Rebuilding Dementia Care Skills After the Pandemic: A Guide for Care Facilities
The COVID-19 pandemic disrupted dementia care in facilities, causing skill loss, increased isolation, and a setback in care quality. This article explains why these changes happened and offers concrete steps to rebuild skills and routines. You are not alone in facing this challenge, and with patience and structured effort, progress is possible.
Key points
- The pandemic caused a significant setback in dementia care skills and quality in facilities.
- Rebuilding requires intentional, competency-based training and consistent routines.
- Resilience is possible—many care partners and staff have grown stronger through the experience.
- Personalized care based on life history and preferences is essential.
- Simple interventions like exercise and sensory activities can improve outcomes even in later stages.
- Supporting staff resilience is critical to retaining skilled caregivers and improving care quality.
How the Pandemic Affected Dementia Care Quality
The pandemic exposed and worsened the frailty of the dementia care system. Lockdowns, isolation, and staff shortages meant that many residents with dementia lost access to familiar routines, social interaction, and skilled care. Staff, often with minimal training in dementia-specific approaches, were asked to deliver compassionate care while also enforcing infection control measures. This created a situation where residents experienced increased confusion, agitation, and decline in daily living skills. The loss of in-person visits from family and friends further compounded the emotional and cognitive toll, as caregivers could no longer fill in the gaps in the person's history or provide the comfort of familiar faces.
Why Skills Were Lost and the Challenge of Rebuilding
Dementia care requires specialized skills that go beyond general caregiving. Many staff members entered the field during or after the pandemic without adequate training, leading to a 'fresh group' of workers who may be more detached and less aware of how to respond to dementia symptoms. The pandemic also disrupted ongoing training and support systems, such as support groups and in-person coaching, which are vital for building competence. As a result, care facilities lost ground culturally, with some reverting to outdated ideas about dementia symptoms rather than understanding them as expressions of brain change. Rebuilding these skills is not instant—it requires intentional, competency-based training and a commitment to creating a supportive environment.
The Role of Resilience and Hope
Despite the setbacks, resilience is a powerful force. Many care partners and staff have reported that they learned and came out stronger from the experience. Dementia itself has been described as a 'gift wrapped in a strange package,' and the pandemic forced many to find new ways to cope. Rebuilding skills is possible, especially when facilities invest in training that boosts knowledge and practical techniques. Even for those with later-stage dementia, simple interventions like 20 minutes of exercise twice a week can improve mobility and independence. The key is to approach rebuilding with patience, consistency, and a focus on the person's remaining strengths.
General caregiving information, not medical advice. Check medications and major care changes with your clinician.
Step-by-step
Start by conducting a skills audit with your care team. Identify which dementia care skills (e.g., communication, redirection, personal care) have declined or were never fully developed. Use a simple checklist or competency assessment tool to pinpoint gaps.
Implement a structured, competency-based training program for all staff. Use a curriculum that covers brain changes, communication techniques, and positive approaches to care. Schedule regular, short training sessions (e.g., 30 minutes weekly) rather than one-time workshops.
Re-establish consistent daily routines for residents. Post a visual schedule in each resident's room and common areas. Include times for meals, activities, rest, and personal care. Consistency reduces confusion and anxiety.
Rebuild social connections by facilitating small-group activities. Start with one-on-one interactions (e.g., reading a book together, looking at photos) and gradually introduce group activities like music sessions or gentle exercise. Use video calls with family if in-person visits are limited.
Use positive communication techniques: speak slowly, use simple words, and give one instruction at a time. When a resident is agitated, use a calm voice and a long exhale to lower the energy in the room. Avoid arguing or correcting—instead, validate their feelings.
Incorporate sensory activities that engage the person's remaining abilities. Examples: a hand massage with scented lotion, listening to familiar music, or folding towels. These activities can reduce agitation and provide a sense of purpose.
Monitor for signs of delirium, especially after illness or medication changes. Delirium can look like sudden confusion or agitation and requires immediate medical attention. Discuss any changes with the resident's clinician.
Create a 'care partner notebook' for each resident. Include their life history, preferences, likes/dislikes, and effective calming strategies. Share this with all staff and update it regularly. This helps fill in the gaps when the person cannot speak for themselves.
Schedule regular debrief sessions for staff to share challenges and successes. Use these to reinforce training and build team resilience. Encourage staff to take breaks and practice self-care to prevent burnout.
Evaluate progress monthly. Track improvements in resident engagement, reduction in agitation episodes, and staff confidence. Adjust the plan based on what works. Celebrate small wins to maintain motivation.
What not to do
Do not assume that staff who were hired during the pandemic have adequate dementia care skills. Many entered the field with minimal training. Instead, provide ongoing, structured training and supervision.
Do not rush to 'fix' everything at once. Rebuilding skills takes time. Trying to implement too many changes simultaneously can overwhelm both staff and residents. Focus on one or two key areas first.
Do not ignore the emotional impact of isolation on residents. Even if they cannot express it, they feel the loss of familiar faces and routines. Make an effort to provide consistent staff assignments and regular family contact.
Do not use a one-size-fits-all approach. Each resident has a unique history and set of abilities. Personalize care based on their life story, preferences, and stage of dementia.
Do not forget to support staff resilience. The pandemic increased burnout and turnover. Provide emotional support, recognition, and opportunities for professional growth to retain skilled caregivers.
Do not neglect the role of physical activity. Even for those with advanced dementia, gentle exercise can improve mobility and mood. Avoid keeping residents sedentary for long periods.
Practical tools
Skill Audit Checklist
Create a simple checklist covering key dementia care skills: communication, redirection, personal care, activity engagement, and infection control. Rate each staff member's competence (e.g., beginner, developing, proficient). Use this to guide training priorities.
Positive Communication Phrases
Use these exact phrases: 'I see you are feeling upset. Let's take a deep breath together.' 'Would you like to help me fold these towels?' 'It's time for lunch. Let's walk to the dining room.' Avoid: 'No,' 'You're wrong,' 'Remember...'
Visual Schedule Board
A dry-erase board or laminated card with simple icons (e.g., sun for morning, bed for sleep, fork for meals). Place in resident's room. Update daily. Point to each icon when explaining the next activity.
Life Story Template
A one-page form with prompts: 'Favorite music,' 'Past job,' 'Hobbies,' 'Children's names,' 'What calms them.' Fill out with family or from records. Keep in resident's chart and share with all staff.
Calming Kit
A small box with items: scented lotion (lavender), a soft fabric square, a photo album, a familiar music player with headphones, and a stress ball. Use when resident shows signs of agitation.
Staff Debriefing Guide
A 10-minute structured conversation: 'What went well today?' 'What was challenging?' 'What did you learn?' 'What support do you need?' Rotate facilitators to build team cohesion.
Discuss with your clinician
Ask the resident's doctor about any new medications or changes in behavior that may indicate delirium or infection.
Discuss the appropriate level of physical activity for residents with advanced dementia or other health conditions.
Inquire about the need for a formal cognitive assessment after a period of decline to rule out other causes.
Ask about the use of antipsychotic medications for agitation—these should be used only as a last resort and under close supervision.
Discuss the facility's infection control protocols and how they can be adapted to minimize distress for residents with dementia.
Related guides
- Caring for a person with dementia during COVID-19 at home
- Caregiving techniques for attention deficits in dementia
- Positive Approach to Care (PAC): A Practical Guide to Teepa Snow's Philosophy, Training, and Resources
- Delirium symptoms overview
- Resilience and Perceived Gains: How to Protect Your Mental Health as a Dementia Caregiver
- hoarding and dementia
- Dementia sensory simulation exercises for caregivers
- life and purpose after a dementia diagnosis
- Trauma-Informed Caregiving: A Framework to Prevent Burnout