Dementia Care: Understanding, Communicating and Keeping People Safe
Understand what dementia changes, read distress as a message, talk so people understand, and keep people safe from wandering and harm.
ForNursing home, Home health, Hospice staff
TimeAbout 65 minutes
Lessons8, each with a quick check
FinishA quiz (80% to pass) and a printable certificate of completion
What you will learn
Name changes in memory, language and attention that dementia can cause.
Treat yelling, hitting or pacing as a sign of an unmet need.
Start every contact with your name, their name and eye contact.
Stay calm and keep everyone safe when a resident becomes agitated.
Recognize sundowning in the late afternoon and evening.
Know which residents are at risk of wandering.
Explain person-centered care in your own words.
Let the person do as much as they can for themselves.
Written by Pact Compliance from federal rules and CDC, CMS, OSHA and NIH guidance (sources under each lesson), checked October 2026. Where your facility's policy is different, follow your facility's policy.
Lesson 1: What Dementia Changes
In this lesson you will:
Name changes in memory, language and attention that dementia can cause.
Explain that the disease, not the person, causes these changes.
Expect good days and bad days.
The brain changes
Not the person
Dementia is a disease of the brain. Alzheimer's disease is one kind. It changes how a person thinks, remembers, and acts. The National Institute on Aging says something important for you to remember. It is the disease, not the person, that causes these changes. When a resident forgets your name, repeats a question, or gets upset, they are not doing it to you. The disease is making daily life hard for them. Your patience is part of their care.
Words get hard
Attention fades
Dementia often makes talking and listening hard. A person may struggle to find the right word. They may not understand what some words mean. They may lose track in a long conversation, or lose their train of thought. Background noise, like a TV, a radio, or other people talking, can make it hard for them to follow you. Some people lose a language they learned later in life. They may go back to their first language, such as Spanish. Knowing this helps you plan how you talk to them.
Show the answer
The disease is making it hard for her to remember. Answer calmly each time. NIA says the disease, not the person, causes these changes.
Behavior changes
Common signs
Dementia can also change behavior. NIA lists many common changes. A person may seem anxious, scared, or upset more easily. They may seem sad or lose interest in things. They may hide things, or think others are hiding or taking things. Some see things that are not there. Some pace, wander, or have trouble sleeping at night. Some may hit, or act in sexual ways that are not usual for them. These are symptoms of the disease. They need a care plan, not blame.
Good days
Bad days
A person with dementia can seem like themselves one day, and act very differently the next. NIA says this change from day to day is common. So do not decide that a resident is 'faking' on a good day or 'being difficult' on a bad day. Meet them where they are each time you walk in the room. If a resident is much worse than usual, tell your nurse. A sudden change can be a sign of something else, like an illness.
Depression too
Watch and tell
Depression is common in people with Alzheimer's and other dementias. It can look like some of the same symptoms, like pulling away from people or losing interest in things. You will not diagnose it. But you can notice it. Tell your nurse if a resident seems sad, cries more, stops eating, or stops doing things they used to enjoy. The behavioral health course covers this more.
Your rule
Required training
Federal rules for nursing homes say every nurse aide's yearly in-service must include dementia management. For aides who care for people with memory problems, it must also cover care of the cognitively impaired. That means people whose thinking is affected. Nursing homes must also give the right care to residents who have dementia, to help them be as well as they can be. This course is part of that training. The next lessons give you tools you can use on your very next shift.
Treat yelling, hitting or pacing as a sign of an unmet need.
Check for common causes like pain, hunger, toileting and noise.
Report sudden changes in behavior to the nurse right away.
Behavior is a message
Unmet need
When a resident with dementia yells, grabs, hits, paces, or tries to leave, it is easy to call it bad behavior. CMS asks you to see it another way. These actions are often the person's way to tell you about a need, a pain, or a thought they cannot put into words anymore. CMS calls these expressions of distress. If staff see them only as 'challenging behavior,' the risk of abuse and neglect goes up. So your first job is to be a detective. Ask, 'What is this person trying to tell me?'
Check the body
Pain, hunger, bathroom
Start with the body. NIA lists health problems that can cause distress. They include pain, lack of sleep, and trouble seeing or hearing. Other causes are constipation, hunger, and thirst. So check the basics. Is she wet or does she need the bathroom? Is he hungry or thirsty? Does he have his glasses and hearing aids? Is he too hot or too cold? Is something hurting? A person who cannot say 'my hip hurts' may show it by yelling or pushing you away.
Show the answer
Take him to a quieter spot or turn the TV down. NIA lists noise and too many conversations as triggers for distress.
Check the room
Too much noise
Next, look at the room around them. NIA says a noisy or stressful place can cause distress. Examples are many people talking at once, or a loud TV or radio. A crowded dayroom, a busy hallway, or a TV blaring can be too much. Try a quieter spot. Turn the TV down. Lower your own voice. Sometimes a calm room is the best care you can give.
Check feelings
Fear and loss
Then think about feelings. Sadness, fear, stress, confusion, and worry can all cause distress. NIA also lists a sudden change in a known place, routine, or person. A new aide, a new room, or a new schedule can be scary. Feeling lonely can cause it too. So can being pushed to do something the disease has made very hard. Reassure them that they are safe and that you are there to help. Slow down, and give them time.
Sudden change
Tell the nurse now
Here is a safety rule. NIA says sudden or fast changes in behavior should be brought to a doctor's attention right away. This is especially true if the person has had an infection or a recent change in medicine. So if a resident who is usually calm is suddenly very confused, very sleepy, or very upset, do not wait. Tell your nurse right away. Say what changed and when. The nurse can check for things like infection, pain, or a medicine problem.
Track it
Share it
Patterns help the team find the cause. NIA says keeping track of behavior changes can help caregivers and providers see a pattern. Notice what happened just before. What time was it? Who was there? What were you doing? For example, 'She yells every time we start her shower,' or 'He paces before dinner.' Share what you notice with your nurse, or write it where your facility says to. Your notes can lead to a better care plan for that person.
Start every contact with your name, their name and eye contact.
Use short, simple choices and yes-or-no questions.
Avoid arguing, baby talk and talking about the person as if they are not there.
Name and face
Every time
Good care starts with how you say hello. Make eye contact and call the person by name. Tell them your name, every time. 'Good morning, Mrs. Hill. It's Maria. I'm here to help you get dressed.' NIA also says to watch your tone, volume, face, and body language. Try not to look angry or tense. A warm, matter-of-fact manner helps. CMS adds that people with dementia respond to the feelings you show, more than the words you say.
Short and simple
One step each
Keep it short. Use simple words. Give one step at a time. Instead of, 'Let's get up, go to the bathroom, and then get dressed for breakfast,' try, 'Let's stand up.' Wait. Then, 'Now let's walk to the bathroom.' Allow more time for the person to answer. Be patient, and try not to interrupt. If they do not understand, say it again with different words. Saying the same words louder rarely helps. Also cut down on noise while you talk. NIA says background sounds from a TV, radio, or other people can make it hard for a person with dementia to follow. Turn off the TV or step into a quieter spot before you explain something important.
Show the answer
'Do you want the blue shirt or the red shirt?' NIA suggests simple choices and yes-or-no questions.
Simple choices
Yes or no
Open questions can be hard. NIA gives examples. Instead of, 'What do you want for dinner?' ask, 'Do you want fish or chicken?' Instead of, 'How do you feel?' ask, 'Are you feeling sad?' Questions with a yes-or-no answer, or two simple choices, are easier. Choices still matter. They let the person stay in charge of their own day.
Don't argue
Try again later
Arguing almost never works. If a resident says it is 1960, or that her mother is coming to get her, correcting her can make her upset. NIA says to be patient, avoid arguing, and reassure the person you are there to help. Try saying, 'You miss your mom. Tell me about her.' If a task is not going well, it is OK to stop, step back, and try again a little later. Instead of 'That's not how you do it,' try 'Let's try it this way.'
Adult to adult
No baby talk
People with dementia are adults. Talk to them that way. NIA says do not use baby talk or a 'baby voice.' Do not talk about the person as if they are not there. That includes talking to a coworker over the person's head during care. Avoid nicknames like 'sweetie' unless the person likes them. Use the name they prefer. Respect keeps dignity, and dignity is a resident's right.
Touch and show
Body language
As words get harder, other ways to communicate matter more. NIA says you can use gentle touch to guide a person, or hold their hand while you talk. Show what you mean. Hold up the toothbrush. Point to the chair. Watch their face and body too. As people lose the ability to talk clearly, their faces may show sadness, anger, or frustration. That is them talking to you. Listen with your eyes.
Lesson 4: When Care Gets Hard: Agitation and Aggression
In this lesson you will:
Stay calm and keep everyone safe when a resident becomes agitated.
Use stop, step back and try again instead of force.
Get help and report what happened.
Agitation
What it is
NIA describes agitation as being restless and worried, and unable to settle down. An agitated person may pace, not sleep, or act aggressively. They may yell, or try to hit or hurt someone. NIA says that most of the time, agitation and aggression happen for a reason. Common causes are pain, depression, or stress. Others are too little sleep, constipation, too much noise, or too many people in the room. Being pushed to do something that is now very hard, like bathing, is another cause.
Stay calm
Lower your voice
When a resident is upset, your calm is your best tool. NIA says be patient and try not to show frustration. Speak calmly. Listen to the person's concerns and avoid arguing. Reassure them that they are safe and that you are there to help. If you feel yourself getting upset, take a deep breath. Count to ten. A calm face and a soft voice can lower the tension in the room.
Show the answer
Stop, make her safe, and step back. Try again later or get help. Stopping and stepping back lowers the risk of harm. Pushing through can make it worse.
Stop and step back
Try again later
If care is causing the upset, stop. Make the person safe, then step back. Pushing through usually makes it worse. It can also lead to injury, for them and for you. Give them space and time. Try again in a few minutes. A different approach may work better, or a different staff member they trust. Never use force, threats, or holding someone down to finish a task. That can be abuse.
Redirect
Something they enjoy
Try turning their attention to something else. NIA suggests a snack, a drink, or an activity. Ideas include music, a favorite TV show, a short walk, a book, or a simple task like folding towels together. Use what you know about the person. What do they like? What calms them? Ask the family, look at the care plan, or ask your nurse. The right song or a familiar photo can turn a hard moment around.
Keep safe
Get help
Sometimes a person becomes aggressive. NIA says if this happens, stay at a safe distance until the behavior stops. Keep other residents away. Move items that could be used to hurt someone out of reach. Call for help. Do not try to handle a dangerous situation alone. In an emergency, follow your facility's emergency process, or call 911 if you are in a home. Tell the responder the person has dementia.
Report it
Help the plan
After things calm down, tell your nurse what happened. Say what was going on just before, what you tried, and what helped. NIA says to talk with a health care provider if aggressive behavior gets worse. If anyone was hurt, or if one resident hit another, it must be reported like any other allegation. Your report helps the team look for causes like pain or infection, and update the care plan. That makes the next shift safer for everyone.
Recognize sundowning in the late afternoon and evening.
Use routine, daylight and activity to help prevent it.
Support good sleep.
Sundowning
Late in the day
Some people with dementia get more restless, upset, or confused as daylight fades. This is called sundowning. NIA says it happens in the late afternoon or early evening. You may see more pacing, more calling out, or more attempts to leave. NIA says being overly tired can make late-day restlessness worse. If you work evenings, you may see this often. Knowing it is coming helps you plan.
Same time
Every day
Routine helps. NIA suggests bathing, dressing, and eating at the same times each day. A steady routine means fewer surprises. Fewer surprises mean less fear. Follow the resident's usual routine as much as you can, and follow the care plan. When the routine has to change, explain it simply and give extra reassurance. Remember that residents also have the right to choose their own schedule, including when they sleep and wake up. A good routine is built around their choices.
Show the answer
Time by a window or outside in the sunlight during the day. NIA suggests daily sunlight to help prevent sundowning.
Daylight
Stay active
Light and activity during the day can help. NIA suggests time outside, or sitting by a window to get sunlight each day. It also says to let in natural light during the day. Aim for some physical activity every day, but do not plan too many activities. NIA says being active can improve mood and sleep. A short walk in the hall or a chair exercise group can make a difference by evening.
Late-day habits
Naps and drinks
Small habits matter. NIA suggests avoiding caffeine, like coffee or cola, late in the day. It also suggests avoiding alcohol late in the day. Discourage long naps and dozing late in the day, because that can make nighttime sleep harder. Follow the care plan and the resident's choices. Some people want their evening coffee. If you think a habit is making evenings harder, tell your nurse. The team can talk about it with the resident and family.
Calm evenings
Soft and quiet
As evening comes, make the space calm. Lower noise. Turn down the TV. Close the curtains as it gets dark, and turn on soft lights. NIA suggests soothing music and familiar objects, like photos. Slow down your own pace. NIA notes that your own worry can rub off on the person. If a resident is upset, reassure them, listen, and redirect them to something calm. Many of the tools from the last lesson work here too.
Watch and share
What helps
Every person is different. What helps one resident may not help another. Notice what works for each person you care for. Maybe it is a warm drink, a certain song, or a call from family. Notice what makes it worse, like a loud dayroom or a late nap. Share what you learn with your nurse and the next shift. Your notes can become part of that person's care plan, and help every caregiver who comes after you.
Lesson 6: Wandering and Exit-Seeking: Keeping People Safe
In this lesson you will:
Know which residents are at risk of wandering.
Notice early signs that a person is trying to leave.
Act fast, using your facility's missing-person process, if someone is missing.
Wandering
A real danger
NIA says many people with Alzheimer's wander away from home or from their caregiver. A person who wanders can get lost, fall, or be hurt by weather or traffic. CMS also lists wandering and elopement as expressions of distress. Elopement means leaving a safe area without anyone knowing. So wandering is a message too. The person may be looking for a bathroom, for home, or for something to do. Your job is to keep them safe and to look for the need behind it.
Know who
Know the plan
Know which people in your care are at risk of wandering. This should be in their care plan. Know what the plan says. For example, how often to check on them, and what helps them. NIA says a person with a history of wandering should not be left alone. In a home, that means not alone and unwatched. In a facility, it means following the checks in the care plan. Know where your residents are, especially at shift change and during busy times.
Show the answer
Go to her calmly, walk with her, and gently redirect her. Meeting her where she is and redirecting keeps her safe without a struggle.
Early signs
Packing up to go
Watch for signs that a person is getting ready to leave. They may pace near doors, try door handles, or follow visitors out. They may pack a bag, put on a coat, or say they need to go home, pick up the kids, or go to work. NIA suggests keeping signs of leaving, like shoes, keys, suitcases, coats, and hats, out of sight. When you see these signs, go to the person. Walk with them. Gently redirect them to a safe activity.
Meet the need
Redirect
Try to meet the need behind the wandering. Do they need the bathroom? Are they hungry, bored, or in pain? Are they looking for someone? You can say, 'Let's walk together,' and guide them back. Do not argue. Telling a person 'You can't go home, you live here now' can upset them more. Physical activity during the day can help, too. Tell your nurse if wandering is new or getting worse.
Not locked away
Rights still matter
Safety does not mean locking people away. Shutting a resident in their room against their will is involuntary seclusion. That is a form of abuse. Using restraints for staff convenience is not allowed either. Your facility has its own safety plan, like door alarms or secured units, and rules for using them. Follow that plan. Do not invent your own, like tying a door shut or blocking a resident in their room. If you think a resident needs more supervision, tell your nurse.
Missing person
Act fast
If a resident or patient is missing, act right away. Every minute counts. Tell your nurse at once and follow your facility's missing-person process. That often means a code, a search, and a call for help. Know the resident's description, what they are wearing, and a recent photo. NIA suggests keeping a recent photo to help police if a person is lost. In a home, call 911 and your agency. Do not wait to see if they come back on their own.
Your facility's policy (ask your supervisor):
Your facility's missing-resident (elopement) code and steps
Where wandering-risk residents' photos and descriptions are kept
Lesson 7: Person-Centered Care and Preventing Abuse
In this lesson you will:
Explain person-centered care in your own words.
Use what you know about a person's life to guide care.
Know why residents with dementia face higher abuse risk, and how to protect them.
Person-centered
They lead
The federal rule defines person-centered care. It means focusing on the resident as the one in control, and helping them make their own choices and run their own daily life. Dementia does not erase that right. It means we work harder to find out what the person wants. Watch their reactions. Offer simple choices. Ask family what the person liked. Person-centered care is not one way for everyone. It is the right way for this person.
Know their story
Use it
Every resident has a life story. A job they were proud of. People they love. Music they danced to. Foods they grew up with. Knowing this helps you connect. It helps you calm a hard moment. It helps you find activities that matter to them. Look at the care plan or 'about me' page if your facility has one. Talk with the family. Listen to the resident. A retired farmer might like to sort seeds or talk about the weather. A former teacher might like to help read the menu. Small things like this bring dignity.
Show the answer
They may not be able to tell anyone, and distress can be misread as bad behavior. NIA and CMS both point to these risks.
Higher risk
Why it happens
NIA says people with memory problems or dementia may be more open to abuse. So are people who depend on others for help with bathing, dressing, and taking medicine. They may not be able to tell anyone what happened. They may not be believed when they do. CMS also says that when staff see dementia distress only as 'challenging behavior,' the risk of abuse and neglect goes up. That is why dementia care and abuse prevention are taught together.
Never punish
Never force
Here is what abuse can look like in dementia care. Yelling at a resident who repeats questions. Rough handling during a shower. Threatening, like 'If you hit me again, you won't get dinner.' Leaving someone wet because they 'fight' changes. Holding someone down to finish care. Shutting someone in a room. None of these is ever OK. They are abuse or neglect, even when you are tired, even when the resident hit you first. Use the tools from this course instead: stop, step back, look for the need, get help.
Take care of you
Ask for help
Dementia care is hard work. It is OK to find it hard. When a resident's care is wearing you down, tell your nurse. Ask to switch assignments for a while, or to have a second person for hard tasks. Take your breaks when you can. Find someone to talk to. NIA reminds caregivers to take time to rest and care for their own needs. Caring for yourself is part of caring for them.
Speak up
Report
If you see a coworker being rough, mocking, or cruel to a resident with dementia, report it right away. Do not wait because the resident 'won't remember' or 'can't tell anyone.' That is the reason they need you. Use the reporting steps from the abuse course. In a nursing home, abuse must be reported right away, and no later than 2 hours. You are the resident's voice when they no longer have the words.
Lesson 8: Help With Daily Care: Bathing, Dressing and Mouth Care
In this lesson you will:
Let the person do as much as they can for themselves.
Make bathing feel safe, warm and private.
Break dressing and mouth care into small steps.
Do with, not for
Independence
Dementia slowly changes a person's ability to bathe, dress, and eat. NIA says the main goal is balance. Let the person be as independent as possible, and give support when they need it. Doing everything for someone may be faster. But it can take away skills they still have, and it can take away their pride. So ask yourself, 'What can this person still do?' Then let them do it, even if it takes longer. Holding a washcloth or brushing their own hair still counts.
Private moments
Feelings matter
Bathing and dressing are things most of us have always done in private. NIA says a person may feel embarrassed and not want help. They may feel angry that they cannot care for themselves anymore. That is a normal feeling, not bad behavior. Be patient. Close the door and the curtain. Keep the person covered as much as you can. Privacy during personal care is also a resident's right.
Show the answer
With the hands or feet, telling her each step first. NIA says hands and feet feel less threatening and can help the person relax.
Before the bath
Warm and ready
NIA says bathing can be one of the hardest things a caregiver does. A person may find it scary, embarrassing, or uncomfortable. Plan ahead. Gather supplies first so you never have to leave. Use a bath chair and a non-slip mat. Make the room warm and not too dark. Check that the water is a comfortable temperature. Be matter-of-fact: 'It's time for your shower now.' If they say no, offer a choice: 'Now or in 15 minutes?' Try to keep bathing at the same time of day.
During the bath
Never alone
Let the person help. They can hold the washcloth, sponge, or shampoo. Tell them each step before you do it. Start with the hands or feet. NIA says those areas feel less threatening, and starting there can help the person relax. Put a towel over their shoulders or lap so they feel less exposed, and wash under the towel. If they get upset, talk about something else. And here is a safety rule. NIA says never leave a person with Alzheimer's alone in the tub or shower.
Other options
Skin check
If a full shower is too upsetting, NIA suggests a sponge bath for the face, hands, feet, underarms, and private areas. Washing a person while they sit in a chair can be easier. Washing hair at a sink can help too. Ask your nurse before changing how care is done, and follow the care plan. After bathing, pat the skin dry. Dry between skin folds and check for rashes. Tell your nurse about any rash, sore, or bruise you find.
Dressing
Mouth care
For dressing, NIA suggests laying out clothes in the order they go on, like underwear first, then pants, then a shirt. Hand the person one item at a time, or give one simple step at a time. Fewer choices make it easier. For mouth care, go step by step: pick up the toothpaste, take the cap off, put it on the brush, now brush. Let them do as much as they can. If they have dentures, help keep them clean. Looking and feeling clean and neat helps a person feel more like themselves.
Answer every question. You need 80% to pass. You can try again as many times as you like.
Your quiz covers the lessons for: Nursing home ( questions). Change your setting
Please read
This free course gives you a certificate of completion from Pact Compliance. It is not continuing education (CE) credit and is not approved by any state.
Your employer decides whether it counts toward required in-service hours. Home health and hospice aide training must be given or supervised by the agency's registered nurse.
California: it does not count toward CNA or HHA renewal hours.
Your name and quiz answers stay in your browser and are never sent to Pact.
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Certificate of Completion
This certifies that
completed the online in-service course
Dementia Care: Understanding, Communicating and Keeping People Safe
Setting
Completed
Seat time
Quiz score
Certificate ID
This free course gives you a certificate of completion from Pact Compliance. It is not continuing education (CE) credit and is not approved by any state. Your employer decides whether it counts toward required in-service hours. Home health and hospice aide training must be given or supervised by the agency's registered nurse. California: it does not count toward CNA or HHA renewal hours.
Part of this topic needs a hands-on check with your supervisor; this online course does not cover that part.
Pact does not keep a record of this certificate. Print it or save it as a PDF and give a copy to your supervisor. pactcompliance.com/free-training/dementia-care/
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