When a person living with dementia reacts strongly to a caregiver because of their appearance, voice, accent, cultural background, or other personal characteristics, the situation can be particularly challenging for everyone involved.
The caregiver may feel hurt, rejected, or unsure how to continue providing care safely.
Families may experience their own emotional burden in these moments, including embarrassment, discomfort, guilt, or even fear of being perceived as discriminatory, particularly when the trigger relates to the caregiver’s appearance or ethnicity.
Finding a way to communicate this to the healthcare professional can feel quite daunting when all they are trying to do is protect their loved one’s comfort and dignity while also caring about the caregiver’s feelings.
The Difficult Realities of Living with Dementia
A note before we begin.
We are sharing these stories because what follows are stories that require conversations that can be difficult to have, but avoiding them does not help the person living with dementia, their family, or the caregivers providing their care.
Sometimes, the most compassionate response begins with asking a different question:
“What might this person be experiencing that we cannot see?”
That question can help us move beyond judgment and toward understanding, while still recognizing the dignity, safety, and emotional well-being of everyone involved.
The Story of Angie, Doreen, and Albert
The following stories are shared to provide context to help families and care professionals navigate through awkward and uncomfortable situations and consider the underlying reasons that may be contributing to these behaviours.
Angie’s Story
A home care coordinator shared an experience involving “Angie,” a woman living with Alzheimer’s disease who needed support with personal care and household tasks.
When arranging her care, Angie’s family made a specific request — one they shared somewhat awkwardly and apologetically. They explained that their Mom would become extremely distressed and angry during care interactions when supported by a caregiver who was non-caucasian and whose accent was pronounced. This was behaviour they had not seen before their Mom developed symptoms of dementia.
Although uncomfortable, the family asked whether this preference could be considered when assigning their mom’s caregivers.
The family also shared that before dementia changed Angie’s abilities, she had experienced a stressful experience involving a person of colour (the “trigger”) who worked in her home. They believed this past experience may have been connected to the reactions they were now seeing in their Mom.
Given the intensity of Angie’s distress and the known factors that appeared to trigger it, the care team chose to assign caregivers who were less likely to evoke these responses.
This was not about validating or reinforcing a bias. It was about recognizing a known trigger and considering how best to provide safe, respectful care. There was no benefit in repeatedly exposing Angie to a known source of distress when doing so could compromise Angie’s sense of safety and the safety and well-being of her caregivers.
Doreen’s Story
In a similar case, the long-term care staff noticed that “Doreen,” a woman living with dementia, would become highly distressed when supported by caregivers from different cultural backgrounds, particularly when their accents or communication styles were unfamiliar to her.
The staff has observed that Doreen would become resistant during care interactions with certain caregivers. As they learned more about Doreen’s history, they recognized that her reactions were connected to fear and past experiences rather than a deliberate intention to harm others.
Doreen herself may not have been able to explain why certain caregivers made her feel fearful or uncomfortable. With dementia, a person may lose some of their ability to understand (ie., reasoning impairment) what is happening in the moment, while feelings connected to past experiences (i.e., emotional memory) can remain. Doreen may have felt that something was wrong or unsafe without being able to explain why.
Albert’s Story
Before “Albert” moved into the care home from the hospital, his Care Plan stated that he should be supported by female workers only. Staff was warned that he could become physically aggressive with male caregivers, particularly larger men.
In the busy care home, however, having a female caregiver available was not always possible.
One morning, “Dom,” a tall, dark-skinned male care aide, heard Albert’s call bell. Dom knew he was not supposed to provide Albert’s care, but when he realized that a female caregiver had rung the bell for assistance, he went to help.
The moment Albert saw Dom, his expression changed. He raised his fist and threatened to hit him.
Dom was understandably concerned, but he remained calm and approached cautiously. “I’m here to help you,” he said. The female caregiver reassured Albert, explaining that she had asked Dom for help.
Although Albert remained distressed, Dom minimized physical contact, explained each movement before doing it, and kept his voice calm. Both caregivers were nervous, but they did their best not to let Albert see their anxiety. The morning care took longer than expected but was completed without incident.
Over the following weeks, Dom gradually began supporting Albert alongside female caregivers, and eventually, using Dom’s approach, other male caregivers started supporting Albert too. The team learned that Albert responded best when caregivers kept conversation to a minimum, especially if male caregivers were involved in the care.
The family later shared something that helped the team understand what may have been behind Albert’s reaction. While in the hospital, Albert had experienced an upsetting interaction with a male caregiver with dark skin and a strong, deep voice, who had been rough during care. His family believed this experience may have contributed to Albert becoming fearful and defensive around men who reminded him of that caregiver.
Trauma‑Informed Care in Dementia Support
Trauma‑informed care is an approach that recognizes how past experiences of fear, loss, or harm can shape a person’s emotional and behavioural responses in the present. It assumes that behaviour is often a reflection of the nervous system trying to protect the person. It is not an intentional or conscious choice, nor a personal attack, nor a sign of “difficult personality.”
Trauma‑informed care asks us to start by asking “Why?” or “What happened to this person?” rather than “What is wrong with the person?”
In the stories of Doreen, Albert, and Angie, each person showed behaviours that seemed confusing or hurtful at first glance, but when we looked deeper, we saw that their reactions were connected to past experiences, emotional wounds, or moments of fear that their brains could no longer sort through.
Trauma‑informed care helps us see these behaviours not as “problems,” but as “expressions of past pain resurfacing in the present.”
Imagine you once had a frightening car accident at a particular intersection. For years, that intersection was safe. You drove through it without thinking, but after the accident, your body remembers. Even though the intersection itself did nothing wrong, you might feel anxious every time you approach it. Your heart rate increases. Your hands tighten on the steering wheel. You may even avoid that route altogether.
The difference is that we can talk about it. We can explain what happened. We can unpack the fear, seek therapy, and slowly rebuild a sense of safety.
For someone living with dementia:
They may not be able to explain what they are feeling.
They may not understand why their body reacts the way it does.
They may not remember the event, but still feel the fear.
They may remain stuck in the emotional memory even when the factual memory is gone.
A Message of Inspiration and Gratitude to All Caregivers
Trauma-informed care matters deeply. It invites us to respond with patience, gentleness, curiosity, and compassion, and reminds us not to take changed behaviours in dementia personally.
Sometimes, even with the very best of intentions, we ourselves may be the trigger. When this happens, it does not mean we have failed, done something wrong, or provided poor care. In these situations, the most caring and compassionate thing we can do is to step away and allow someone else to provide the care.
Recognizing when our presence is contributing to a person’s distress and having the professionalism and humility to step back is not giving up. It is an act of caregiving. It protects the person’s dignity and safety while also protecting our own well-being.
Most importantly, we want to remind you not to allow someone’s changed behaviour to diminish the value of the excellent, compassionate, and caring work you do.
The care you provide matters.
Especially in the difficult, uncomfortable, and emotionally challenging moments, your kindness, patience, and compassion create an immeasurable impact on the well-being, comfort, and dignity of vulnerable people – particularly those whose changing cognitive abilities are no longer within their control.
Thank you for all that you do.
You are appreciated.
You are valued.
You are needed.
Free 20-Minute Consultation (for NEW Clients)
If you found this article helpful and if you’re worried about a loved one or a friend and aren’t sure where to turn, you’re not alone. We’re here to help! Reach out, and together we can brainstorm solutions tailored to your unique situation. Start by visiting our website at https://dementiasolutions.ca/private-consulting/ to schedule your free 20-minute consultation with one of our experienced Dementia Care Advisors. We’re here to support you every step of the way.
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DISCLAIMER:
This article is based on a true story; however, names, locations, and certain events have been altered to protect the privacy and confidentiality of the individuals involved. Any resemblance to actual persons, living or dead, or actual events is purely coincidental.
The contents of this blog are provided for information purposes only. They are not intended to replace clinical diagnosis or medical advice from a health professional.
