3 Essential Tips to Reducing Challenging Situations in Dementia Care

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By Valerie FeurichJuly 25th, 2019

3 Essential Tips to Reducing Challenging Situations in Dementia Care


Anger, swearing, hallucinations, or aggressive outbursts are a few of the challenging situations caregivers (or care partners, as we like to call them here at Positive Approach® to Care) might experience when trying to offer care to a resident or loved one. As if this disease wasn’t heart-wrenching enough, having the person in your care struggle and fight your well-intended actions can be hurtful and frustrating.

To help you reduce the occurrence of these situations and have better care outcomes, we’ve put together a few tips and action-steps you can try to make dementia care a bit less difficult:

  1. Get out your detective’s hat and looking glass

You don’t need to become a private investigator, but it helps to know that a great number of challenging situations are caused by an unmet physical or emotional need. What does that mean?

As a person’s ability to express themselves diminishes due to the progressing dementia, they might no longer be able to tell you if something is wrong. They might have developed a urinary tract infection. They might have fallen and are in pain. They might be dehydrated, but are unable to ask for water or even know what the discomfort is from.

There are many reasons a person living with dementia might be in some form of distress and not be able to tell you. By looking into and considering each option, you stand a good chance of finding the cause of their response and eliminating it to return peace and comfort to the person in your care.

    1. Approach and Connect – the Right Way

    You may know that a person’s field of vision, how much one can see on their sides without turning their head, gets smaller as we age. But did you know that with dementia, a person’s visual field shrinks to the size of binoculars by mid-stage? In late stage dementia it even reduces to monocular vision.

    Quick tip: Make binoculars with your hands and hold them in front of your eyes to experience how little a person living with dementia is able to see.

    Did you notice that you can’t see what is to your side, down below, or above you without moving your head? That is one reason people living with dementia are easily startled when you approach them from the side or come up from behind. Instead, always approach from the front so they can see you first.  

      1. Use the Environment to Your Advantage

      Human behavior is greatly influenced by its surroundings and environment. The same holds true for a person living with dementia. Paying attention to settings, sounds, sights, lighting, or even smells can greatly impact your care outcomes.

      Here are a few examples on how you can use this to your advantage:

      During bath time, set the room temperature so it is very warm; that way the person in your care will be more comfortable undressing.

      Turn on their favorite music to help lighten the mood, and possibly help them reminiscence and connect through stories.

      You could also decorate the room to create a more inviting atmosphere.

      Case study: At the Memory Care unit of a senior care campus, the staff had trouble during bath time. Along with beginning to use MP3 players to play residents’ favorite tunes when it came to bath time, Sarasota, Florida based artists K.C. Higgins gave the cold and uninviting bathroom a makeover that changed it all (see images below). After that, staff reported that bath time has become much more peaceful and enjoyable for all.




      Always keep in mind: It’s not you - it’s the disease

      Over time, dementia robs the person of who they once were and you might see new reactions appear that can be puzzling or shocking to you. Always keep in mind that these reactions are caused by the dementia, not the person in your care. After all, dementia is not a memory problem, but active brain failure.

      If there is one habit that is worth working on and practicing for care partners, it’s the skill to not take things personally. As hard as it may be, remind yourself that the cursing or anger that might appear to be directed at you is really a symptom of the condition. Not only may it help you feel a little better when a challenging situation occurs, but it can help safeguard the relationship between you and the person in your care.

      18 Comments on “3 Essential Tips to Reducing Challenging Situations in Dementia Care”

        1. Avatar

          Hi Judy!
          Yes, that shower was hand-painted by artist K.C. Higgins. I’m not sure of the exact process, but I will see if I can get you his email address so you can reach out and maybe get some tips.
          Best wishes,

      1. Avatar

        This information is great, but I have a situation with someone in our care. She has for the past month been focused on her death and being tortured. She thinks there is an upstairs and that she may as well go up there and undress so that she can be punished and raped. We don’t have an upstairs and she isn’t being tortured. She upsets those around her and I can’t figure out how to get rid of whatever it is that triggered this behavior. Do you have any suggestions that I can try to make her more comfortable and less anxious?

        1. Avatar

          Hi Kathy, that really sounds like a challenging situation!
          If it is okay with you I’ll forward your message to one of our PAC Consultants, Carolyn Lukert, so she can reach out directly via email and get a little more information to see if she can help out.
          Best wishes, Valerie

      2. Avatar

        This info is very helpful. In my husband’s case, I have an aide who sponge bathes him in the evenings because he refuses to take a shower. The aide has been with us for over a year so he knows her well. Lately, I hear him protesting a lot when she’s sponge bathing him. I know there’s probably a reason for this behavior and a way to make him more comfortable during this process, but how do we find out what it is?

        1. Avatar

          Hi Elaine! That has got to be difficult. Your husband has been doing ok with an aide he knows well, until recently. I wonder what has changed? Sounds like it is time to dig deeper into the details. I am wondering if our free 30-minute phone consultation might be a good option at this point. One of our certified consultants can help explore strategies with you after gathering additional information. To set this up, simply send an email to consult@teepasnow.com, or submit your request at the bottom of this page: https://teepasnow.com/services/consulting/phone-consultations/. Would you like to give that a try?

      3. Avatar

        My mother in-law has developed a spitting behavior that started during her visits to the bathroom a few months ago and has now become something she does throughout the day while walking with her walker or sitting with other residents. We consulted a dementia care consultant director of nursing at a neighboring memory care facility for a 2nd opinion on the new behavior and she advised us to lovingly make mom aware that she shouldn’t spit on the floor to try to stop the constant spitting. Mom agrees that she would like discreet cuing from her aides to help her to stop the increased spitting. Mom is very active, happy, and verbal and she’s not aware that she’s spitting on the floor. The problem is that the director of resident enrichment at mom’s memory care facility advocates habilitation therapy [only] and the aides are directed to ignore this new behavior and just allow it to continue. Now the spitting is nonstop wherever mom goes at restaurants and other public places. We know this is the dementia and we would welcome your suggestions on how to try to lovingly and gently help mom with the spitting behavior. Her current medical/dental providers don’t see any medical conditions present that would cause the spitting (excessive saliva was ruled out).

        1. Avatar

          Hi Jody, that sounds like a tricky situation!
          I’m wondering if a phone consultation with one of our Certified Positive Approach to Care Consultants might help (the first 30-minute consultation is free, no obligation)?
          If that sounds of interest, would you prefer to submit your information directly (this is the link: https://teepasnow.com/services/consulting/phone-consultations/), or have me forward your message to one of our consultants so they can contact you instead?”
          Best wishes,

      4. Avatar

        Hi Valerie, Thank you so much for your help! We would welcome the free 30 minute phone consultation and we are very grateful for your kindness and help. We will submit our post to the link you provided. Thanks again!

      5. Avatar

        My mother has been diagnosed with Lewy Body Demential. She has gradually lost weight over the past 3 years but the weight loss has accelerated the past 6 months or so. She is SO thin she looks anorexic. She has lost all muscle tone due to being so sedentary. She is between the second to last and last stage. Is this typical of Lewy Body? I am constantly worried about how thin she is.

      6. Avatar

        Hi I’m interested in your approach and wonder if you do this in the UK? I am a.Dementia Advisor and Counsellor and would like to do something similar to your service in the USA. Regards Anne

      7. Avatar

        These are all great situations to learn from and I was anxious to see ideas in the responses. However, all were referred to a private phone consultation. How can the rest of us learn from these examples? Can you possibly follow up and respond with a brief synopsis of ideas that were shared in each one?

      8. Avatar

        Hi Valerie,

        I work at an Adult Day Health Care facility and in spite of my personal efforts, the staff here does not engage the people who attend. They give them the choice of a puzzle or a coloring book. Otherwise, they sit and look at each other.
        Granted all the people who attend are not dementia patients, but a good majority are.
        They will do chair exercises for approximately 10 minutes twice a week. They will occasionally do a “school type” project that takes them maybe 10 minutes. Then they are back to sitting and looking at each other.
        The facility is run by a board of directors and when the board members come through once a month, the staff will have the people who attend play a game.
        The staff isn’t allowed to have contact with the board members and the majority of the staff is happy because it is less work for them if they don’t have to “engage”. They sit in rocking chairs and talk to each other…
        I’m between a rock and a hard place! Not sure what to do! I did run into a board member, and mentioned my issues and was told it would be “investigated” but that was a month ago and to date, nothing has happened.
        The director here is much loved by the board and it is my word against the directors.
        This facility has gone through 18 CNA’s in the last 5 years, and there are only 3 on staff at any given time.
        I suppose I should walk away, but I love the people who attend so much and want better for them!
        Any advice?

      9. Avatar

        I like what you said about approaching people with dementia properly so you don’t startle them. My friend’s mother has dementia. She will probably have to find a place that offers specialized dementia care for her mom.

      10. Avatar

        Thank you for explaining how a person with dementia might be distressed but won’t know how to tell you. This is great for everyone to know regardless of if they have family members with dementia. This way, if they ever meet somebody with it, they know how to handle it a bit better.

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