Behavioral Issues With a Long-Term Care Resident

If you are the adult child of an aging parent, you may have struggled with the idea of your parent moving into an assisted living community or some other type of long-term care center. Now you find yourself facing a situation in which your mother or father is engaging in problematic behavior at the assisted living or another type of senior community.

Fortunately, at this time administrators of the assisted living community want to try and find the cause and a solution to the behavior currently being exhibited by your parent. The reality is that there oftentimes are situations in which causes are eliminated and problematic behavior ceases. There are also situations in which treatments are available for some sort of condition that is giving rise to problematic behavior. 

In this article, we discuss behavior issues in long-term care. We take a look at causes and treatments, strategies to eliminate challenging conduct on the part of your parent. 

Four Categories of Causes of Long-Term Care Resident Behavior Problems

History suggests, and research confirms, that there are four broad categories of causes of long-term care behavior problems. These are:

  • Cognitive decline
  • Environmental factors
  • Inadequately treated pain or illness
  • Psychological factors

Cognitive Decline

A primary, if not the primary, reason individuals in long-term care exhibit behavioral problems is because of cognitive decline. Oftentimes, cognitive decline is categorized by medical professionals as mild, moderate, and severe. Some individuals postulate that behavioral issues are not displayed when an individual is rated as having only mild cognitive decline. In fact, that is a false conclusion (perhaps premised on false hope).

The reality is that when an individual begins to experience mild cognitive decline, that person very well may exhibit problematic behavior – including, but not limited to, aggression. For this reason, when cognitive decline is detected in a resident of a long-term care facility, including an assisted living community, that individual, family members, and staff need to be aware of the potential for behavioral issues. 

Later in this article, four strategies for intervention in regard to behavioral issues are discussed. If behavioral problems, including aggression, are exhibited when an individual is diagnosed with mild cognitive decline, these intervention tactics typically prove successful. In other words, a person with mild cognitive decline still has the capacity to rein in challenging conduct with the supportive assistance of the intervention strategies discussed in a moment in this article.

Environmental Factors

Environmental factors can play a primary role in behavioral issues or problems exhibited by a resident in a long-term care facility, including in assisted living. For example, if a person in a long-term care community (including assisted living) has a semi-private living space, that situation can represent an environmental condition that gives rise to negative behavior in some instances. A resident exhibiting problematic behavior is responding (albeit inappropriately) to his or her roommate or by the reality that he or she has to occupy shared space.

As is the case with behavioral issues arising from cognitive decline, there are intervention strategies to address problematic conduct arising from environmental factors. These are also discussed in a moment in this article.

Inadequately Treated Pain or Illness

Among the four categories of the most frequent reasons why behavioral issues arise among people in long-term care (including assisted living) is inadequately treated pain or illness. When it comes to pain, the better adjective really is improperly treated. This is because a person with pain issues might be undermedicated or overmedicated. In either scenario, the risk of inappropriate or problematic behavior is enhanced.

In addition, if an individual in long-term care is diagnosed with a disease, illness, or other type of medical condition, the failure to properly treat that matter can also give rise to problematic behavior. Interventions to address poor behavior arising from improper pain management and disease treatment are presented in a moment.

Psychological Factors

Finally, psychological factors can impact the manner in which a person in long-term care behaves or conducts his or her self. Different psychological factors or issues can result in an older individual exhibiting behavioral problems:

  • Anxiety
  • Depression
  • PTSD

In some instances, a person in long-term care, including assisted living, may be suffering from multiple mental health conditions. A common combination of mental health conditions afflicting an older individual is that of anxiety and depression. 

Four Categories of Treatments for Long-Term Care Resident Behavior Problems

Once again, history suggests and research supports the determination that treatments for behavior problems fall into one or another of four broad categories. These are:

  • Behavioral interventions
  • Environmental changes
  • Medication
  • Psychological interventions

Behavioral Interventions

There are behavioral interventions that can be helpful in addressing a resident of assisted living or some other type of long-term care facility who may be “acting up.” For example, if a resident is being disruptive of a community event, program, or activity, the individual can be removed from the function. This does need to occur in a respectful manner and not in a way that is overly punitive or degrades the resident.

Environmental Changes

Environmental changes can also be helpful in modulating negative behavior displayed by a resident of a long-term care facility. The roommate scenario discussed elsewhere in this article provides a useful example when it comes to environmental changes. 

If a resident is engaging in inappropriate behavior seemingly due to a roommate situation, an environmental change may make a difference. In other words, moving the resident displaying problematic behavior to another room may eliminate the underlying cause of the disruptive conduct. 


In many instances, behavioral issues associated with a resident of long-term care, including assisted living, can be addressed with the use of medication. Medication can be helpful in controlling inappropriate behavior of a resident of long-term care in a number of ways:

  • Medication can be used to manage pain properly
  • Medication can be utilized to appropriately treat a medical condition or disease
  • Medication can be used to address mental health conditions like depression or anxiety

Keep in mind that the recommendation here is not to unnecessarily sedate a resident of a long-term care facility unnecessarily. The idea of gratuitously sedating residents is not an accepted practice in this day and age. 

Psychological Interventions

A final area in which intervention is possible when it comes to a long-term care resident with behavioral issues is found in psychological interventions. Psychological interventions can include:

  • Individual therapy
  • Group therapy
  • Psychiatric assistance (including appropriate psych medication or mediations)

In the final analysis, a good many behavioral issues that can arise with a resident of long-term care, including a person in assisted living, are manageable. In other words, a number of behavioral issues can be resolved with proper intervention.

If a resident is facing cognitive decline, ultimately the time may come when such a person will need to be assessed for a different living environment. For example, an individual afflicted with progressive cognitive decline may end up with a dementia diagnosis, including Alzheimer’s disease. Such a state of affairs may necessitate the transition of an assisted living community resident into a more appropriate memory center.