Problem behaviors come up more frequently as your loved one's Alzheimer's disease or dementia progresses. If your family member is at an adult day care center, you can be certain its staff is seeing those difficult behaviors, too.

How do centers handle bad behaviors? Here's a primer on what to expect.

The most common challenges are:

  1. Aggressive behavior. If a person with dementia gets frustrated, she may shout, hit or push. Or the behavior may start for no apparent reason.
  2. Anxiety. Mom may be restless and need to pace. She may fidget, shake her hands or talk non-stop. One person at my center, The Ivey, stopped recognizing himself in the mirror and saw his own image as another person who might try to hurt him. (We taped material to the mirror when needed and alerted his caregiver about this concern so she would be prepared for it at home).
  3. Difficulty processing words. "Let's get up and go to lunch" may be a simple suggestion, but not to a person losing his ability to comprehend language.
  4. Wandering and trying to leave. Participants who have trouble settling down at home and try to get out the front door may attempt to do the same at adult day care.
  5. Hallucinations. Your loved one may imagine spiders crawling on the floor, dirt in freshly prepared food, or other frightening images.

A well-trained adult day care staff will have plenty of techniques to handle problems. We'll listen attentively to agitated participants, reassure them, and help them feel they are heard, even if we have difficulty understanding their words. If the person can't understand our words, sometimes non-verbal cues work better. We might show them we'd like them to sit down for lunch. As for hallucinations, we'll be empathetic by saying, "I'll get the broom and kill those spiders" or "Don't worry, we have other things to eat" and return with a fresh plate of food.

People with agitation can be redirected by getting them involved in exercise or on-one-one activities they enjoy, such as music or looking at a photo book with a staff member and telling stories about what they see. This strategy can bring forth happy memories from the past with even the most advanced dementia patients at adult day care.

Aggressive participants require a swift response. We remove them from the group for everyone's safety and move them to a place in the center that's quiet and peaceful. (At The Ivey, we have a tranquility room just for this purpose.) One-on-one time with a favorite staff member can help the participant settle down.

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We'll call the caregiver if the behavior is threatening. Trying to hit others, pushing chairs, or attempting self-harm is reason for an immediate call. The caregiver may need to arrange a change in medication with the patient's neurologist.

Typically, if you can't manage your loved one's behaviors at home, and a change in medication doesn't help, adult day care staff may have difficulty managing the behaviors, too. Talk with your center's staff about whether it's time for a 24-hour memory care facility.

The best adult day care staff will be thoroughly educated about the physiology and psychology of dementia, and have years of experience working with patients who have the condition. Look for patience, compassion, flexibility and the ability to work well under pressure. A sense of humor is also important. You want someone who will laugh with your loved one during the day, who will know that even with dementia, life can still have its joy.