Behaviour changes in those with dementia Understanding triggers, keeping your people safe, and the importance of asking for help

A care home’s management of dementia is broad. It involves ongoing care, support, and evaluation from—and not limited to—in-house Health Care Professionals (HCP’s), families, social workers, nurses, GP’s, mental health practitioners, and Dementia Intensive Support (DIS) teams.  Timely comeback from external support teams is essential in keeping both the individual and other care home residents safe.

Those of you that have been or are currently on a dementia journey with a loved one will recognise that the onset of dementia can bring about changes in behaviour and often impact an individual’s mental wellbeing. It’s a sad reality of the disease, but if well managed, those effected can continue to lead fulfilling lives, maintaining their interests, and living as independently as possible.

Where shifts in behaviour become part of the individual’s disease, a care home’s priority must be to keep them and those around them safe while continuing to provide adequate care. If challenging behaviour is a demonstrated behaviour, care homes must seek to understand who is at risk, the frequency of occurrence, and look to identify any triggers. Too frequently do we read newspaper headlines that share stories of care homes that have failed to respond to the challenging behaviours of an individual, conducts that can include assault on another resident that on rare occasions, result in death.

Understanding what triggers challenging behaviour in people with dementia is vital in determining the most suitable management strategies and in knowing whether the presented behaviour should be referred for extra support. There is an abundance of professional support teams out there, and their services must be utilised.

Leaf’s process for assessing behaviour-challenged individuals utilises a multi-agency coordinated response tool where, through the appropriate narrative with both our dementia resident and HCP’s, we gain insight into potential triggers such as underlying health concerns or symptoms, their current medication, and the occurrence of any significant life events. All of these things can affect the behaviour of a person, and through engagement, some of the causes can be quickly resolved.

The response tool ensures we can minimise triggers and, when needed, supports us in making referrals to the most suitable HCP while keeping agencies informed. We believe that professional curiosity serves to support individuals with dementia positively, and we encourage their families to stay involved with any recommendation that we make, helping us to make informed decisions that are in the best interest of our residents.

In a person with dementia, behavioural challenges can manifest at any time and present themselves in a multitude of ways. Our response tool is complemented by the implementation of our Behaviour Management Programme (BMP), and where necessary or beneficial, we call on support from HCPs, DIST, and families of the individual.

Leaf Care has a non-medication-first-approach to challenging behaviour, further supporting us in eliminating short-term causes and allowing us to differentiate challenges in behaviour compared with those of mental health. Where individuals are found to be mental health challenged, alternative pathways are discussed. We further protect our residents and their families by choosing not to ensure new residents with already identified behavioural have a multi-agency agreed plan for the challenges which are manageable and realistic, prioritising safeguarding, and minimising risk to our existing residents.

While there are a multitude of support teams that serve to support HCP’s in times of need, there is still work to be done in terms of emergency support response times to challenging behaviours in care homes. We need better coordinated multi-agency pathways that give greater transparency to the support available and the legal framework that binds them, along with a more collaborative and inclusive way of operating. Leaf’s all-inclusive approach to clinical assessments, reporting, and decision making, hope in some way to drive change and improvement in the wider context of coordinated care.