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Substitution Instead of Subtraction: How to Change a Problematic Behavior Without Causing Distress

When your loved one with dementia does something that creates a challenge—like wandering, spilling drinks, or hiding items—your first instinct might be to take the thing away or stop the behavior outright. But that often leads to confusion, frustration, and more distress for both of you. The strategy of 'substitution instead of subtraction' means you replace the problematic object or activity with a safer, more acceptable alternative, without the person even realizing something was removed. This approach honors their dignity, reduces agitation, and gives you concrete, practical tools to try today. You are not failing; you are learning a new way to connect and care.

Key points

  • Substitution means replacing a problematic behavior with a safer, acceptable alternative—never taking something away without offering something else.
  • Always start by observing the behavior to understand the unmet need behind it—physical, emotional, or environmental.
  • Use the 'cover and redirect' technique: present a new, exciting object, then gently cover the old one without mentioning it.
  • Keep your language simple, use gestures, and offer positive feedback—avoid arguing or correcting their reality.
  • Document what works and what does not, and be flexible—what works today may not work tomorrow.
  • Take care of yourself first; you cannot substitute effectively if you are burned out. Use respite care and support groups.

Why Subtraction Backfires and Substitution Works

When a person with dementia experiences a change in their environment—like having something taken away—their brain may not process the removal as a logical safety measure. Instead, they may feel a sense of loss, confusion, or even threat. Teepa Snow’s Positive Approach to Care explains that people living with dementia often lose 'object permanence'—the ability to remember that something existed once it is out of sight. So if you try to remove a mirror because they are frightened by their reflection, they may not recall the mirror was there, but they will feel the distress of something being 'gone' without understanding why. This can lead to agitation, searching behaviors, or accusations of theft.

Substitution works because it taps into what is still present and engaging. Instead of taking away the mirror, you cover it with a curtain or a piece of fabric and immediately draw their attention to something else—a photo album, a snack, or a walk. The old object is not removed; it is simply hidden behind something new and interesting. The person’s brain does not have to process a loss; it only has to process a new, positive focus. This reduces the cognitive load and the emotional fallout, making the day smoother for both of you.

The Brain’s Need for Safety and Predictability

Dementia changes how the brain interprets the world. What seems like a simple fix to you—like hiding the car keys to prevent wandering—can feel like a betrayal or a mystery to your loved one. They may not remember where the keys were, but they will feel the absence and become anxious or suspicious. The source passages from Dementia Careblazers emphasize that the goal is not to 'correct' the person or remove the problem, but to 'remove the obstacle' in a way that does not create a new problem. For example, if someone throws away good bread because they think it is stale, you can put the bread in a place they cannot easily access (like the back of the fridge) and put a bell on the refrigerator door so you hear when they open it. Then, when they go for the bread, you can intervene with a redirection: 'Oh, can I have a piece of that bread?' This way, you are not taking the bread away; you are substituting the action of throwing it away with a social interaction.

The key is to see the behavior as a symptom of an unmet need—whether physical (hunger, pain, needing the bathroom), emotional (fear, loneliness, boredom), or environmental (too much noise, confusing shadows). Teepa Snow advises caregivers to 'stop the judgment' and instead ask: 'What are they trying to do? What need are they communicating?' When you shift from 'How do I stop this?' to 'What can I offer instead?' you open the door to creative, compassionate solutions that preserve their sense of control and your peace of mind.

General caregiving information, not medical advice. Check medications and major care changes with your clinician.

Step-by-step

  1. Pause and observe without judgment to find the real need behind the behavior—note the time, place, and what happened just before, since the behavior usually has a purpose (boredom, fear, hunger, insecurity, restlessness).

  2. Choose a substitution that meets that same need in a safer or simpler way—for example, a supervised walk or a folding-towel chore instead of unsupervised wandering, pre-cut bite-sized food instead of a knife, or an automated pill dispenser that locks after each dose instead of a visible bottle.

  3. Use 'cover and redirect' to make the swap feel seamless: place a new, engaging object (a colorful scarf, a photo album, a soft fidget item) in their line of sight, and as they reach for it, gently drape a cloth over the problem item so its disappearance goes unnoticed.

  4. Introduce the substitution with simple words, a warm and unhurried tone, and hand-under-hand guidance—touch the item to your own lips or hands first, then guide theirs, and praise even the smallest attempt so the moment feels like success rather than correction.

  5. If it doesn't work, step back and try again later with a different object, activity, or setting—dementia is unpredictable, and flexibility matters far more than getting it right the first time.

  6. Keep a simple log of what works and what doesn't so patterns emerge and you can prepare substitutions ahead of time; this also eases the guilt that comes from feeling like nothing you try helps.

  7. Take care of yourself first—step away when you feel overwhelmed, reach for respite care or a friend, and replace the word guilt with the word regret, reminding yourself that doing your best is enough.

What not to do

  • Don't argue or try to correct their reality; if Dad says he needs to go to work tomorrow, join his world with 'You worked so hard—tell me about your job,' and let the conversation flow toward a related memory or activity.

  • Don't remove an object abruptly without a replacement ready, because the sudden absence will register as loss or even theft in their mind, even if they can't name what they're missing.

  • Don't use physical force, grabbing, or restraint during an outburst—give them space, leave the room if needed, quietly remove any weapons or sharp objects from reach, and return a few minutes later with a calm demeanor and a fresh approach.

  • Don't take the behavior personally or assume it's intentional; when they are hardest on you, it is often a 'cruel compliment' meaning they trust you enough to let their guard down, and the behavior is a symptom of a struggling brain, not an attack on you.

  • Don't use 'elderspeak' or a childlike, high-pitched tone—simplify your words and slow your pace, yes, but always speak to them as the adult they are, using their name and respectful phrasing.

Practical tools

  • Behavior Tracking Log

    A simple notebook or phone note with columns for date, time, behavior, what seemed to trigger it, what substitution you tried, and the outcome—within a week or two, clear patterns usually appear that help you plan ahead.

  • Substitution Brainstorm Worksheet

    A two-column page: 'Need I observed' on one side (restlessness, fear, thirst, need to feel useful) and 'Safe substitutes I could try' on the other, with a notes area to record which ones they actually accepted.

  • Teepa Snow's Positive Approach to Care Resources

    Free and paid videos, online workshops, and the hand-under-hand technique tutorials that underpin the substitution method, giving you a visual reference you can return to whenever a new behavior surfaces.

  • Respite Care Locator

    The ARCH National Respite Network or your local Area Agency on Aging can connect you to in-home aides, adult day programs, or short-term respite stays so you can step away to rest without worrying about your loved one's safety.

Discuss with your clinician

If your loved one is taking multiple medications and you are considering an automated pill dispenser, ask the doctor or pharmacist which model is safe and how to set it up correctly. Some dispensers may not be suitable for certain medications (e.g., those that need refrigeration).

If the behavior you are trying to substitute involves aggression, self-harm, or refusal of essential care (like eating or bathing), discuss with the doctor whether there is an underlying medical issue (e.g., infection, pain, or medication side effect) that needs treatment before behavioral strategies can work.

If you are considering using a lock or alarm to prevent wandering, ask the clinician about the safest options that do not create a fire hazard or a fall risk. Some locks may be illegal in certain facilities or states.

If your loved one has a history of falls or seizures, discuss any environmental changes (like moving furniture or covering mirrors) with their doctor to ensure safety.

Related guides

Sources