Picture this: Margaret refuses her breakfast again. David paces the corridor for the third time this hour. Janet keeps asking for her mother, who passed away decades ago.

In many care settings, these are logged as "challenging behaviours." But what if we've been asking the wrong question all along?

What if the challenge isn't the behaviour itself but our ability to hear what's really being said? Hence we focus on this being a ‘behaviour that challenges,’not a ‘challenging behaviour.’

Every Behaviour Is a Message

At PMH Consultancy and Education, we work from a fundamental truth: behaviour is communication. When words become harder to find, the body and emotions speak louder.

Consider Margaret's refused breakfast. Perhaps the dining room feels overwhelming too bright, too noisy, too many people. Or the food looks unfamiliar. Or she's in pain but can't articulate where.

David's pacing? He might be searching for purpose, responding to a lifetime habit of activity, or trying to find ways to cope with his anxiety.

Janet's repeated question isn't confusion… it's a call for comfort, security, and the unconditional love only a mother provides.

Pat Hobson explores this in the Enabling People with Dementia: Understanding and Implementing Person Centred Care, which has a chapter that focuses on that every behaviour is shaped by the person's unique biography, current health, and immediate environment. When we stop managing behaviour and start interpreting it, we transform care.

Three Questions That Change Everything

Instead of asking "How do we stop this behaviour?" effective dementia care asks:

1. What is this person trying to tell me?
   Look beyond the action to the underlying need. Is it physical discomfort? Emotional distress? Environmental overwhelm? Unmet social connection?
2. What has changed in their world?
   New medication? Different staff? Altered routine? Even subtle shifts can trigger profound responses in someone living with dementia.
3. How can I adapt my approach?
   The responsibility isn't on the person to change their behaviour—it's on us to modify our environment, communication style, and care approach.

This shift from control to curiosity is where dignity lives.

The Environment Speaks Too

Dementia care research consistently shows that the environment shapes behaviour as powerfully as any medical intervention.

High-stress environments create high-stress responses:

• Harsh fluorescent lighting increases agitation
• Background noise (TV, multiple conversations, equipment) heightens confusion
• Clutter and complexity trigger anxiety
• Inconsistent caregivers erode trust

Supportive environments reduce distress:

• Natural light supports circadian rhythms and mood
• Familiar objects and photos provide anchoring points
• Consistent routines create predictability and safety
• Meaningful activity prevents restlessness

One residential care home we worked with reduced "behaviours that challenge" by 60% simply by introducing quiet hours, dimming lights in the afternoon, and ensuring residents saw the same three staff members each day.

The smallest changes often yield the biggest impact.

Learning to Listen Without Words

Effective dementia communication requires us to become fluent in a new language, one spoken through:

• Body language: Tension, relaxation, withdrawal, reaching out
• Facial expressions: Grimaces of pain, frowns of confusion, eyes lighting up with recognition
• Vocal tone: Agitation, contentment, fear, joy
• Energy and rhythm: Restlessness, fatigue, engagement, disconnection

This attentive listening allows us to:

• Identify needs before escalation: Catch discomfort before it becomes distress
• Prevent crises rather than manage them: Proactive care instead of reactive intervention
• Build trust that transcends words: Consistent, empathetic presence creates safety

When a person living with dementia feels truly heard, something remarkable happens. Anxiety decreases. Connection deepens. Dignity is preserved.

From Understanding to Action: Building Skilled Teams

Compassionate care requires more than good intentions…. it demands knowledge, skill, and ongoing reflection.

At PMH Consultancy and Education, we equip care teams with practical frameworks to:

• Understand behaviour patterns: Identify triggers, unmet needs, and communication attempts
• Implement person-centred and person led strategies: Tailor approaches based on individual biography and preferences
• Create supportive environments: Modify physical and emotional spaces to reduce distress
• Build reflective practice: Foster cultures where staff regularly ask "What is this person experiencing?" rather than "What is this person doing?"

Empowered teams deliver transformative care. When your staff understand the "why" behind behaviour, they stop feeling frustrated and start feeling effective. Burnout decreases. Job satisfaction rises. And most importantly, the people in your care feel understood, valued, and safe.

The Invitation: Listen Differently, Care Differently

The next time someone living with dementia shouts, withdraws, or resists:

Pause.

Breathe.

Ask: "What might they be trying to tell me?"

Because when we listen to behaviour as communication rather than categorising it as a problem to solve, everything changes.

We move from control to connection.
From frustration to understanding.
From institutional care to truly person-centred and person led support.

Ready to Transform Your Dementia Care Approach?

If your organisation is committed to creating care environments where every person feels heard and valued, PMH Consultancy and Education can help.

Our services include:

• Dementia care training programmes tailored to your team's needs
• Person-centred and person led care frameworks and implementation support
• Environmental audits and improvement strategies
• Ongoing consultancy for sustainable culture change

Book a free discovery call to explore how we can support your team in building more compassionate, effective dementia care.

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