Memory Care Communities for Aggressive Dementia Patients

Alzheimer’s and other forms of dementia are conditions that fragment a person’s memory and cognitive abilities. Seniors can find this frustrating and confusing, which may make them exhibit aggressive behaviors. They might lash out verbally or physically, which can be hurtful to caregivers, who may fear for their own safety. According to a 2023 Alzheimer’s Association report, caregivers looking after loved ones with dementia are twice as likely to experience significant emotional and physical difficulties compared to those caring for seniors without memory loss conditions.

Consequently, many families consider care in a community setting with specially trained staff who know how to identify triggers, calm anxieties and handle aggressive episodes with understanding and kindness. In addition, these communities offer opportunities for social interaction and mental stimulation, which can effectively help manage challenging behaviors associated with dementia among seniors.

This guide explores the benefits specialized memory care communities can offer you and your loved one. It explains how they work with residents to manage their aggressive behaviors and costs and payment options. But let’s begin with the causes and characteristics of aggressive dementia.

Aggressive dementia refers to when individuals with Alzheimer’s or other forms of dementia display behaviors that are hostile, violent or confrontational. These behaviors can include physical aggression, such as hitting or pushing, as well as verbal aggression, including shouting and using offensive language. 

The causes of aggressive dementia can vary, but they often arise from factors such as frustration and confusion due to memory loss, difficulty expressing needs or emotions, feeling overwhelmed by sensory stimuli and experiencing physical discomfort.

Seniors with Alzheimer’s or other forms of dementia may express an array of characteristics that fall into the category of aggressive dementia, including: 

• Physical aggression
• Verbal aggression
• Restlessness and agitation
• Resisting care activities
• Suspicion or paranoia
• Wandering or attempting to elope
• Disruptive or repetitive behaviors
• Hyperactive or impulsive behaviors
• Withdrawing from social activities
• Mood swings or emotional outbursts

Memory care communities offer a supportive and specialized environment for seniors who have become aggressive because of dementia. They’re designed to meet the unique needs of individuals facing cognitive decline and provide a range of benefits that can enhance their quality of life. This list includes some key advantages of memory care living:

• Structured and secure environment: This includes managed daily routines, controlled access and safety measures that prevent residents from wandering, such as controlled exits.
• Trained staff with dementia expertise: Staff have the expertise and understanding necessary to manage and de-escalate challenging situations.
• Individualized care plans: Plans consider each senior’s unique challenges and behaviors, ensuring they get appropriate support, medications and assistance with daily activities, such as bathing.
• Meaningful engagement and activities: Communities prioritize activities that stimulate cognitive function and promote social interaction. Residents can participate in tailored programs that cater to their abilities, interests and preferences — fostering a sense of purpose and enjoyment.
• Enhanced social support: Seniors can socialize and connect with fellow residents who share similar experiences and challenges. This can reduce feelings of isolation and help to form a supportive community.
• Involved family members: Communities often involve families in the care process, providing education and support to help them understand the challenges associated with aggressive dementia. 
• Relief for caregivers: Moving a loved one with aggressive dementia to a memory care community can provide relief for caregivers who may be experiencing high levels of stress and burnout. Knowing their loved one is in a specialized and supportive environment with trained staff can alleviate worries about care quality.
• 24/7 care and support: Communities offer round-the-clock care and support, which ensures assistance is available when needed. Continuous care can provide peace of mind to residents and their families.
• Safe and purposeful environment: Communities create an environment that promotes safety, comfort and purpose. Thoughtfully designed programs, sensory cues and comfortable settings provide a sense of familiarity and stability, reducing anxiety and increasing the residents’ overall well-being.
• Access to specialized services: Communities often have access to specialized services such as therapy, rehabilitation and support groups that specifically cater to individuals with aggressive dementia.

Memory care communities employ various approaches to effectively work with aggressive residents to enhance their well-being and comfort. Let’s briefly look at some of the most common strategies.

Used effectively, communication helps staff reduce residents’ feelings of frustration and confusion and promotes trust. Strategies include:

• Adjusting tone: Staff adjust their tone of voice when communicating with aggressive residents, using a calm and reassuring approach.
• Asking personalized questions: Engaging residents with questions that align with their interests or past experiences can help redirect their focus and encourage positive interaction.
• Validating feelings: Staff validates the emotions of aggressive residents, acknowledging their feelings and offering reassurance and empathy.

Dementia can make verbal communication challenging, so staff compensates through body language and physical contact. Examples include:

• Eye contact: Making deliberate eye contact can promote a sense of connection and trust.
• Supportive stance: Adopting nonthreatening postures, such as standing with an open posture and relaxed body language, can help create a more calming and supportive environment.
• Frontal approach: Staff members approach residents from the front rather than from behind or the side, reducing the likelihood of startling them and potentially triggering aggressive behaviors.

The environment is as important to seniors’ well-being as their interactions with staff and loved ones. Consequently, you’ll find memory care communities typically include the following:

• Aromatherapy: Introducing scents, such as lavender and chamomile (known for their calming effects), can create a soothing atmosphere.
• Therapeutic music: Playing soft, relaxing music can help reduce anxiety and agitation, promoting a sense of comfort.
• Lighting adjustments: Adjusting the lighting in common areas and individual rooms creates a softer and more gentle ambiance.

Each resident typically has a tailored care plan designed to address aggressive behaviors. However, if these persist and all attempts to manage the resident’s behavior are unsuccessful, the community may consider eviction. This decision is not made lightly; it’s often prompted by the resident posing a threat to themselves, others or when the community lacks the necessary facilities to provide the required level of support.

It’s important to note that, regardless of the circumstances, the community is unlikely to violate its own admission and retention policies, as these are typically part of the contract with the senior’s family.

While eviction is typically a last resort, facilities may have grounds to use this option. Examples include:

• Physical violence or aggression toward other residents or staff members that poses a significant risk of harm
• Repeated and severe disruptions that impact the overall well-being and quality of life of other residents
• Inability to follow community rules or guidelines consistently
• Engaging in destructive behavior that causes extensive property damage or poses a safety hazard
• Refusal or inability to comply with necessary medical or psychiatric treatments
• Repeated instances of elopement or attempts to leave the community unsafely
• Persistent and disruptive behavior that negatively affects the ability of staff members to provide care for other residents
• Engaging in illegal activities within the community premises that jeopardize the safety and well-being of others

Discovering your loved one is facing eviction can be distressing. If you find yourself in this situation, here are some steps you can take:

• Review the contract: Examine the contract and any other documents you signed when your loved one entered the community. Pay particular attention to the section on eviction procedures.
• Understand the reasons: Get clarity on the specific reasons behind the community’s decision. Request a detailed explanation from the management to help you understand the situation and whether any alternatives were considered.
• Consult with the doctor: Speak with your loved one’s doctor or health care provider to assess their condition, behaviors and potential interventions that could help address possible underlying issues. Their professional input and guidance can provide valuable insights and support your case.
• Communicate with community management: Openly and respectfully converse with the management. Share your concerns, ask questions and express your commitment to finding a resolution for all parties.
• Seek mediation or legal assistance: If necessary, consider mediation or consult with a legal professional experienced in elder care issues. They can help you understand your rights, provide guidance and help you navigate the eviction process.
• Consider alternative solutions: Work with the community to explore solutions that address their concerns to avoid eviction. 
• Document and maintain records: Keep detailed records of all communications, meetings and actions taken throughout the eviction process. You may need this information as evidence to support your case.
• Advocate for your loved one: Be a strong advocate for your loved one’s rights and well-being. Stay involved in their care, attend meetings and actively participate in discussions about their situation — ensuring their voice is heard and needs prioritized.

Choosing a memory care community for someone with aggressive dementia requires careful consideration. It’s essential to select one that has specialized features and staff trained to provide proper care and treat your loved one with kindness, regardless of their challenging behaviors. 

The following checklist covers what a community should provide. It highlights key factors to consider, such as specialized features, staff training, safety measures and quality of care. 

Since memory care typically involves specialized support services, costs are usually 20% to 30% more than assisted living. In 2021, the average monthly cost of memory care in the United States was $5,625. Some families may need to consider ways to pay, so let’s look at several options.

Medicare rarely covers long-term memory care costs in a community setting, but it can pay some related expenses, such as medications and therapies. Medicare Part A may cover short-term stays in skilled nursing facilities for rehabilitative purposes following a qualifying hospital stay.

Medicaid can pay for care under certain circumstances. The following are examples of how it can help, although, since Medicaid varies between states, families shouldn’t assume what’s available in one state applies to all.

• Home and Community-Based Services Waivers: Some states offer HCBS waivers that allow Medicaid beneficiaries to receive long-term care services in a memory care community. Waivers may cover services such as personal care assistance, case management and respite care.
• Medicaid Managed Long-Term Services and Supports Programs: MLTSS programs provide comprehensive long-term care services for eligible individuals. Programs may cover the costs of residing in a memory care community and the necessary support services.
• Medicaid State Plan Benefits: All states must provide mandatory Medicaid benefits, but some also offer optional benefits. These may include coverage for memory care services in a community setting.
• Supplemental Security Income: Some states provide additional financial assistance through optional state supplements for individuals who receive SSI benefits. These supplements can help cover the costs of care in a memory care community.

Veterans benefits can provide financial assistance, although families should contact their local VA office to determine what’s available in their area. Here are some benefits you can find with the VA:

• Aid and attendance pension: The Aid and Attendance Program is an enhanced pension benefit available to eligible wartime veterans and surviving spouses.
• State veterans homes: State veterans homes offer long-term care services for eligible veterans. They provide comprehensive care at reduced rates, making it more affordable for veterans to receive memory care in a community setting.
• Veterans-Directed Home and Community-Based Services: The VD-HCBS program gives eligible veterans greater control over their care by directing their own services and supports. Veterans can use their benefits to pay for memory care services in a community setting.
• Community care: In certain cases, veterans may be eligible for community care programs where they can receive memory care from community providers. The VA may cover the costs of care in a memory care community if it deems it necessary and appropriate for the veteran’s needs.

If your loved one has a long-term care insurance policy, it may cover some or all of the expenses associated with memory care. You should review the policy’s details to understand the coverage and any limitations or specific requirements.

Many families use private funds, including personal savings or income, to cover the costs of memory care. This option provides flexibility and control over the payment process. Homeowners may consider utilizing a reverse mortgage to access funds for memory care. This financial arrangement allows them to convert a portion of their home’s equity into regular payments, which they can use to pay for care.

Use the search tool below to find for memory care communities in your area. Be sure to speak to each community to confirm that the staff is equipped to work with residents with aggressive dementia.