A Personal Connection
My interest in dementia care didn't begin in a textbook. It began during my undergraduate psychology studies, when I started learning about the lived experiences of families navigating a diagnosis that slowly reshapes who a person appears to be — while the person themselves remains at the centre. That interest has only deepened through my current Honours research at Charles Sturt University, where I'm investigating how workplace support may buffer the relationship between job demands and burnout among paid dementia care staff across Australian care settings. The more I learn about what care staff face day-to-day, the more convinced I become that positive behaviour support has an essential role to play — not only for the people living with dementia, but for the people walking alongside them.
Understanding Behaviour in Dementia
When we talk about "behaviours of concern" in dementia, we're usually referring to what the clinical literature calls behavioural and psychological symptoms of dementia (BPSD). These can include agitation, wandering, verbal or physical aggression, repetitive vocalisations, sleep disturbance, apathy, and resistance to personal care. These presentations are common — they occur in the majority of people living with dementia at some point across the disease trajectory — and they are one of the primary reasons families seek residential care and support staff experience workplace stress.
But these behaviours are not random, and they are not meaningless. They almost always serve a communicative function. A person who is calling out repeatedly may be in pain. Someone who resists showering may be frightened by a sensory environment they can no longer make sense of. A person who strikes out during a transfer may be responding to a perceived threat in a moment of confusion. If we start from the assumption that all behaviour is communication — a foundational principle in positive behaviour support — then we are already in a better position to respond with compassion and precision rather than restraint or sedation.
What Does PBS Look Like in Dementia Care?
Positive behaviour support (PBS) is a framework most people in the NDIS space associate with intellectual disability. And for good reason — it has a strong evidence base in that context. But PBS is not diagnosis specific. It is a values-driven, evidence-informed framework built on understanding why a behaviour occurs (its function) and then changing the environment, routines, interactions, and supports around the person so that the behaviour is less likely to occur and quality of life improves.
In dementia care, PBS involves several key elements. It starts with thorough functional assessment — understanding the antecedents (what comes before a behaviour), the behaviour itself, and the consequences (what happens after). From there, we develop individualised, preventative strategies that are grounded in person-centred care and designed to address the unmet needs driving the behaviour. These strategies might include environmental modifications (reducing noise, improving lighting, creating familiar sensory cues), structured routines that provide predictability, communication approaches tailored to the person's current cognitive and language capacity, and meaningful engagement in activities that connect to the person's life history and identity.
Critically, PBS in dementia must be adaptive. Unlike some other contexts where the goal is skill-building toward greater independence, dementia is a progressive condition. Strategies that work at one stage may need to be revised as cognitive and functional capacity changes. The PBS framework accommodates this — it is iterative by design, with ongoing monitoring, data collection, and plan review built into the process.
Recent Australian research has reinforced this. Fisher and colleagues (2022) outlined the case for extending PBS to dementia populations, noting that it provides a structured, non-pharmacological alternative at a time when legislation and best-practice guidelines are actively moving away from medication as a first-line response to BPSD. A subsequent pilot study by the same research group (Fisher, Reschke et al., 2024) trialled PBS training across three residential aged care organisations with support staff and family members. Participants reported increased confidence, improved knowledge of behaviour support principles, and a new understanding of why behaviours occur — shifting their focus from managing behaviour to understanding it.
Why the Workforce Matters
One of the clearest findings in the dementia care literature is that the quality of behavioural support a person receives is inseparable from the wellbeing and capability of the people delivering it. Staff working in dementia care — whether in residential aged care, community settings, or NDIS-funded supports — face high emotional demands, complex behavioural presentations, and often do so with limited training and resources. Research consistently shows that these demands contribute to burnout, compassion fatigue, and high turnover. In Australia, the National Disability Services Workforce Census has reported annual turnover rates in the disability sector of up to 25%, and aged care faces similar, if not more pronounced, challenges.
My research draws on the Job Demands–Resources (JD-R) theory, which proposes that burnout develops when the demands of work (time pressure, emotional load, complexity) outstrip the resources available to the worker (supervisor support, peer support, autonomy, training). Importantly, the JD-R model also suggests that certain resources — particularly perceived workplace support — can buffer this relationship. That is, when staff feel supported, the pathway from high demands to burnout may be weakened. If this buffering effect holds, it has direct implications for how organisations structure their teams, supervision, and professional development — particularly for staff working in behaviourally complex dementia care.
The takeaway for practice is straightforward: investing in staff support is not a luxury. It is a prerequisite for delivering quality PBS. A behaviour support plan is only as effective as the people implementing it. If support workers are burned out, under-trained, or unsupported, even the most carefully designed plan will struggle to be implemented with the consistency and responsiveness it requires.
Where PBS and Dementia Care Are Heading in Australia
There are reasons to be cautiously optimistic. The Australian Government's National Dementia Action Plan 2024–2034 has identified workforce capability as a priority action area, alongside improving diagnosis, post-diagnostic support, and research. The NDIS itself, while primarily designed for people under 65, funds behaviour support for younger-onset dementia populations and has driven significant growth in PBS practitioner capability through the Positive Behaviour Support Capability Framework. Meanwhile, recent cross-sectional research by Fisher and colleagues (2025) surveying residential aged care staff has reinforced the call for dementia-specific behaviour support training, dedicated behaviour support practitioner roles within aged care, and evidence-based practice frameworks that clearly define roles and expectations.
As PBS practitioners, we have an opportunity — and, I'd argue, a responsibility — to contribute to this evolving space. Whether we're working with a 42-year-old with younger-onset frontotemporal dementia under the NDIS, or consulting into an aged care facility supporting an 80-year-old with Alzheimer's disease, the principles remain the same: understand the person, understand the function of the behaviour, change the environment before you try to change the person, minimise restrictive practices, and keep quality of life at the centre.
Closing Thoughts
Positive behaviour support for people living with dementia is still an emerging application of a framework that has a much longer history in intellectual disability. But the early evidence is promising, the policy direction is supportive, and the need is urgent. What I've come to appreciate — through my clinical work at Kevria, my Honours research, and my own reading — is that good dementia care and good behaviour support are not separate things. They are the same thing, viewed through the same lens: understanding the person in front of you, respecting their rights, and building a world around them that makes sense.
References
Australian Government Department of Health and Aged Care. (2024). National Dementia Action Plan 2024–2034. https://www.health.gov.au/our-work/national-dementia-action-plan
Fisher, A., Connolly, T., O'Connor, C., & Kelly, G. (2022). Positive behaviour support for people with dementia. International Journal of Geriatric Psychiatry, 37(12). https://doi.org/10.1002/gps.5844
Fisher, A. C., Reschke, K., Shah, N., Cheung, S., O'Connor, C., & Piguet, O. (2024). "It's opened my eyes to a whole new world": Positive behaviour support training for staff and family members supporting residents with dementia in aged care settings. American Journal of Alzheimer's Disease & Other Dementias, 39. https://doi.org/10.1177/15333175241241168
Fisher, A., Reschke, K., Shah, N., Cheung, S. C., O'Connor, C. M. C., & Piguet, O. (2025). Behaviour support for people living with dementia in residential aged care: A cross-sectional survey of staff experiences and support needs. Dementia. https://doi.org/10.1177/14713012251366740
Kelly, G., Kremer, P., Louise, K., & Fisher, A. (2024). Behaviour support provision in Australia: A cross-sectional survey of practitioners developing behaviour intervention plans. Australian Journal of Social Issues. https://doi.org/10.1002/ajs4.307
Macfarlane, S., Kurrle, S., Grosvenor, S., & Cunningham, C. (2024). Editorial: Behaviour support for people with dementia. Frontiers in Psychiatry, 15, 1389668. https://doi.org/10.3389/fpsyt.2024.1389668