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Memory Care for Aggressive Dementia Patients

16 minute readLast updated July 17, 2025
Written by Susanna Guzman
fact checkedby
Marlena Gates
Reviewed by Maureen Bradley, senior care expert and former community directorMaureen Bradley, a specialist with A Place for Mom, has advised families on senior care for 20 years.
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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.

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Key Takeaways

  1. Memory care may be the right fit when someone is dangerous to themselves or others, or when family caregivers are struggling to keep up.
  2. Staff training, personalized care plans, and environmental design help memory care communities manage aggressive behaviors.
  3. Aggression is often triggered by an underlying concern, such as confusion, frustration, disorientation, pain, fear, and untreated or medical conditions.
  4. Rarely, a memory care resident who is behaving aggressively may receive medication or be referred to an inpatient psychiatric facility.

When is memory care the right fit for aggression?

If your loved one is living with dementia and is behaving aggressively, memory care may be the right fit if:[01]

  • Their own safety, or the safety of others, is at risk
  • You and other family caregivers are struggling to keep up with their needs
  • Your health, or the health of other family caregivers, is suffering

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.”

Moving from assisted living to memory care: one family’s story

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.”

How memory care communities manage aggressive behavior

Memory care communities use several strategies to recognize, understand, prevent, and manage aggressive behavior in residents who have dementia. These include:[02]

  • specially trained staff
  • individualized care plans, and
  • environmental supports

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Memory care staff training

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:

  • Is the person comfortable?
  • If they’re incontinent, are they clean and dry?
  • Are they cold or hot?
  • Are they reacting negatively to being told what to do and when to do it (e.g., eating or bathing)?

“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]

How memory care staff are trained to prevent aggressive behavior

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]

  • Ask when they’d like to shower, or when they’d like to eat, rather than telling them when these activities will take place
  • Proactively attend to the resident’s comfort by ensuring they’re clean and dry and their room isn’t too hot or too cold

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.

How memory care staff are trained to respond to aggressive behavior

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]

  • Postponing care tasks
  • Giving the resident time and space to calm down
  • Changing the resident’s caregiver
  • Reassuring the resident, or redirecting their interest
  • Validating their feelings by listening empathetically and speaking with, and not at, the resident
  • Using supportive language, sitting or standing next to the resident, and maintaining eye contact
  • Speaking calmly and in a controlled, patient, and non-threatening manner

Systematic and repeated training in how to respond to aggressive behavior is just one tool that helps memory care staff work more effectively.

How memory care staff work together

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]

  • Recognize that aides often know residents best because they spend more time with them
  • Encourage nurses and doctors to seek input from aides
  • Pay close attention to how doctors, nurses, and aides get along, communicate, and work together
  • Observe how residents react to the physical environment, including noise, movement, temperature, lighting, and how well people get along when they’re in the same space
  • Encourage staff to talk about what seems to work well and what could be improved when engaging with aggressive residents

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.

Personalized care plans

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]

  • Eat
  • Bathe, dress, and attend to other personal hygiene needs
  • Engage in creative activities, such as music, art, and crafts
  • Socialize with others
  • Engage in intellectual activities, such as reading or doing a puzzle
  • Engage in physical activities, such as taking a walk
  • Engage in spiritual or religious activities

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 environment

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:

  • Circular floor plans that allow residents to walk around without feeling locked in
  • Interior courtyards that enable residents to access the outdoors in a safe and secure way

“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.

How specialized activities and therapies reduce aggression

“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:

  • Engaging activities. Memory care programs include tailored social events, brain-stimulating games, crafts, and holiday celebrations. These fun events can redirect attention, soothe aggression, and spark memories.
  • Music therapy. Memory care staff members have long relied on the effects of music therapy for dementia. Studies show that music can lower stress levels and evoke positive memories. Memory care communities often play select classical music, church hymns, or cheerful sing-alongs to provide a sense of comfort.[06]
  • Aromatherapy. Diffusing lavender essential oil twice a day can significantly reduce aggression among people who have dementia.[07] Aromatherapy can also be used to remind residents of cherished memories or daily events, such as mealtimes.
  • Homelike and peaceful surroundings. Dementia care experts know that furniture and furnishings from home, such as art, blankets and pillows, and photographs can be comforting for residents who have dementia.[03]

“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.

When is medication an appropriate treatment for aggressive behavior?

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.

Questions to ask about how a memory care facility uses medication to manage aggressive behavior

To understand how a memory care facility might use medication to manage aggressive behavior, consider asking these questions:[09]

  • When do you use medication to manage aggressive behavior?
  • What types of medications do you use, and what are the potential side effects?
  • How do you think about the benefits and risks of using medication to manage aggressive behavior?
  • How do you determine when a medication is working?
  • If a medication isn’t working, what’s your process for making adjustments?
  • If you use antipsychotics, how do you ensure they are used safely and sparingly?

Memory care questions? Get expert help

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Can memory care communities evict hostile residents?

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.

Where do combative residents go?

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]

Are there alternatives to residential memory care?

Yes, depending on your loved one’s needs, there are several alternatives to a memory care facility. These include:

  • Respite care. If your loved one has dementia and has been aggressive in the past, but doesn’t need around-the-clock care, consider respite care. This option gives you and other family caregivers a much-needed break while ensuring your loved one’s safety.
  • Hospitalization. If your loved one’s aggression is being managed with medication, or if they have an underlying medical condition that’s making their dementia worse, a hospital stay that provides around-the-clock care and access to diagnostic tests and treatments may be more appropriate.
  • Nursing home. Unlike memory care facilities, which typically provide only limited medical care, nursing homes provide 24-hour skilled nursing care. If your loved one has other serious medical conditions in addition to dementia, their doctor may recommend a nursing home with a memory care unit that’s equipped to handle people who have aggressive outbursts.

How to find memory care for an aggressive loved one

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.

Families also ask

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:

  • Work with your loved one’s doctor to reassess their care needs and behaviors
  • Explore alternatives, such as facilities that specialize in dementia care
  • Consider temporary hospitalization

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.

SHARE THE ARTICLE

  1. WebMD. (2024, Nov. 12). 8 signs it’s time for memory care.

  2. 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 studiesInternational Journal of Nursing Studies.

  3. Ooi C, Yoon P, How C, et al. (2018, October). Managing challenging behaviours in dementiaSingapore Medical Journal.

  4. Alzheimer’s Association. Daily care plan.

  5. Quirke M, Bennett K, Chau H, et al. (2023, October 30). Environmental design for people living with dementiaEncyclopedia.

  6. Gale A, Stoesser K, Fortenberry K, et al. (2021, July). Pharmacologic management of agitation in patients with dementiaAmerican Family Physician.

  7. Alzheimer’s Society. (2021, July). Antipsychotics and other drug approaches in dementia care.

  8. Rand Corporation. (2024, November). Use of inpatient psychiatric facilities by Medicare beneficiaries with dementia. Office of Behavioral Health, Disability, and Aging Policy.

Written by
Susanna Guzman
Susanna Guzman is a professional writer and content executive with 30 years of experience in medical publishing, digital strategy, nonprofit leadership, and health information technology. She has written for familydoctor.org, Mayo Clinic, March of Dimes, and Forbes Inc., and has advised Fortune 500 companies on their content strategy and operations. Susanna is committed to creating content that honors the covenant between patients and their providers.
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Edited by
Marlena Gates
Marlena Gates is a senior editor at A Place for Mom, where she's written or edited hundreds of articles covering senior care topics, including memory care, skilled nursing, and mental health. Earlier in her career, she worked as a nursing assistant in a residential care home for children suffering from severe traumatic brain injuries. Marlena holds a master's degree in nonfiction writing, plus a degree from the University of California, Davis, where she studied psychobiology and medical anthropology. While there, she worked as a research assistant in the psychobiology department.
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Maureen Bradley, a specialist with A Place for Mom, has advised families on senior care for 20 years.
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