Memory care units in assisted-living facilities, as well as facilities that are dedicated exclusively to patients suffering from dementia, provide residential services to older adults who suffer from Alzheimer’s disease and other forms of dementia. While “memory care” includes the same services that assisted-living facilities provide to residents who do not have dementia, it often supports residents with daily activities that exercise the brain, calm distress, and reduce the risk of self-harm. Memory care units and facilities also concentrate on resident safety by keeping doors locked, monitoring resident movements, and training staff members to deal appropriately with the agitation or aggression that may accompany Alzheimer’s.

Caregivers who manage dementia patients have a difficult job. While most older adults residing in assisted-living facilities recognize their need for help with their activities of daily living, Alzheimer’s patients may regard caregivers as strangers who want to hurt them. Learning how to respond nonviolently to aggression or to soothe a patient who resists bathing requires specialized training.

Unfortunately, caregivers have not always had the training they need. In response to local news reports about assisted-living facilities in Arizona that placed residents at risk, Arizona passed a law in 2024 that required the state Department of Health Services to establish binding standards for memory care providers. After a year of negotiation with providers and senior advocates, the state has announced new rules to improve the quality of care that dementia patients receive while assuring the safety of other residents.

Violence in Assisted-Living Facilities

NPR reports that “violent altercations between residents in long-term care facilities are alarmingly common.” Studies have found that 8% to 15% of residents have been subjected to verbal or physical abuse by other residents. The risk of being subjected to another resident’s aggressive behavior is highest in memory care units.

A year-long series of investigative reports by the Arizona Republic highlighted the prevailing belief that violent behavior by dementia patients is inevitable and that nothing much can be done about it. One facility had a particularly dismal record of violence leading to police intervention and citations by state regulators. The state is seeking to place that facility in receivership, a legal procedure to wrest control from its owners.

Violent behavior is clearly not the fault of residents who suffer from diseases that have damaged parts of the brain responsible for behavioral control. Violent behavior is typically a response to fear and confusion. Residents may become disturbed when another resident enters their room and may view violence as a preemptive act of self-defense.

Coping with potential and actual violence is a difficult burden for caregivers at assisted-living facilities. Research suggests that staff members are often “inadequately trained to manage the complex emotional, behavioral, and functional impairments characteristic of these residents.”

Arizona’s New Rules

In response to Arizona’s new law, the state has developed regulations that address resident safety and welfare in memory care facilities. Nurses and other caregivers who work with residents suffering from dementia will need to participate in eight hours of state-approved training when they begin their employment and another four hours of continuing education in each year that follows. Managers are required to receive additional training that is specific to their duties.

Training programs must be designed to help staff members:

• understand cognitive impairments and their impact on behavior;
• learn strategies to communicate with cognitively impaired residents;
• manage behaviors such as wandering, aggression, and agitation;
• promote the dignity, comfort, and emotional health of residents;
• implement individualized service plans for residents who receive memory-care services;
• recognize, prevent, and report abuse;
• assist with the unique challenges that dementia patients have in their activities of daily living; and
• manage medications.

Facilities will now be required to ensure that they have adequate staff to respond to residents’ needs. While adequate staffing is essential to resident safety, expanding staff may be challenging in a time when caregivers are in short supply.

Finally, facilities that provide memory care services will be required to provide meaningful activities to residents with dementia that are tailored to their abilities. They must also create environments that go beyond locked doors to prevent wandering, including familiar spaces designed for cognitive stimulation and engagement.

The new regulations take effect on July 1, 2025.