Redirecting, distracting, and reassuring aren't wrong. They just can't work until you understand what's actually happening first.
A husband in one of my support groups once told me, "I've tried everything." Redirecting. Distracting. Reassuring. Validating. He had done all of it, exactly as he'd been taught, and none of it was working anymore.
He wasn't doing anything wrong. That's what I want caregivers to hear first, because I've had this same conversation more times than I can count, and it almost always starts the same way: someone convinced that if a strategy didn't work, they must have done it wrong.
Most dementia care advice hands caregivers a list of strategies before it ever teaches them to ask what's actually happening. Redirect. Distract. Validate. Reassure. Those strategies aren't wrong. I teach them myself. But a strategy handed out before anyone understands the cause of a behavior is a guess, not a plan.
Why the Same Dementia Strategy Doesn't Always Work
As a physical therapist, I would never hand someone exercises for a sore shoulder without first finding out what was causing the pain. Two people can walk in with the exact same symptom and need two completely different treatments. Dementia behavior works the same way.
Take something as ordinary as someone refusing a shower. That single behavior could come from several different causes:
- The water might be too cold
- The bathroom might echo in a way that feels disorienting
- They might be embarrassed about needing help
- They might be afraid of falling
- They might be in pain
- Something frightening may have happened the last time they were in there
Each of those causes needs a different response. None of them get better because you switched to a different strategy on the list. They get better once you know which one you're actually dealing with.
What Should You Ask Before Responding to Dementia Behavior?
Before deciding what to do, ask what you're actually seeing. Not "what's the right thing to do" but "what's actually going on right now."
That single shift changes the whole process. Instead of running through a list of techniques and hoping one works, you start looking for the signal underneath the behavior itself: what changed, what might be uncomfortable, unfamiliar, painful, or overwhelming in this specific moment.
Researchers who study behavioral and psychological symptoms of dementia describe this the same way: behavior is a form of communication, especially once verbal language becomes harder to access (Warren, 2022). A person who can't say "I'm scared" or "that hurts" will often show you instead.
What Helps Tonight When a Strategy Stops Working
You don't need a new framework to start asking better questions. You can start tonight, with whatever is happening right now.
- Pause before you respond. A few seconds of noticing is more useful than jumping straight to a strategy.
- Ask three questions. What changed right before this started? What might be uncomfortable, painful, or frightening? What might be unfamiliar about this moment?
- Try one adjustment at a time. If you guess the water temperature is the problem, change only that before trying anything else, so you actually learn what worked.
- Write down what you notice. A single line in your phone (what happened, what you tried, what changed) turns tonight's guess into tomorrow's knowledge.
Reading the Behavior Before You Respond to It
The goal isn't a better strategy. It's a better question. Redirecting, distracting, validating, and reassuring will keep failing you if you reach for them before you understand what you're actually looking at. Ask what's going on first, and the right response gets a lot easier to find.
This is only the first piece. Once you get comfortable asking what's actually happening, the next question is how to organize what you find, so you're not starting from scratch every time. That's where we're headed next.
Want to hear the whole conversation? Navigating Dementia is up now. Search for it wherever you listen to podcasts, or hit play right here: episode link.
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ABOUT THE AUTHOR
Carlyn Lenfestey, PT, MPT, CDP, CADDCT, is a licensed physical therapist with 25 years of clinical experience and 15 years specializing in dementia care. She is the founder of A Better Way: Dementia Care Solutions, LLC, the creator of the Wheel of Function Framework™, and the host of the podcast, Navigating Dementia.
DISCLAIMER
The information provided in this blog is for educational purposes only and should not be considered medical advice. Always consult with a doctor or a licensed physical therapist before starting any new exercise routine, using assistive devices, or following the recommendations mentioned. Every individual's needs are different, and professional guidance is essential to ensure safety and appropriateness of care.
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