For people living with dementia who display aggressive behavior, memory care provides structured, 24/7 support and peace of mind for families. Because staff in memory care homes know that aggressive behavior is often triggered by pain, fear, frustration, or an underlying medical condition, they’re trained to address these issues first. Memory care staff are also trained to respond to aggression using calming and soothing tactics. A memory care community’s physical environment and staff culture are also key to preventing and managing aggressive outbursts. Rarely, medication and transfer to inpatient psychiatric facilities may be used to manage aggressive behavior.
Is memory care the right fit?
Let our free assessment guide you to the best senior living options, tailored to your needs.
If your loved one is living with dementia and is behaving aggressively, memory care may be the right fit if:[01]
Knowing that trained memory care professionals are caring for your loved one and ensuring their safety can provide peace of mind.
Niki Gewirtz with A Place for Mom, who has more than 20 years of experience in residential care communities, recalls a resident who had dementia and whose wife was caring for him in their home.
“He was up all night, which kept her up all night. When she’d try to get him to shower or change his clothes, he became physically combative,” Gewirtz said. “She moved him into memory care and within one week, he was engaging in activities during the day and sleeping better at night.”
Gewirtz notes, “Because the staff were trained to approach calmly and pay attention to when he wanted to take a shower, his wife went from being worn-out and sleep deprived to getting the rest she needed. She visited him daily and was able to focus on being his wife instead of fighting to help him care for himself.”
Mark Young, who worked with A Place for Mom to find care for his mom, said that her community worked with them to offer a solution to her changing behavior. His mom was living in the assisted living unit when she was diagnosed with sudden onset dementia, and her symptoms, including verbal aggression, began to progress quickly.
“She was really disturbing the other residents in assisted living with her swearing and loud outbursts,” Young said. “And when someone would come in to change her or give her a shower, it became a dramatic event for the facility and [the caregivers].”
Rather than evict his mother, the staff kept everyone’s best interests in mind and helped place her in the proper setting to meet her new care needs.
“[The community] recommended we move her [from the assisted living unit] into memory care because of her states of agitation.”
Memory care communities use several strategies to recognize, understand, prevent, and manage aggressive behavior in residents who have dementia. These include:[02]
Is memory care the right fit?
Let our free assessment guide you to the best senior living options, tailored to your needs.
Many staff who work in memory care communities and care homes are trained not just to react to aggressive behavior, but also to understand what might be causing it. For example, memory care staff are trained to consider:
“The biggest struggle I see is getting loved ones to shower,” says Gewirtz. “Trained dementia caregivers know to approach slowly and from the front, not startling the person by coming from behind. Using strategies like [saying], ‘Let’s get you cleaned up and then get a cup of coffee’ can help by getting the person to agree with the first thing to get to the thing they do want,” she says.
Aggressive behavior in a loved one can seem very personal, and difficult to understand. Because they’re trained to recognize triggers in the moment and detect patterns, professional memory care staff can intervene effectively and work toward prevention.[02]
Memory care staff are often trained to pay close attention to residents’ unique needs and ensure they’re met to prevent aggressive outbursts. For example, a caregiver who recognizes a resident’s strong need to be independent may:[02]
Family caregivers typically have other jobs, such as caring for children and managing a career. Professional memory care staff, on the other hand, can focus entirely on your loved one, and can more easily accommodate your loved one’s needs.
While aggressive behavior can often be prevented, it’s not a guarantee, so memory care staff are also trained to respond appropriately to aggressive outbursts. Many use a person-centered approach to care and communication that helps center and soothe the individual. David Troxel, former president and CEO of the California Coast Alzheimer’s Association, explains:
“Any of us would get aggressive if we were frightened, in pain, or frustrated,” said Troxel. “Sometimes, these behaviors are not all that mysterious. Being reflective can help you understand if the behavior was something inadvertently caused.”
Examples of effective responses to aggressive behavior include:[02,03]
Systematic and repeated training in how to respond to aggressive behavior is just one tool that helps memory care staff work more effectively.
The best memory care communities understand that caring for people who have dementia is a team effort. For example, staff leaders in these communities often:[02]
In contrast, family caregivers often work alone. In a memory care community, there are simply more hands, hearts, and heads working together to support residents.
Effective memory care communities make it a priority to understand each resident’s background, personality, likes, dislikes, and health history. This person-centered approach helps to prevent aggressive behavior.
“The best facilities and programs develop an individualized care plan that focuses on remaining abilities and strengths. I believe 90% of the time, you can make things better,” Troxel says.
Personalized care plans are typically structured around the time of day (e.g., morning, mid-day, evening) and reflect a resident’s preferences for whether, when, and how they:[04]
Memory care facilities often hold regular staff meetings to help all parties remain aware of a resident’s particular triggers and specific strategies to address them. They also communicate directly with the resident’s family to further personalize their care plan. This ensures a resident is well cared for and gives the family peace of mind.
Memory care facilities promote a soothing and supportive environment with research-backed, dementia-conscious community design features.[02,05] Helpful elements such as activity-specific lighting and quiet, open spaces can ease aggression in people who have dementia and create a more peaceful environment.[02]
Other environmental supports include:
“You’ll also see things like ‘engagement stations,’ where residents who’re wandering or have a hard time sitting still can do independent or 1:1 activities with staff,” Gewirtz says.
“Activities in memory care are strategically scheduled,” Gewirtz notes. “High-energy activities like exercise or walking groups are typically after breakfast when people are more alert and have more energy. In the afternoon, when people might experience sundowning or higher levels of anxiousness, the staff will bring in things like music therapy and aromatherapy,” she says.
Another way memory care communities and care homes combat aggression is by incorporating memory care activities and calming therapies into everyday routines, such as:
“We had a resident who was a mom and grandmother who was sundowning. We discovered that giving her a realistic baby doll calmed her significantly,” Gewirtz recalls.
“Some families don’t understand the benefit of baby dolls and think they’re childish. But it can truly help some moms and grandmothers tap into their nurturing nature and can be very comforting,” she says.
Many memory care communities consider use of medication to treat aggression caused by dementia a last resort. Although some caregivers may turn to medication to manage aggression, most dementia care experts caution against them.[08]
“The problem with using medication for dementia is that you often trade one problem for another,” said Troxel. “It could knock down a patient’s aggression, but side effects could cause them to fall and break their hip a week later. With good care planning and productive activities, about nine out of 10 times dementia patients don’t need to be medicated.”
Gewirtz agrees. “Many communities are moving away from pharmaceutical approaches to behavior management and looking at therapeutic approaches such as hand massages and other calming or redirecting approaches,” she says.
Contemplating adding medication can be a challenging conversation for many families, but it may be helpful in some cases. Family caregivers and memory care staff members should consult a resident’s doctor about adding any medication to a care plan.
To understand how a memory care facility might use medication to manage aggressive behavior, consider asking these questions:[09]
Memory care questions? Get expert help
Tell us your care needs to receive personalized guidance from our advisors.
Yes, a memory care community can evict a hostile resident if they’re a threat to staff members or other residents. That said, evicting an aggressive resident from a memory care community or care home is both rare and a last resort. Before taking this action, an individual’s care team will often work with them and their family to explore other options.
Most facilities will only evict a resident who is a persistent danger to other residents, to staff members, or to themselves. Memory care communities will typically highlight eviction guidelines and standards in resident contracts.
Troxel notes that residents who are “spontaneously aggressive” — versus those whose triggers for aggression are consistent and predictable — are more likely to be evicted.
When you begin your search for a memory care community or care home, be sure to share information about your loved one’s behavior openly with community care and admissions staff. The better staff understand their care needs, the more they’ll be able to help. If staff don’t know your loved one’s triggers for unpredictable and aggressive behavior, then they may feel they can’t help.
Rarely, the staff of a memory care facility will seek to transfer a resident who’s been combative to an inpatient psychiatric facility.[10] An inpatient psychiatric facility may be freestanding or it may be a certified psychiatric unit inside a regular hospital.
The goal of transferring a resident to an inpatient psychiatric facility is to stabilize them and to provide them with more intensive care services than the memory care community is able to provide, such as counseling, medication management, and personalized activities.[10]
Yes, depending on your loved one’s needs, there are several alternatives to a memory care facility. These include:
Within A Place for Mom’s nationwide memory care network, more than 99% of communities require specialized memory care training for staff. All these communities (100%) specifically train staff to handle restlessness, manage anxiety, aggression, and agitation, and use redirection to relieve disorientation in residents.
A Place for Mom’s Senior Living Advisors can help your family find memory care that fits your loved one’s specific needs. Our advisors will consider your loved one’s unique situation, care needs, and budget to help you find the best fit — all at no cost to your family.
Original article by Nirali Desai.
People who have dementia may display aggressive behavior that can be harmful for the person themselves and for others. Memory care facilities may increase supervision or modify a resident’s environment to help reduce triggers that lead to aggression.
To care for someone with dementia who is aggressive, stay calm and reassuring, and try to understand their concerns. Help them feel some control by maintaining a routine and reducing triggers. It’s important to know when help from professionals is necessary for everyone’s health and safety.
Yes, some nursing homes accept aggressive people who have dementia if they have trained staff, or a specific memory care unit designed to meet the needs of these residents. Let them know up front about behaviors and triggers for the most effective support.
Aggression is a symptom of dementia; it’s not a stage that has a clear beginning or end. This symptom varies widely from person to person, so there’s no way to tell how long it will last. A loved one’s care team can help you manage triggers, which may reduce the frequency of aggressive behaviors.
If your loved one is evicted from a memory care unit because they’ve acted aggressively toward someone:
People who have dementia and who are aggressive are not always locked in special care units, but many facilities use secure units to minimize the risks for residents and staff.
When people living with dementia-related aggression have nowhere to go, they’re often temporarily hospitalized to address their behavioral issues. During this time, health care professionals work to stabilize the person and find a good long-term care solution.
WebMD. (2024, Nov. 12). 8 signs it’s time for memory care.
O’Donnell E, Holland C, Swarbrick C. (2022). Strategies used by care home staff to manage behaviour that challenges in dementia: A systematic review of qualitative studies. International Journal of Nursing Studies.
Ooi C, Yoon P, How C, et al. (2018, October). Managing challenging behaviours in dementia. Singapore Medical Journal.
Alzheimer’s Association. Daily care plan.
Quirke M, Bennett K, Chau H, et al. (2023, October 30). Environmental design for people living with dementia. Encyclopedia.
Bleibel M, Cheikh AE, Sadier NS, et al. (2023, March 7). The effect of music therapy on cognitive functions in patients with Alzheimer’s disease: a systematic review of randomized controlled trials. Alzheimer’s Research & Therapy.
Li R, Gilbert B, Orman A, et al. (2017, January 23). Evaluating the effects of diffused lavender in an adult day care center for patients with dementia in an effort to decrease behavioral issues: a pilot study. Journal of Drug Assessment.
Gale A, Stoesser K, Fortenberry K, et al. (2021, July). Pharmacologic management of agitation in patients with dementia. American Family Physician.
Alzheimer’s Society. (2021, July). Antipsychotics and other drug approaches in dementia care.
Rand Corporation. (2024, November). Use of inpatient psychiatric facilities by Medicare beneficiaries with dementia. Office of Behavioral Health, Disability, and Aging Policy.
The information contained on this page is for informational purposes only and is not intended to constitute medical, legal or financial advice or create a professional relationship between A Place for Mom and the reader. Always seek the advice of your health care provider, attorney or financial advisor with respect to any particular matter, and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not endorse the contents of the third-party sites.
Memory Care options tailored to your needs