Behaviours of Concern MAT Aged Care

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About us

MAT Aged Care Centre (MAC) – Queensland provides permanent aged care and residential respite care options, with professional nursing staff operating round the clock and visits from specialist clinicians. In addition, we offer care, support and programs for people living with dementia.

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When working in frontline healthcare, it is important to understand that people do not always act or respond to situations in a predictable manner.

Everyone who works with people should have a basic understanding of how to identify and respond to behaviours of concern. This applies to aged care workers as well as people working in a range of other roles. In the past, behaviours of concern were often referred to as difficult or challenging behaviours.

They can include a range of behaviours that are not appropriate in a particular situation or indicate that an individual is experiencing problems related to their physical or mental health, the environment or how they communicate with or relate to others.

Duty of Care

The quality of care a resident receives from nurses and other staffs in the aged care home can make the difference between enduring life or enjoying it; and the duty undertaken by staff for the care of residents goes beyond the legal duty to exercise due care in order to avoid causing them injury. Staff in the aged care home are also obligated to display compassion and kindness as well as adhering to ethical and moral codes in providing services to the residents.

Code of Conduct for Aged Care

The Code of Conduct for Aged Care describes the behaviour expected of aged care providers, their governing persons (e.g. board members and Chief Executive Officers) and aged care workers.

The Code gives the Aged Care Quality and Safety Commission (the Commission) the power to deal with behaviour that is not consistent with the Code and has been developed based on the existing National Disability Insurance Scheme (NDIS) Code of Conduct.

Who is covered by the Code?

The Code will apply to residential, home care and flexible care services. Flexible care includes the Transition Care Program, Multi-Purpose Services Program and Short-Term Restorative Care Program.

The Code will apply to:

  • approved aged care providers
  • their governing persons (e.g. board members and CEOs)
  • aged care workers who are:
    • employed or otherwise engaged (including on a voluntary basis) by the provider
    • employed or otherwise engaged (including on a voluntary basis) by a contractor or subcontractor of the provider to provide care or other services to consumers.

What are your responsibilities?

People receiving aged care should always be treated well and feel safe.

As an aged care worker providing care, supports and services, you have the most contact with people receiving care. Your behaviour affects how people feel about themselves and if they feel safe and supported.

You must always act in a way that is respectful, kind and consistent with the behaviours set out in the Code.

Your responsibilities under the Code are in keeping with your existing obligations under the Aged Care Act 1997 (the Act), including the Aged Care Quality Standards.

What are provider’s responsibilities?

Approved providers must behave and treat people receiving aged care services in ways consistent with the Code and take steps to make sure aged care workers and governing persons do the same.

Providers are expected to support, equip and prepare you to carry out your role. This includes, for example, providing training, making sure policies and procedures are easily accessible, and taking action to make sure you meet the Code.

What can the Commission do?

The role of the Commission is to protect and enhance the safety, health, wellbeing and quality of life of people receiving aged care services.

If it is found that an aged care provider and/or the people who provide care have behaved in a way that is not consistent with the Code, the Commission can take action.

The legislation includes protections to ensure providers or individuals are given the chance to respond to concerns raised. Appropriate procedural fairness applies.

The Commission have access to a range of compliance and enforcement actions to respond to different situations. In severe cases, action may include banning a current or former aged care worker or governing person from working in aged care. In the case of approved providers, sanctions may be applied or the approved provider status may be revoked.

Definition of Behaviour of Concern

Behaviours of concern means culturally unacceptable behaviour/s of such intensity, frequency or duration that the physical safety of the person or others is likely to be placed in jeopardy, or behaviour which is likely to seriously limit use of, or result in the person being denied access to, ordinary Aged Care facilities.

Behaviours of Concern

People experiencing confusion or other cognitive impairments may have difficulty thinking clearly and understanding what is happening around them.

Confusion or cognitive impairment may be associated with dementia, but can also be a result of other conditions such as dehydration, infections or reactions to medications. People experiencing confusion may appear to be forgetful, puzzled, bewildered, uncertain, angry, upset or distressed


Changes in the behaviour of elderly people or those who suffer from medical conditions for example dementia are very common. Aggression in dementia is characterised by physically and/or verbally threatening behaviours directed at people, objects or self. It is often quantified by specific acts which can include:

  • verbal insults, shouting, screaming
  • obscene language
  • hitting, punching, kicking
  • pushing, throwing objects
  • sexual aggression

Aggression can be a purposive and overt response to a violation of personal space or a perceived threat. It often occurs during personal care tasks involving close carer-/staff-resident contact. Aggression can also arise from underlying depression, psychotic symptoms,

environmental stressors and/or unmet needs.

Intrusive behaviour

A person who is intrusive can cause other people offence. You need to handle the situation sensitively because they may not be aware that they are being intrusive and acting in an inappropriate way. Intrusive behaviour includes going through other people’s things or being too interested in their personal lives. You should:

  • gently steer the people away from the situation where they are engaging in intrusive behaviour
  • change the topic of conversation if the people asks someone else too many personal questions or gossips about others
  • provide diversional activities so the people will not be bored

Manipulative behaviour is not as noticeable as some other behaviours of concern. You may need to observe this over a period of time. Once you are aware that someone is engaging in manipulative behaviour, monitor what is happening and intervene if necessary to prevent others being manipulated. You should:

  • learn to recognise an individual’s preferred type of manipulative behaviour; for example, getting others to do things for them or spreading false information X observe the impact the behaviour has on others
  • be firm but gentle when refusing requests or when intervening and explaining why their behaviour is inappropriate and hurtful to others.

Dementia causes people to lose their ability to recognise familiar places and faces. It’s common for a person living with dementia to wander or become lost or confused about their location.

Wandering can be dangerous, especially if the people wanders off in the evening. You need to act as soon as you see them start to wander and then apply strategies to minimise the wandering. You should:

  • search for the people in all the places they might be X notify your supervisor, other staff, security, the police and family members if it is clear the people has disappeared
  • if you find the people about to wander, speak calmly to them and gently guide them back to where they should be
  • offer diversional activities they enjoy
  • monitor them closely
  • ensure the people has regular health checks for their health.
Noisiness / Vocally disruptive behaviour

Vocally disruptive behaviour (VDB) is a term that includes screaming, abusive language, moaning, perseveration, and repetitive and inappropriate requests.

Calling out may be the only way that the person is able to communicate sadness, frustration or distress. It can be described as any vocalisation that causes stress within the persons environment.

VDB can be intermittent or incessant and include vocalisations such as singing, screaming, abusive or verbally aggressive comments, perseveration, repetitive questioning, groaning and sighing.

Causes include physical and/or psychological discomfort or social isolation, combined with operant learning, in the context of reduced stress thresholds due to cognitive impairment.

Self-destructive behaviour

Put simply, self-destructive behaviour means doing things that will cause us physical or mental harm. Psychologists also refer to this as dysregulated behaviour. Sometimes these actions can bring pleasure in the short-term, or momentarily help to relieve feelings of stress, anxiety and depression.

Examples of self-destructive behaviors include: Physical harm or self-injury behaviors, such as cutting.

Verbal offensiveness

May include:



Harassment Verbal Abuse or threats


Refusal of care occurs when a resident chooses not to accept the services offered. Refusal can come in many forms:

  • Refusal service (i.e. showering/toileting)
  • Refuse what is required
  • Refuse to eat
  • Refuse to take medication

Inappropriate behaviour / Disinhibited behaviours

Inappropriate behaviour or disinhibition in dementia typically occurs with reduced capacity to edit immediate impulsive responses. Behaviours include those associated with impaired judgement and reduced awareness of the environment and the impact on others.

These behaviours can include:

  • simulating sexual acts
  • requesting unnecessary genital care
  • attempts at intercourse, rape
  • sexual aggression
  • propositioning others
  • grabbing, groping
  • sexual remarks
  • masturbation in public
  • exhibitionism
  • fondling, frotteurism
  • chasing others for sexual purposes

When disinhibited behaviours present with a sexual resonance, they tend to be more problematic. Sexually ambiguous behaviour such as undressing in front of others and/or in an inappropriate place or attempting to remove irritating clothing, e.g. tight or soiled underwear, may be mistakenly deemed sexually inappropriate. Urinating in inappropriate places can occur when the person with dementia is unable to remember where the toilet is or find their way to the

Additionally, misinterpretation of the intentions of carers and/or staff, an unmet need for human contact, attention or affection in combination with diminished insight, judgement and/or awareness of their surroundings and others, may trigger these behaviours in a person with dementia.


If a patient begins to show signs of apathy, follow the procedure below:

  • It is important to respond calmly so as to not cause the patient any distress
  • Evaluate whether there is anything abnormal about the persons behaviour
  • Do not let them feel concerned that they may be doing anything wrong
  • Break tasks into small manageable tasks that they can accomplish
  • Offer a different passive activity
  • Continue to monitor the patient
  • If they continue to be apathetic then report this to your manager.
Factors that contribute to behaviours of concern
FrustrationIsolationInfections including for example Urinary Tract Infection
Sleep deprivationFinancial pressuresPain
DisabilityCultureCentral Nervous System disorders
Trauma e.g. head injury, concussion, amnesiaSelf-esteemMental illnesses
Cerebral irritationPeer pressureCancer
Self HarmPerceptionsDiabetes
Factors that contribute to behaviours of concern
ABC Approach

At MAT Aged Care we use the ABC approach as a way of characterising events and resultant behaviours. A behaviour in response to an activating event generates a consequence. If the consequence is inappropriately managed, the situation may escalate and in turn become another activating event.

(Assess factors by reviewing information)
(Usually identified on the basis of observation of the patient)
(consequence of the behaviour for the patient)
Ask: ‘What are some care strategies that I can develop to
prevent the behaviour or prevent the severity of its impact?’

You will find an example scenario below.

De-escalation Procedure


You must follow the below procedure when dealing with aggressive patients.

  • Approach the person with respect and empathy
  • Try to manage your emotions – don’t take it personally
  • Anticipate any potential triggers for conflict
  • Monitor your non-verbal and verbal communication style
  • Manage the environment

The following principles will assist you in managing the situation effectively:

Monitor your verbal communication

  • Keep the conversation centred on the person’s needs.
  • Reassure them and acknowledge their grievances.
  • Have a concerned and interested tone of voice.
  • Ask open questions to build discussion.
  • Do not shout or raise your voice.
  • Do not give threats, orders or advice.
  • Avoid ‘If I were you…’ or ‘You’d better stop that right now or…’
  • Do not argue the point. You don’t need to defend or justify yourself.

Monitor your non-verbal communication

  • Allow time for open communication. Don’t rush
  • Move slowly and gently
  • Use culturally appropriate eye contact
  • Relax your body
  • Do not place hands on hips or in pockets, finger wag or prod, cross arms or clench fists
  • Give at least two arms’ length of personal space
  • Remove bystanders and unnecessary staff from the view of the person
  • or if possible, move the patient to an area away from public view
  • Consider the impact of sensory needs e.g. lighting, noise, sensory items
  • Ensure the person’s privacy
  • Keep exits clear and accessible
  • Remove potentially dangerous items
  • If the person has a weapon ask them to put it down. Don’t ask them to hand it over.
  • If you are in immediate danger use the panic button and call for help.
  • Call security or the police.

Managing the environment:

Procedures for our dementia patients

When dealing with dementia patients displaying behaviours of concern you must remember that these behaviours do not define them. These people are valuable and more valuable than their behaviour. People with dementia are more than what they are now. They are also the culmination of what they once were.

Having an understanding of your patients’ background can assist you in seeing them in a different way. This is the first step when dealing with any behaviour of concern. See below for additional strategies when dealing with specific behaviours of concern:


As soon as patient has been identified as missing and all rooms have been checked, the following procedure must be followed:

  • Check the logbook to find out when the patient was last seen
  • Check the patients file to find out more about them if you do not know them well enough
  • Check areas that the patient likes to visit first and connects them with their past
  • When the patient has been located, remind them where they are and who you are
  • Remember that they may have mobility issues and may forget, ensure that you know what the patient requires.
  • If patient cannot be located within 30 mins, you must report this to your manager.
  • The manager will decide when to would be appropriate to contact police – this will be assessed on a case-by-case basis.
Inappropriate behaviour

Ensure you keep yourself and your reputation safe by keeping your physical distance, staying visible in a common area and try to have two people with the patient at all times. When meeting with the patient follow the procedure below:

  • Start by making the client feel as if they are important
  • Do not respond to flirting with flirting
  • Distract the patient when they try to make inappropriate comments by asking them questions and changing the topic
  • Change the topic
  • Do not discipline the behaviour
  • Check the environment to see if there is a trigger for the behaviour
  • If no trigger is identified, stay calm and ignore the behaviour
  • If the behaviour escalates to a point of distressing others, then seek assistance from your manager.
  • Where behaviour is not able to be managed with these strategies then the behaviour must be reported and a behavioural management plan will be implemented.

When approaching a patient, always ensure you make them feel important. Ask them questions about their day and find out a bit more about them. This will assist you with building a relationship of trust. If a patient refuses to take medication, then follow the procedure below:

  • Start by making the client feel as if they are important
  • Engage the patient in the process rather than telling them they have to do it
  • Frame the behaviour in a way that will allow them to see that doing what is being asked is a good choice
  • Allow them to make the decisions for themselves

If a patient becomes aggressive while you are speaking with them, follow the procedure below:

  • Be mindful of your safety. If you are feeling unsafe or threatened, then leave and seek assistance from your manager
  • Evaluate the patient and the threat level
  • De-escalate the aggression by utilising the de-escalation procedure
  • If it feels safe then engage in conversation
  • Engage them in the process
  • Do not tell them how things are going to be
  • Explain what you would like to do and have them be involved

If a patient begins to show signs of apathy, follow the procedure below:

  • It is important to respond calmly so as to not cause the patient any distress
  • Evaluate whether there is anything abnormal about the persons behaviour
  • Do not let them feel concerned that they may be doing anything wrong
  • Break tasks into small manageable tasks that they can accomplish
  • Offer a different passive activity
  • Continue to monitor the patient
  • If they continue to be apathetic then report this to your manager.
Reporting Requirements
Non-Reportable Incidents – Reported in house

The employee must advise the Aged Care Director or Supervisor as soon as possible of the incident, even if they managed to diffuse the situation. Incidents which involve behaviour of concern or those behaviours which are deemed challenging to us must be reported using the Incident Report Form, within 24 hours after the incident occurring.

Mandatory Reporting

There are 8 types of reportable incidents that must be reported to the Commission:

  • Unreasonable use of force – for example, hitting, pushing, shoving, or rough handling a consumer
  • Unlawful sexual contact or inappropriate sexual conduct – such as sexual threats against a consumer, stalking, or sexual activities without consumer consent
  • Neglect of a consumer – for example, withholding personal care, untreated wounds, or insufficient assistance during meals
  • Psychological or emotional abuse – such as yelling, name calling, ignoring a consumer, threatening gestures, or refusing a consumer access to care or services as a means of punishment
  • Unexpected death – where reasonable steps were not taken by the provider to prevent the death, the death is the result of care or services provided by the provider or a failure by the provider to provide care and services
  • Stealing or financial coercion by a staff member – for example, if a staff member coerces a consumer to change their will to their advantage, or steals valuables from the consumer
  • Inappropriate use of restrictive practices – where it is used in relation to a consumer in circumstances such as:
    • where a restrictive practice is used without prior consent or without notifying the consumer’s representative as soon as practicable
    • where a restrictive practice is used in a non-emergency situation, or
    • when a provider issues a drug to a consumer to influence their behaviour as a form of restrictive practice
  • Unexplained absence from care – where the consumer is absent from the service without explanation and there are reasonable grounds to report the absence to the police.

The Commission must be notified of all reportable incidents. This includes incidents that occur, or are alleged or suspected to have occurred, and includes incidents involving a care recipient with cognitive or mental impairment (such as dementia).

Incidents that are not one of the 8 reportable incident types listed above are not required to be reported to the Commission. However, depending on the circumstances, they may need to be reported to another government body.

Approved providers should always consider their local regulatory environment when determining whether an incident must be reported and to whom.

All incidents that occur in the provision of care, whether reportable or non-reportable, must be managed in line with a service’s IMS.

Reporting Timeframes

If a reportable incident occurs or is alleged or suspected to have occurred, the provider must immediately act to protect the safety and wellbeing of those involved.

You must indicate whether the incident is either Priority 1 or Priority 2 based on:

  • the incident type
  • the harm and/or discomfort caused to the resident
  • whether there are reasonable grounds to report the incident to the police.

The priority of the incident determines when it must be reported to the Commission.

Priority 1 Reportable Incident

Priority 1 reportable incidents must be reported to the Commission within 24 hours of the provider becoming aware of the incident.

Priority 1 reportable incidents are incidents:

  • that have caused or could reasonably have been expected to cause, a consumer physical or psychological harm and/or discomfort that would usually require medical or psychological treatment to resolve, or
  • if there are reasonable grounds to contact the police, or
  • of unlawful sexual contact or inappropriate sexual conduct, or
  • when there is the unexpected death of a consumer or a consumer’s unexplained absence from the service.

Reporting to the police

You must report an incident to the police where there are reasonable grounds to do so. This includes scenarios where you are aware of facts or circumstances that lead to a belief that an incident is unlawful or considered to be of a criminal nature (for example sexual assault). These incidents must also be reported to police within 24 hours of becoming aware of the incident.

Reporting to police in relation to criminal conduct should occur regardless of whether the incident is alleged or suspected to have occurred.

If you are in any doubt about whether an incident is of a criminal nature, make a report to the police. Police are the appropriate authorities to investigate and identify whether an incident may involve criminal conduct.

Priority 2 Reportable Incident

Priority 2 reportable incidents are those that do not meet the criteria for a Priority 1 reportable incident.

Providers must report Priority 2 reportable incidents to the Commission within 30 days of becoming aware of it occurring.

Providers must report incidents using the SIRS tile on the My Aged Care Provider Portal.

Assault by Residents with a Mental Impairment

There are exceptions where reporting externally is optional where an assault has been carried out by residents with a mental impairment.

  • In this case the facility must have reasonable grounds for believing that the person who carried out the reportable assault is a resident with diagnosed mental impairment. The facility must form this view within the 24 hours after the allegation of the reportable assault or after starting to suspect on reasonable grounds that a reportable assault has occurred:
  • In this case an internal report must be done and care plans for behaviour management reviewed and evaluated to prevent repeat of similar incident. The records of both the incident, management plans for prevention of the repeated incident must be kept in the Compulsory reporting files.

When is Defusing conducted

Defusing (immediate small group support) is conducted by a trained staff member and is designed to bring the experience of the incident to a conclusion and provide immediate personal support. The aim is to stabilise the responses of workers involved in the incident and provide an opportunity for them to express any immediate concerns. This step should take place within 12 hours of the incident.

Strategies include:

  • Review the event.
  • Clarify workers’ questions and concerns.
  • Encourage workers to talk about what happened.
  • Identify current needs.
  • Offer workers advice, information and handouts on referrals and support agencies.
  • Arrange debriefing and follow-up sessions to provide additional information about the event when available.

Debriefing (powerful event group support) is usually carried out within three to seven days of the critical incident, when workers have had enough time to take in the experience. Debriefing is not counselling. It is a structured voluntary discussion aimed at putting an abnormal event into perspective. It offers workers clarity about the critical incident they have experienced and assists them to establish a process for recovery.

Trained debriefers help the workers to explore and understand a range of issues, including:

  • The sequence of events
  • The causes and consequences
  • Each person’s experience
  • Any memories triggered by the incident
  • Normal psychological reactions to critical incidents
  • Methods to manage emotional responses resulting from a critical incident.
Where to get help
  • Your supervisor or manager
  • Human resources manager or officer
  • Occupational health and safety officer
  • Health and safety representative
  • Your doctor
Training Videos
Behaviour of Concern – Aggression

Behaviour of Concern – Apathy
Behaviour of Concern – Inappropriate Behaviour
Behaviour of Concern – Refusal
Behaviour of Concern – Wandering