--- title: "Dementia and changed behaviours training for care workers" description: "What Australia’s Aged Care Quality Standards and US nurse aide rules ask of dementia training, and how care staff practise the moment a resident says no." canonical: https://peopletechrevolution.com/work/industries/aged-care-disability/dementia-changed-behaviours-training --- [Our Work](https://peopletechrevolution.com/work) / [Industries](https://peopletechrevolution.com/work/industries) / [Aged care](https://peopletechrevolution.com/work/industries/aged-care-disability) # Dementia and changed behaviours training for care workers When a resident living with dementia says no, the next sentence decides the morning. The moment ## Seven in the morning, and the answer is no A woman living with dementia is woken for her shower by a worker she does not recognise. “We need to get you washed before breakfast” is true, and to her it can sound like a threat. Her voice rises, and so does the worker’s. The corridor, first thing in the morning. Her armchair, and the words to choose. Standing over her, or sitting beside her. The rules ## Dementia is named in the training rules Australia and the United States both name dementia in the training they expect of care staff. A new worker, before the morning round. ### Australia: the strengthened Quality Standards Australia’s [strengthened Aged Care Quality Standards](https://www.agedcarequality.gov.au/providers/quality-standards/strengthened-aged-care-quality-standards) reach this moment twice. Under [Outcome 5.6](https://www.agedcarequality.gov.au/strengthened-quality-standards/clinical-care/cognitive-impairment), people “who experience cognitive impairment (whether acute, chronic or transitory) receive comprehensive clinical care services”. [Action 2.9.6](https://www.agedcarequality.gov.au/strengthened-quality-standards/organisation/human-resource-management) asks that all aged care workers “regularly receive competency-based training in relation to core matters, at a minimum”, including “caring for individuals living with dementia”. Competence shows up in a bathroom, when a resident says no. Eye level, unhurried, in a sunroom. ### United States: nurse aide training Federal nursing home rules at [42 CFR 483.95](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-483/subpart-B/section-483.95) set nurse aide in-service training of “no less than 12 hours per year”, which must “include dementia management training and resident abuse prevention training”. The [National Institute on Aging](https://www.nia.nih.gov/health/alzheimers-changes-behavior-and-communication/coping-agitation-aggression-and-sundowning) explains why: “People with Alzheimer’s disease may become agitated or aggressive as the disease gets worse.” Where practice fits ## Understand the cause, then say the second sentence [Dementia Training Australia](https://dta.com.au/changed-behaviour-consultancy/) describes changed behaviour, sometimes called BPSD, as something staff can learn to understand the causes of, and find ways to avoid or reduce. Asking about the garden before anything else. ### The worker who had practised A second worker, on another morning, says her own name first, sits at eye level and asks about the garden. Nothing about the shower has been decided yet. Both workers completed the same module, and one of them had said that sentence before. Practice gives every worker that sentence, in a [VR de-escalation scenario](https://peopletechrevolution.com/xr/vr-de-escalation-training) where a wrong turn hurts no one. How it runs ## Short scenarios, between tasks Care workers rehearse in a [VR headset](https://peopletechrevolution.com/xr/virtual-reality) or with an [AI roleplay partner](https://peopletechrevolution.com/ai/ai-roleplay-practice) in a browser. Each attempt leaves a record: who practised, which situations, how many attempts. Practising the words in a headset. Message practice in an aged care lounge. Talking it through after an attempt. The evidence ## What the research reports A systematic review of VR simulation for family carers of people with dementia reports mixed results on empathy. An older woman meets her own reflection. ### Empathy, and practice [Huang and colleagues](https://doi.org/10.1111/inm.13240) report that “Inconsistent quantitative results were reported on the effects of VR-based simulation on empathy enhancement.” Practice for care staff aims at something narrower and easier to check: the worker rehearses the exchange, gets it wrong without anyone being hurt, and tries again. [Does VR training work?](https://peopletechrevolution.com/learn/does-vr-training-work) sets out effect sizes where studies report them. Where PTR began ## Aged care is where People Tech Revolution started Two public strands of that start: university trials in aged care, and The Ageing Revolution. PTR’s co-founder, interviewed on ABC News. ### QUT’s aged care VR trials QUT Design Lab ran [Transforming Aged Care with Virtual Reality](https://research.qut.edu.au/agedcarevr/) in 2021 and 2022 with Griffith, Melbourne, La Trobe and Monash, across six aged care facilities in Queensland and Victoria. [ABC News](https://www.abc.net.au/news/2022-06-02/qld-virtual-reality-aged-care-centres-covid/101112460) named Leonie Sanderson, our co-founder, as the project coordinator. An older woman’s first moments in VR. ### The Ageing Revolution [The Ageing Revolution](https://www.theageingrevolution.com/) began in 2015 as a force to address ageism, and it calls People Tech Revolution its tech arm. The wider work is on the [aged care training page](https://peopletechrevolution.com/work/industries/aged-care-disability), and the delivered programs are in the [aged care and disability case studies](https://peopletechrevolution.com/work/case-studies/aged-care-disability). Questions ## What providers ask first Short answers for educators, care managers and quality leads. An elder, her daughter, and a listener. ### How is this different from dementia awareness training? Awareness training teaches what dementia is. This is practice for what to say when a person living with dementia is distressed, and it builds on those basics. An orientation worker walks beside a man with a long cane. ### Does every care worker need a headset? The same rehearsal runs in a browser, which suits a rostered workforce across several sites. A clinician leans in to an older woman at the desk. ### Can scenarios come from our own homes? They are written from situations your staff describe, with no resident name or record in them. A volunteer talks with a coordinator. ### What does a quality lead see? Evidence of competency-based practice that someone outside the room can read: who practised, which situations, and how many attempts. An older man at a craft table, seen through the headset. ### Is disability support covered too? Disability support workers have [their own de-escalation training page](https://peopletechrevolution.com/work/industries/disability), and hospitals have [de-escalation training for hospital staff](https://peopletechrevolution.com/work/industries/healthcare-medical). - [Occupational violence and aggression training](https://peopletechrevolution.com/xr/occupational-violence-aggression-training) - [Psychosocial hazards training](https://peopletechrevolution.com/learn/standards/psychosocial-hazards) - [Customer aggression training](https://peopletechrevolution.com/xr/customer-aggression-training) - [Talk to us about your staff](https://peopletechrevolution.com/talk-to-us) Working in aged care or dementia care? [Open the contact form](https://peopletechrevolution.com/work/industries/aged-care-disability/dementia-changed-behaviours-training#contact) Ask Simon’s Digital Twin a question ## Sources Each rule in full, on the regulator’s own site. ### [Strengthened Aged Care Quality Standards](https://www.agedcarequality.gov.au/providers/quality-standards/strengthened-aged-care-quality-standards) Aged Care Quality and Safety Commission, Australia The Standards the two outcomes above come from. ### [Outcome 5.6, Cognitive impairment](https://www.agedcarequality.gov.au/strengthened-quality-standards/clinical-care/cognitive-impairment) Aged Care Quality and Safety Commission Care for people with delirium, dementia and other forms of cognitive impairment. ### [Outcome 2.9, Human resource management](https://www.agedcarequality.gov.au/strengthened-quality-standards/organisation/human-resource-management) Aged Care Quality and Safety Commission Competency-based training that includes caring for individuals living with dementia. ### [Changed Behaviour Consultancy](https://dta.com.au/changed-behaviour-consultancy/) Dementia Training Australia Changed behaviour, also called BPSD, and understanding its causes. ### [Virtual reality-based simulation intervention for enhancing the empathy of informal caregivers of people with dementia: a mixed-methods systematic review](https://doi.org/10.1111/inm.13240) Huang and colleagues, International Journal of Mental Health Nursing, 2024 Quantitative results on empathy were inconsistent. ### [42 CFR 483.95, Training requirements](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-483/subpart-B/section-483.95) Electronic Code of Federal Regulations, United States Nurse aide in-service training that includes dementia management training. ### [Coping With Agitation, Aggression, and Sundowning in Alzheimer’s Disease](https://www.nia.nih.gov/health/alzheimers-changes-behavior-and-communication/coping-agitation-aggression-and-sundowning) National Institute on Aging, United States Why agitation and aggression become more likely as the disease progresses.