Solving Dementia Mysteries

Dear Dr. Jeff: Our team struggles with the reality of the attempt to provide quality care for residents with dementia and the care philosophy espoused by dementia experts and enshrined in regulations by CMS. We believe in nonpharmacologic approaches, in person-centered care, in the theory that dementia behaviors are not simply random and should be understood. And, of course, we are well aware of the black box warning on antipsychotic use for dementia management. But when residents kick, bite, or scratch our staff and sometimes other residents, when incessant screaming disrupts the other residents, when noncompliant behaviors place residents at risk of injuring themselves or endanger potential recovery and return to the community, we often seem to have few alternatives.