Caring for Residents With Dementia: A CNA's Guide

Many nursing home residents live with Alzheimer’s disease or another dementia, and CNAs spend more time with them than any other staff. Federal rules require every CNA program to teach care of cognitively impaired residents, and nursing homes must include dementia training in your yearly in-service hours (42 CFR 483.95(g)). Here are the practical skills that make the biggest difference.

How to communicate

Tips from the National Institute on Aging (NIA) and the Alzheimer’s Association:

• Approach from the front, make eye contact, say the person’s name, and introduce yourself.
• Speak slowly and clearly in a warm, calm voice. Watch your face and body language too.
• Ask one question at a time, and give extra time to answer. Don’t interrupt.
• Offer simple choices (“Would you like the blue shirt or the red one?”) instead of open questions.
• Give step-by-step instructions and show what you mean.
• Don’t argue or correct. Arguing about facts usually makes things worse.
• Never talk about the person as if they aren’t there, and avoid baby talk.
• Use gentle touch, like guiding a hand, when it’s welcome.

As speech declines, nonverbal communication matters more. Some people who spoke two languages may go back to only their first language.

When a resident is agitated or aggressive

According to the NIA, agitation and aggression usually happen for a reason. Common causes include pain, too little sleep, constipation, medication effects, loneliness, too much noise, sudden changes in routine or caregivers, and being pushed to do something they can no longer do.

• Stay calm and patient. Use a soothing voice and reassure them they’re safe.
• Look for the cause, and tell the nurse about possible pain or a change in condition.
• Redirect to something pleasant, like a snack, music, or a short walk.
• Reduce noise and clutter.
• Protect yourself and others. Give space during an aggressive moment and get help.

Sundowning

Sundowning is restlessness, agitation, irritability, and confusion that starts as daylight fades. NIA suggests:

• Keep a consistent daily schedule.
• Encourage daylight exposure and physical activity during the day.
• Limit late-afternoon naps, and avoid caffeine late in the day.
• Keep evenings calm and well lit.

Why non-drug approaches matter

Since 2012, CMS has worked with nursing homes through the National Partnership to Improve Dementia Care to reduce unnecessary antipsychotic medications and increase person-centered, non-drug approaches. Many of those approaches depend on CNAs: consistent staff assignments, more exercise and time outdoors, watching for and reporting pain, and activities matched to each person.

Frequently asked questions

Keep reading