How to find a care home for people with behaviours of concern

When people have complex health conditions, they can show aggressive or verbally abusive behaviour. This can make safely caring for them a challenge and care homes for challenging behaviour are often a good option.

Many people with behaviours of concern, also known as challenging behaviour, are able to live in mainstream residential homes or supported living. Others thrive in care homes that specialise in care for people with these behaviours.

Finding a suitable care home for someone who displays challenging behaviour can feel overwhelming. Families often worry about safety, quality of care, and whether their loved one’s needs will truly be understood and met. With the right information and support, it is possible to find a care home that provides compassionate, specialist care and promotes dignity, wellbeing, and quality of life.

This guide explains what challenging behaviour means in a care setting and how to find a care home equipped to support it effectively.

What are behaviours of concern?

The term ‘behaviours of concern’ refers to behaviours that can cause harm or distress. This could be to the person doing them and/or other people around them or associated with them.

Behaviours of concern can include:

• Physical violence towards others or to themselves
• Verbal abuse
• Damage to property and possessions
• Sexually inappropriate behaviour, such as touching, language or taking their clothes off in communal areas thus impacting on their dignity
• Refusing to eat, drink or wash

Julie Booth, head of quality at Exemplar Health Care, says: “The people we support usually display behaviours which have made it difficult for them to interact with others safely or effectively. This might be physical or verbal aggression or offensive language. Many of them have been deemed to have behaviours that are considered ‘too complex’ for mainstream nursing and care services.”

How long a person lives with behaviours of concern depends on the cause and the individual. Many people with a brain injury can make a full or near-full recovery. But for people with dementia or other degenerative disorders, the damage to their brain gets progressively worse over time. Care for behaviours of concern supports each person and the challenges they face on an individual basis.

Ms Booth explains: “Our community-based homes and OneCare services provide person-centred care and rehabilitation that focuses on maximising independence, building everyday living skills and empowering people to live as fulfilled lives as possible.”

Why do people have challenging behaviour?

Behaviours of concern can have a range of causes, often involving damage to the brain or a mental health condition. 

People can experience behaviours of concern due to:

• Dementia
• A mental health condition, such as depression, bipolar disorder, schizophrenia or personality disorders
• A brain injury, such as from trauma to or medical insult to the brain such as a tumour, haemorrhage or infection
• A disability the person was born with, such as autism, or genetic conditions
• Stroke

These can affect a person’s ability to regulate their behaviour and emotions as well as others. They may lose their inhibitions, their reasoning and analytic skills or experience very strong emotions due to the chemical imbalances in the brain.

What are the signs of challenging behaviour?

People may exhibit these behaviours in response to something they are feeling but they are unable to understand why they feel that way or to express themselves or communicate effectively. They may show the behaviour because:

• They feel ill, in pain, hot, cold or uncomfortable
• They are confused or disorientated
• They are feeling a negative emotion, such as loneliness, sadness, anger or helplessness
• They feel overwhelmed by a strong urge or unpleasant thought
• They feel suffocated by their surroundings, such as in a loud or busy place

Why specialist care homes are important

Standard care homes may not always have the training, staffing levels, or environment needed to safely support challenging behaviour. Specialist care homes focus on understanding the cause of behaviour, not just managing the symptoms.

A good specialist care home will:

• Use person-centred care approaches
• Focus on de-escalation rather than restraint
• Adapt environments to reduce stress and triggers
• Employ trained, experienced staff
• Work closely with families and professionals

How do care homes reduce challenging behaviour?

Through professional care, many people find new coping strategies and learn skills to manage their feelings.

Ms Booth explains: “Our trained teams work with individuals to understand the reasons for their behaviour, learn the skills to manage their own behaviour, to identify, remove and reduce any trigger factors and implement strategies to reduce the frequency, duration and impact of incidents of behaviours of concern. 

“We look at psychological methods of distraction and diversion before other methods are considered.

“Our approach to behaviour support focuses on how we can prevent the need for restrictive practices and reduce the frequency and intensity of behaviours of concern, so that people can live a fulfilling life and integrate with society without their behaviour restricting what they can do.”

Care homes that care for people with challenging behaviour will have high staffing levels. Often one member of staff to one resident, or two members of staff to one resident. They will also have in-house activities and life skills teams that enable people to take part in everyday activities that are meaningful to them.

“This helps to reduce feelings of frustration for people who display behaviours of concern,” adds Ms Booth.

How to find a care home for challenging behaviour

Consider specialist or smaller settings

Smaller homes or specialist units may offer higher staffing ratios and more consistent, personalised support—often crucial for complex needs.

Get a needs assessment

Ask your local authority or healthcare team to assess care needs and confirm whether specialist provision is required, including staffing and behavioural support.

Use trusted sources to shortlist homes

Go to the leading care home reviews site, carehome.co.uk and you can search here for care homes in your area and look at reviews from the residents and their families. Look at regulator reports (e.g. CQC in England), local authority recommendations, and specialist provider listings. Prioritise homes with strong safety and responsiveness ratings.

Ask focused questions before you visit

Check their experience with challenging behaviour, staff training (e.g. PBS/de-escalation), staffing levels, incident prevention, and how families are involved.

Visit and observe the environment and culture

Notice how staff communicate, the atmosphere, noise levels, routines, and whether residents seem calm and engaged.

Trained and experienced staff

Staff should be trained in:

• Positive Behaviour Support (PBS)
• De-escalation techniques
• Mental health and neurological conditions
• Trauma-informed care

Ask about staff turnover and ongoing training, as consistency is crucial for people with complex needs.

Creating care plans

Every person who receives professional care has a care plan. This takes into account the person’s medical needs and care and support needs, plus their hobbies, interests and how they want to live a fulfilling life.

The care home should create detailed care plans that:

• Identify triggers for behaviour
• Set out proactive strategies to prevent distress
• Focus on strengths, preferences, and routines
• Are reviewed regularly

Behaviour should always be understood as communication.

Is medication used at care homes for challenging behaviour?

Medication can sometimes play a role in supporting people with challenging behaviour, but it should never be the first or only response. Good care homes view behaviour as communication and prioritise understanding underlying causes such as pain, anxiety, unmet needs, or environmental triggers.

Safe and ethical use of medication

A good care home will:

• Use medication only when clinically appropriate
• Involve GPs, psychiatrists, or specialist clinicians
• Regularly review dosage and effectiveness
• Aim to reduce or stop medication where possible
• Clearly explain decisions to families and advocates

Medication should never be used simply to control behaviour or make care easier.

‘Meaningful activities’ can help manage behaviours of concern

Activities are an important part of any care home. In a care home that specialises in challenging behaviour, having meaningful activities for the residents to take part in is an important part of supporting them to manage their behaviours of concern.

Ms Booth says: “‘Meaningful activities’ will depend on what’s meaningful to that person. They’re based on their interests, history, experiences and hobbies. 

“This may include everyday activities that promote a sense of worth or purpose, including choosing out clothes for the day or making a cup of tea, as well as social activities based on their interests and hobbies. As part of some people’s rehabilitation, we’ll work with them to develop everyday skills such as managing money or taking a bus journey.

“The people who live in our homes regularly go out shopping, to the cinema and for walks in the local area. They attend local events such as concerts and gigs. More recently, local Christmas light displays!

“We will always take a positive and proactive approach to this. If there are any risks associated with people going out of the home, we assess these and ensure that we have strategies in place, in advance, on how they’ll be managed.”

How do care homes keep residents with challenging behaviour safe?

Safety for people with behaviours of concern is crucial. Both from themselves and from other residents, particularly if they have aggressive behaviours.

Ms Booth says: “As part of the assessment process, we do a ‘community fit’ assessment which looks at whether our home is the right ‘fit’ for the individual, and if they’d be a good ‘fit’ for the home and the people who already live there.

“We carefully plan our care and support to minimise risk to everyone, and have stringent safeguarding procedures in place. 

“Alongside many of our care homes we have OneCare services. These services are flats or houses that offer specialist nursing care in a single or dual occupancy domestic living environment, that’s separate to the main care home. 

“They’re ideal for adults who have complex needs that cannot be met in a group setting. This may include those whose behaviours require that they live alone, or those who have difficultly tolerating living with others in a way that increases risk.”

Supporting staff safety and wellbeing

Care work can be an extremely rewarding job, but it is not always easy. Supporting staff wellbeing in care homes for people with behaviours has to be a high priority.

Ms Booth explains how they ensure the support and wellbeing of their team members at Exemplar Health Care: “All of our care and nursing colleagues complete our Exemplar Positive Behaviour Support (EPBS) training that’s been certificated by the British Institute for Learning Disabilities Association of Certified Trainers (Bild ACT). 

“This confirms that the learning meets the Restraint Reduction Network (RRN) Training Standards 2019. 

“The certificated EPBS training includes up to five days of learning. Two cover PBS theory, psychological support, self-protection skills and break away techniques. There are up to three days of level two training which covers restrictive practices. 

“The training provides colleagues with the skills and knowledge to protect people’s fundamental human rights and promote person-centred, best interest and therapeutic approaches to supporting people when they’re distressed. 

“We also have a central team of Mental Health and Behaviour Support Specialists who support our colleagues and service users who display behaviours of concern, including crisis or rapid intervention when a person’s behaviour is escalating.

“The team is made up of Behaviour Support Specialists who take the time to observe the individual, understand the reasons for their behaviour and suggest strategies to reduce distress or discomfort which might be causing the behaviour. 

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