Caring for the Person with Dementia: Behaviors and Communication

Caring for the Person with Dementia: Behaviors and Communication 

The purpose of this course is to familiarize the learner with the care of persons living with Alzheimer’s disease and other types of dementia. This course engages the learner in considering behavior as the language of dementia, offers strategies for interpreting behavior as communication, and provides a problem-solving approach to addressing behavioral expressions of distress, including pain.


Hours: 1.00


Certificates provided by accrediting body (5 Match)

Washington State Department of Social and Health Services (ALL Direct Care Workers)


Relias Learning, LLC is approved as a Curriculum Developer by the Washington State Department of Social and Health Services. This activity is approved for 1.00 contact hours for all WA State Direct Care Workers. Training Provider Code: WA0624. CE Approval Code: CO1933268

Florida Board of Nursing - Certified Nursing Assistants


This is not an accredited course for professional license renewal. Florida CNAs may use this inservice toward meeting their annual inservice requirement.This activity is approved for 1.00 contact hours.

National Association of Long Term Care Administrator Boards (RCAL)


This educational offering has been reviewed by the National Continuing Education Review Service (NCERS) of the National Association of Long Term Care Administrator Boards (NAB) and approved for 1.00 clock hours. If you have any feedback regarding the NAB approved continuing education programs, send your email to the following address: [email protected]

Oregon Department of Human Services (AFH)


Oregon Department of Human Services


This course is approved as continuing education by the Oregon Department of Human Services in accordance with state regulation 411-057-0140 for Assisted Living Administrators, Residential Care facility Administrators and Memory Care Communities within the State of Oregon. This activity is approved by Oregon Department of Human Services for 1.00 contact hours.

Course Details

Course Code: REL-PAC-0-CPDBC
Hours: 1
Type: Online Course
Content Expiration Date: 5/31/2025
Learning Objectives:
Explain how Alzheimer’s disease and other types of dementia affect communication.
Recognize how to communicate effectively with persons who are not able to communicate through verbal language.
List examples of behavioral expressions of distress.
Explain reasons why a person may communicate distress, including pain.
Identify approaches for responding to behavioral expressions of distress and challenging behaviors.
Describe the problem-solving approach to responding to challenging behaviors.
State why approaching from the front is important in caring for a person living with dementia.
List alternatives to restraints.

I. Responding to and managing behavioral expressions of distress

A. Human needs

1. Promote joy and recognize distress

2. Understand behavioral expressions of distress

3.  Provide person-centered care

B.  Understanding behavior as communication

C. Personhood and dementia

1. Recognition

2. Respect

3. Trust

D. Problem behaviors reframed as behavioral expressions of distress

1. Verbal

a) Yelling

b) Singing

c) Swearing

d) Crying

e) Sighing

f) Name calling

g) Crying out with movement

2. Nonverbal

a) Pushing you away

b) Grabbing

c) Hitting

d) Biting, spitting

e) Grimacing

f) Fear-filled eyes

g) Furrowed brow

h) Disengaging

(1) Walking away

(2) Being silent, looking away

i) Refusing care (eating, bathing, dressing)

3. Learning Engagement Activity: Video clips — examples of verbal and nonverbal examples of distress (30 seconds)

4. Behavioral expressions of distress related to unmet needs

II. Problem solving

A. Use a person-centered approach

B. Work to increase the person’s sense of well-being

C. Three-step problem-solving process

1. Learn

a)  As much as you can about the person

b) What might be going on inside the person

c)  What might be going on in the environment

2.  Plan

a) Try to discover the underlying need

b) Brainstorm ways to meet that need

c) Be creative and resourceful

3. Act

a) Try out your ideas in an organized way

b) Review and evaluate the response and adjust as needed

D. Know the person in your care

1.Past history

2. Likes, dislikes

3. Needs

4. Desires

5. What brings joy

E. Assess the environment

F. Identify stressors and soothers

G. First-line interventions

1.  Scheduled toileting

2. Observe for pain

3. Foods/fluids

4. Intervention for boredom

5. Medication side effect or illness

6. Assess for illness/infection

H. Checkpoint 1: Question (multiple choice)

I. Policies and procedures

1. Management practices

2. Stable team of caregivers

3. The physical environment

J. Problem-solving approach

1. Check the task

2.  Make it simple

3. Provide a warning

4. Check the outcome

5. Reduction in distress

K. Checkpoint 2: Questions (multiple choice)

III. Evaluating yourself and your approach as a possible cause of distress

A. Adapting your approach to the person’s needs

B. Case Scenario: Susana Mara and her son Miguel struggle with hair-washing in the shower, and it ultimately is the reason for placement. This negative experience is contrasted with the ALF’s approach.

1.  Susana and Miguel’s story

a) Susana’s story: She “absolutely hates” getting her hair washed

b) Miguel’s story: “I’ve tried everything I can think of.”

c) The emotional experience

d) She’s moving to Ocean Shores Assisted Living

e) How Miguel’s negative attitude affected their experience

2. The ALF’s story

a) Lilia’s plan

b) Access to options

C. The language of dementia

D.Learning Engagement Activity: Video clip — singing to help person with dementia complete task, Joyce Beedle BSN, RN

E. General attitude and approach

1. Verbal communication

2. Nonverbal communication

F. Nine tips for promoting good communication

1. Be patient and supportive

2.  Show your interest

3. Offer comfort and reassurance

4. Give the person time

5. Avoid criticizing or correcting

6. Avoid arguing

7. Take a guess.

8. Limit distractions

9. Focus on feelings rather than facts

G. Good communication skills = good outcomes

1. Learning Engagement Activity: Video clip — good communication (2 minutes)

IV. Ways to communicate to reduce behavioral expressions of distress

A. Developing additional skills and talents for dealing with symptoms of distressed behavior

1. Prevent

2. Distract

3. Redirect

4. Provide compliments and comfort measures

5. Accept and avoid arguing

6. Case scenario — Mrs. Garcia and Mr. Carver

B. Using what you know about the person for intervention and prevention

C. Suggested interventions for specific behaviors

1.  Resident-to-resident disputes or altercations

a) Resident characteristics or risk factors

b) Environmental risk factors

2. Checkpoint 3: Question (multiple choice)

3. Sundowning syndrome

a) Typical sundowning behaviors

b) Limited ability to change

c) Possible causes & solutions

(1) From within the person

(2) From the physical environment

(3) From the psychosocial environment

4.  Common behaviors labeled agitated and aggressive behavior

a) Review of verbal and nonverbal

b) Reframing behaviors as unmet needs

c) Detailed interventions for specific behaviors

5. Wandering and elopement

a) Causes

b) Interventions

6.  Checkpoint 4: Questions (multiple choice)

V. Using environmental and behavioral interventions instead of physical or chemical restraints

A.Definition of physical restraints

B.Definition of chemical restraints

C. Review alternatives to physical and chemical restraints

VI. Negative labeling of behavioral expressions of distress as problems

A. Avoid negative labeling of people living with dementia because of behavior

B. Use term “behavioral expressions of distress” to help understand what person is trying to communicate

VII. Conclusion

Instructor: Cynthia McDaniel, MSN, RN
Cynthia McDaniel MSN RN, is a nurse and administrative consultant in long term care. She is the CEO of ElderWise Inc, a senior living consulting and education group. Cynthia has worked as a nurse consultant for the States of Oregon and Washington,  a geriatric care manager, a regional director of clinical operations for a senior living company, and an assistant professor at Oregon Health & Science University School of Nursing. Her research in assisted living focused on the characteristics of residents in assisted living communities and the role of the nurse in assisted living. Cynthia holds a Master's of Science in Nursing from Gonzaga University in nursing education. She is a Fellow of the Sigma Theta Tau/John A. Hartford Foundation Geriatric Nursing Leadership Academy.  Disclosure: Cynthia McDaniel, MSN, RN has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Instructor: Joanne Rader, MN, RN
Joanne Rader, RN, MN, has worked  as a nurse in the field of long term care for more than 40 years. She graduated from University of Maryland, School of Nursing in 1968, with a BSN and from Oregon Health and Science University in 1979 with a Master's in Psychiatric-Mental Health Nursing.  As a nurse clinical specialist, she worked to reduce the use of physical restraints, inappropriate psychoactive medications, and defensive, self-protective behaviors during bathing for persons with dementia. She was on the faculty of the Oregon Health Science University (OHSU), School of Nursing for 20 years and published numerous articles and books addressing the emotional needs and behavioral symptoms of persons with dementia and co-authored and produced manuals and videos on individualized wheelchair seating for older adults. In 1996, 2002 and 2008, her books, Individualized Dementia Care: Creative, Compassionate Approaches and Bathing Without a Battle,  won  AJN Book of the Year Awards. She is a founding member of the Pioneer Network, an organization working to change the culture of aging in America. Currently, she works as an independent consultant and babysitter for grandchildren. Disclosure: Joanne Rader, MN, RN has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Instructor: Catherine Zimmerman, LICSW, ACHP-SW, CSW-G
Catherine Zimmerman is a licensed independent clinical social worker who has a private practice providing counseling services to people of all ages and all stages of their lives. She is a freelance healthcare writer and speaker specializing in mental health, ethics, hospice and palliative care, gerontological topics, substance misuse, caregiving, stress and trauma.  Zimmerman received her master's degree from Portland State University thirty years ago and is certified in clinical social work-Gerontology. Zimmerman supervises and mentors therapists seeking licensure in Oregon or Washington states. She is the current President of the Washington chapter of the National Association of Social Workers and has provided public presentations on over twenty topics and has numerous published works. Disclosure: Catherine Zimmerman, LICSW, ACHP-SW, CSW-G has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
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Course Delivery Method and Format
Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
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All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
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