Category Archives: Hospital Professionals

Unravelling the Mysteries of Challenging Behavior

Challenging behavior is a catch-all term that, in the context of dementia, includes one or combinations of things like shouting, wandering, biting, throwing things, repetitive talking repetitive movements, destroying personal possessions and other objects without regard for whom it belongs, agitation and general anger, physical  or verbal attacks on others, waking others at night, making sexually inappropriate comments, disrobing inappropriately, and urinating or defecating in undesirable locations. This is not an all-inclusive list and I am sure you can think of many more examples that fit under the umbrella term of challenging behavior.

These behaviors are often surprising and disruptive, and we want the behaviors to stop, we do not understand them, and we see that the problem is with the person having the behavior…. but what we need to remember is the person who is living with dementia and is displaying the challenging behavior is really only trying to communicate an unmet need to us, and we are getting it!

As dementia progresses it limits and impairs the way a person once knew how to communicate, and their attempts to make us understand what they are seeing, feeling, smelling, tasting, or sensing. They may express themselves in a negative way, a way that we call, you guessed it – a challenging behavior.

Let us take a step back for a minute. Maybe if we thought of the challenging behavior as a form of communication we would not be so quick in trying to stop the behavior, maybe we would take a step back, and take time to understand the behavior and then realize it is a behavioral expression.

A person living with dementia may express through their behaviors what they like or do not like about whats going on around them, about their environment or what a caregiver is doing right or wrong for them and often without us knowing we are the cause of the challenging behavior. Mind blowing right!?

Let’s think about this example

Sally is a pleasantly confused woman who is a newer resident living in a memory care facility. She is unable to fully communicate needs verbally but if cued and given enough time she can complete most ADL’s without out hands-on assistance, she generally is very cooperative with staff. However, every morning staff has reported to their manager that when they are getting Sally ready for the day she will bite them when they are trying to assist her. The staff is now refusing to provide care to Sally in the morning because of her biting problem and they want to give her medicine to calm her down.

OK…Now let us think. What is the problem here? I’ll give you a clue…It is not Sally’s biting problem. If you said the staff’s approach you were correct, clearly Sally is not appreciating the help she is receiving in the morning to get dressed.    To understand why Sally is biting we need to try and figure out what she is is trying to tell us.

Here are some things to consider

  • Maybe residents feel they are being rushed
  • Maybe the staff is not giving clear one step directions
  • Maybe it is cold in the room and Sally doesn’t like being cold when she dresses
  • Maybe Sally doesn’t like to get up until 9 am and we are trying to get her up at 6


  • Maybe her behavior is because we don’t understand the uniqueness of Sally and we haven’t take the time to get to know her. If we had talked to her family, we would have discovered that Sally always got up, put her robe and slippers on, made her coffee and enjoyed a cup while reading the newspaper before starting her day.

In this case, Sally just wanted to follow her routine, a routine she had done for years, a routine that felt normal and safe. When caregivers came into her room to get her dressed Sally may have felt out of sorts because she was used to doing things a certain way, she may have felt uncomfortable not following her routine and she may have felt threatened if staff was trying to rush her or if she didn’t understand.

When we seek to unravel the mysteries of behavioral expression in dementia we are not only going to help our resident, but we will be helping ourselves! Start putting the pieces together to help create that person-centered environment we all long to be a part of.

Emmy Kaczmarksi, RN is a Master Trainer for AGE-u-cate® Training Institute, Dementia Educator, Behavioral Specialist, and works at White Pine Senior Living in Hudson, WI.



Why Competency-Based Training Improves Dementia Care

There is an urgent need to equip caregivers to better respond to and care for persons living with dementia.  Traditional training models have focused on the number of classroom hours an individual must spend in training, assuming that a person who completes the required training hours is ready to work successfully with people living with dementia.  The shift to competency-based training improves dementia care by focusing on mastery of tasks and tools that are learned.

Competency-based learning empowers learners to focus on mastery of valuable skills and knowledge and learn by practicing.  This can be valuable for direct care staff in applying techniques, tools and other skills with other staff and their care receivers.

General benefits of competency-based training include:

  • Greater understanding of learning outcomes by applying skills taught.
  • Increased  retention and higher probability that what is taught will be applied
  • Learners’ improved ability to recognize, manage, and continuously build upon their own competencies and evidence of learning
  • Employers’ improved ability to track competencies and achievements

With growing focus on person-centered practices in dementia care, staff may gain knowledge training, but if it is not applied and practiced, the risk of “losing” the skills increases.  Competency-based training includes assessments on whether a person has the knowledge, skills, attitudes, and abilities required to work with individuals with dementia;  understand how to support their dignity and individuality, and can apply his or her training to the unique needs of persons living with dementia.

We face challenges in equipping our workforce to deal with the unique needs of those living with dementia.  As this number increases drastically,  practical, feasible and effective tools for caregivers is urgently needed.  They must be provided with more real-life training before they are asked to help people living with dementia and their families.

Competency-based dementia training should be integrated into every elder care providers’ ongoing training program.

Pam Brandon is President/Founder of AGE-u-cate Training Institute and a passionate advocate for older adults and those that serve them.  Pam is the creator of the internationally recognized Dementia Live® simulation program.

Gearing Up to Help How Caregivers Think, Feel, Act

What’s it really like to live with dementia?  To cope with the anxiety, embarrassment, feelings of loss and hopeless that can so often accompany the progression of dementia.  There are far too many caregivers today who are struggling with truly understanding the depths of living with cognitive decline and sensory changes.  Instead caregivers try to cope with what’s on the surface.  Transformation takes place when caregivers change how they think, feel and act!

What impactful changes could be made if caregivers were able to move into their world… for just a short time and really experience the feelings that they do – the frustrations of doing simple every tasks.  How might that change our level of empathy?  How might that  empower us to do a better job of communicating?  What if we were transformed to be able to care for someone in a whole new way?

I don’t often use our blog platform to share all the exciting things that we have going on at AGE-u-cate Training Institute, but I have to share that we are gearing up to help  thousands more caregivers in 2018.  Our transformational Dementia Live® experience changes how caregivers feel about dementia, because they experience it for themselves.  It changes how caregivers think about the person they are caring for, because they are much more empathetic and understanding of their day to day challenges.  And finally, it changes caregivers actions,  because they they leave this experience being empowered with tools to make changes immediately in how they communicate and care for others.

Dementia Live’s explosive worldwide growth bears witness to the urgent need to equip professional and family caregivers with tools to improve care.   Because this is such a hands-on approach to education and training,  participants retain the knowledge they’ve gained.   For care providers, and organizations who serve older adults and caregivers Dementia Live is hands-down one of the most effective, feasible and affordable training programs available today and a powerful foundational training program for other person-centered care programs and practices.

We’re gearing up to help more caregivers in 2018 with transformational education and training… and hope you will join us in our mission!

Pam Brandon is President/Founder of AGE-u-cate® Training Institute and the creator of the Dementia Live® simulation experience and training program.

Award Wages for Aged Care Workers in Australia

Having just returned from Australia,  I’ll be devoting several upcoming blogs to my research and fact finding with how Australia is advancing in aging and dementia care, as well as dementia and age friendly best practices.  I found their award wages for aged care workers to be one significant difference from the US and worthy of discussion.

Award wages and workplace rights and responsibilities are managed by the Australian Government Fair Work Ombudsman. An employee’s minimum pay rate can come from an award, enterprise agreement, other registered agreement, or the national minimum wage.

Employees must be paid for all the hours they work including the time they spend in training, team meetings, opening and closing the business, and working unreasonable trial (what is equivalent to overtime in US) shifts.

An entry-level Aged Care Worker with less than 5 years of experience can expect to earn an average total compensation of AU$44,000.  An Aged Care Worker with mid-career experience which includes employees with 5 to 10 years of experience can expect to earn an average total compensation of AU$46,000.  An experienced Aged Care Worker which includes employees with 10 to 20 years of experience can expect to earn an average total compensation of AU$46,000.  An Aged Care Worker with late-career experience which includes employees with greater than 20 years of experience can expect to earn an average total compensation of AU$48,000.

Although the healthcare and aged care systems differ from the US, I found that we are all experiencing the same challenges of a rapidly growing aging population.   Workforce shortages, rising costs and changing policies are certainly a global concern.

Employee turnover in Australia is less significant than the US.   While this is  likely due to higher wages,  they also have in place required  training for all care workers, of which dementia care is included.

In late 2016 Dementia Training Australia rolled out Dementia Essentials which is delivered by Alzheimer’s Australia nationally.

The three-day course provides attendees with extensive knowledge of dementia, as well as focusing on person-centred practice, communication strategies, developing appropriate activities, and responding to unmet needs.

AGE-u-cate’s Dementia Live™️ and Compassionate Touch® programs have been overwhelmingly received in Australia and we are excited to be working with providers from across the country in expanding our presence in the coming year.

I learned that while we differ in how our “systems” work we all want to deliver high quality care to our aging populations.  We all have challenges and are learning and growing from each other.

Next blog I’ll be talking about Australia’s amazing Men’s Shed program, so stay tuned!

Pam Brandon is President/Founder of AGE-u-cate® Training Institute and a passionate advocate for older adults and those that serve them.