How Facilities Can Promote the Best Outcomes for Seniors with Dementia

Nursing homes, memory care facilities, and other environments are powerful sources of care for seniors with dementia. They become crucial when the senior can no longer safely live on their own or with loved ones.

Yet, the care provided can vary dramatically between facilities.

Some places focus on person-centered dementia care, which includes an emphasis on the individual and their needs. Others have a management-style approach, where there’s a greater emphasis on routine and compliance to ensure the facility runs efficiently.

An especially important difference is in the use of medications to control difficult dementia symptoms such as aggression. Some facilities do this, where medications like antipsychotics are used to make residents docile and compliant.

Using medication in this way is seriously concerning, as antipsychotics and similar medications aren’t designed to help seniors with dementia. More than that, they can cause considerable harm and even increase the risk of death.

Thankfully, medication isn’t the only approach. There are also non-pharmacological techniques that can be used to improve behavior and actually help the senior in the process.

Understanding these approaches can help you to advocate for your loved one and also choose a facility that focuses on behavioral interventions before medication. After all, many ‘problematic’ dementia behaviors are the result of solvable issues, like discomfort or a health problem.

Alternative Approaches to Behavior Management in Dementia Care

Alternative approaches to behavior management in dementia care are gaining recognition as safer and more effective ways to address challenging behaviors without resorting to medication.

These approaches prioritize the well-being and dignity of individuals with dementia, aiming to improve their quality of life. Here are three critical strategies for non-pharmacological behavior management in dementia care:

Person-Centered Care

Dementia behavior management revolves around person-centered care. This means understanding that each person with dementia has a unique history, preferences, and needs. Caregivers and healthcare providers work closely with patients and their families to understand their life stories, interests, and things that may cause challenging behavior.

By tailoring care plans to meet each person’s specific needs and preferences, it becomes possible to minimize behavioral disturbances and improve quality of life.

For example, if a person with dementia once enjoyed gardening, engaging them in horticultural therapy or tending to indoor plants can provide a sense of purpose and reduce agitation.

Why Person-Centered Dementia Care Helps

Person-centered care has been linked to many benefits, including better quality of life, a better ability to meet complex needs, and decreased agitation.

The approach is important because traditional dementia care often focuses on the symptoms of the disease, rather than the person themselves. This approach means that individual differences are easily ignored and residents are often simply treated as dementia patients.

Not surprisingly, treating everyone as if they were the same can lead to individual needs being unnoticed and a sense of frustration among patients. This is awful, given that dementia is a frustrating condition on its own. Any type of care that increases disempowerment could easily lead to agitation and perhaps behavioral issues.   

Validation Therapy

Validation therapy is an empathetic and supportive approach that acknowledges the feelings and emotions expressed by dementia patients.

Instead of trying to correct or redirect their behaviors, caregivers validate their experiences and emotions. This approach can be constructive when dealing with patients who may be experiencing confusion, anxiety, or frustration.

Caregivers can often de-escalate situations and help individuals feel heard and understood by acknowledging their feelings and providing reassurance.

Why Validation Therapy Can Be Effective

Validation therapy runs contrary to earlier dementia care approaches, which involved regularly re-directing dementia patients to the present.

While re-directing seems logical, it often distresses people with dementia and can contribute to feelings of being unseen and unheard. Plus, regardless of the cause, feelings of distress in the person with dementia are authentic. These shouldn’t be ignored by caregivers simply because the source of distress is in the past rather than the present.

Environmental Modifications

Creating a soothing and comfortable environment can significantly impact the behavior of dementia patients. Simple modifications such as reducing noise, clutter, and excessive stimuli can promote a sense of calm.

Familiar objects and photographs can be strategically placed to trigger positive memories and reduce disorientation. Sensory stimulation through music, aromatherapy, or tactile activities can also engage individuals and improve their mood. A well-designed and dementia-friendly environment can go a long way in preventing or managing challenging behaviors.

The Power of Non-Pharmacological Approaches

Incorporating these non-pharmacological approaches into dementia care plans not only enhances the quality of life for individuals with dementia but also reduces the risks associated with medication use.

By focusing on individualized care, empathetic communication, and environmental considerations, caregivers and healthcare providers can create a more supportive and nurturing atmosphere that promotes the emotional and psychological well-being of dementia patients.

Why Don’t All Facilities Take These Approaches?

The approaches we’ve discussed are powerful and important for dementia care. Yet, they’re not seen in all facilities. Some are surprisingly uncommon. So, why is that?

Lack of Training or Appropriate Policies

First, the approaches we’ve discussed require specific skills and training. Many also aren’t obvious to staff with a limited experience of dementia patients.

The staff may provide excellent care in many other areas. Yet, without sufficient dementia care training, they may not understand how to effectively respond to dementia patients.

This issue could also relate to the facility itself rather than staff.

For example, facilities will often have policies about how staff should deal with particular situations, including aggressive or non-compliant residents. Such policies may end up emphasizing the use of medication over gentler and more person-centered approaches.  

Staffing or Funding Issues

While the approaches we’ve talked about work, they also take time and individual attention. This can become an issue in facilities that are short-staffed or have limited funding.

The facility may not feel that they have the resources to provide the needed level of individualized attention and support. So, instead, they focus on the most efficient approaches.

Beyond this, a lack of staff can mean that staff members don’t get to know and understand their patients well. There simply isn’t enough time. This can mean they’re less aware of the specific challenges a senior faces, their preferences, and their personality.

Such a lack of knowledge makes personalized care much more difficult.

This is another reason you need to be your loved one’s advocate! Staff members will never know them in the way you do. This means you’ll always need to keep an eye out. Being completely hands off isn’t realistic in most situations. 

How Best Care is Defined

Another issue is that people vary in what they consider best care.

Some have a strong focus on autonomy. This includes the idea that seniors should still be able to live and enjoy their life, as much as their disease allows them to. This is the heart of person-centered care, where the importance of choice and preference is still recognized.

Others may have a greater focus on routine and compliance instead. This may even be seen as a good approach to care, as it allows the facility to run smoothly and ensures that staff members have enough time and resources to support everyone. 

A Focus on the Facility, Rather than Individual Residents

Finally, it’s worth remembering that facilities have many priorities to consider. This includes the health and outcomes of all the residents, along with the facility’s reputation, funding, how the facility aligns with regulations, perspectives of the board, and many others.

It can be difficult to balance all these priorities and sometimes residents suffer as a result.

What Family Members Can Do

More than anything, family members need to pay attention to their loved ones, ask questions about care regularly, and advocate when needed.

It’s crucial to be active and engaged here, as even facilities with the best intentions and policies won’t get things right all the time.

A big part of this is asking questions about medication, particularly any antipsychotics. These medications are often employed for off-label uses, including behavioral control (they’re even sometimes referred to as chemical restraints).

Sometimes consent isn’t actually sought for these medications, even though it should be. Other times, family members aren’t given enough details, so they don’t fully understand what they’re agreeing too.

Understanding is crucial.

Some medications come with big risks, including increased likelihood of falls, a stroke, and even death. The medications often do little for the senior’s health overall and often decrease the senior’s quality of life.

That said, sometimes these medications are helpful (often in a small dose, where the patient is carefully observed). As caregiving forum members have highlighted, the medications can occasionally decrease dangerous aggression when all other approaches have failed.

The important thing is to monitor doses and side effects. Healthcare staff and family members should ensure that any medication is actually helping and that there’s a plan for coming off it again.  

For more information, check out our post on How Caregivers Can Protect Seniors from Dementia Medication Abuse.