lessons
1. Staffing Must Match the Care Plan
If this resident is known to need or want a male carer to assist him in important tasks, then we have to ask why this was not provided — and whether there is adequate justification for the fact that a male carer was not available to him. If Person-Centred Care is our aim in these services, we need to resource that aim properly. Under-resourcing a known need is a recipe for escalating incidents like this one.
2. Good Decision-Making Under Pressure
This is a great example of good decision-making from the member of staff. She took “reasonable care” for herself by assessing the level of danger to herself and — on realising it exceeded her personal capacity and that of her team — decided to withdraw and contain rather than restrain.
💡 Key takeaway: “Contain rather than restrain” is a principle that needs to be embedded in training, not discovered in a crisis at 3 a.m. Good decisions like these are hard to take in the moment, but they are ultimately vital for staff to feel enabled and empowered to make them.
3. This Was a Near-Miss
What if the resident had decided, in his fit of rage, to damage not just property and furniture, but to assault the other residents who were asleep in their beds at the time of the incident? The staff had withdrawn from the unit and therefore left the resident there with vulnerable others.
It is not unknown for residents to be assaulted and seriously hurt — or killed — by other residents in care homes. Incidents like this must be reported under RIDDOR as near-misses, so that patterns can be identified before tragedy strikes.
⚠️ Warning: A withdrawn staff team leaves residents unprotected. Every near-miss is a free lesson — but only if your organisation has the systems to capture and learn from it.
4. Training Needs Analysis
What level of conflict resolution and physical intervention skills should care assistants be trained to? This question connects directly to the growing reliance on police to handle incidents that happen inside functioning care facilities.
5. Will the Police Continue to Respond?
There is a growing debate about the true role of police in the control of incidents which occur within functioning businesses and government local-authority facilities.
Dementia care staff call police thousands of times a year — a deeply concerning trend when staff training is poor and teams cannot cope.
Read the coverage: Dementia care staff call police thousands of times each year and Police routinely called to restrain dementia patients.
The Case for Safe Holding Training
Training your staff in Safe Holding in Care Homes, such as we provide, can help you to have a pre-planned, practiced response in mind when a crisis like this happens. Like the carer in the story above, your team needs to be able to understand the best possible decisions they can make to bring safety to a chaotic situation.
✅ Action: Safe Holding training equips care teams with a pre-planned, practiced response. When a resident becomes violent at night, your staff shouldn’t be discovering containment strategies for the first time.
Gerard O’Dea is a conflict management, personal safety and Safe Holding in Care Homes 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