At Bespoke Psychiatry, we understand that managing difficult behaviors in long-term care facilities isn’t just about symptom control—it’s about improving lives. Across nursing homes, assisted living communities, hospitals, and outpatient offices throughout Illinois, our team partners with facilities to provide thoughtful, evidence-based psychiatric care that addresses the why behind behaviors, not just the what.
If you’re working in a facility and struggling with a resident whose behaviors are challenging, here’s a structured approach we use—and how we can help you do the same.
1. Start with a Clear Target and Outcome
Before implementing any intervention, it’s crucial to define the behavior you’re concerned about and—just as importantly—what you want to see instead. For example, if a resident is isolating due to depression, the goal isn’t simply “stop isolating,” but rather “become more engaged, joyful, and socially interactive.”
This clarity shapes every decision that follows. Without a target outcome, treatment becomes reactive instead of intentional.
2. Gather Multiple Perspectives
Behavior doesn’t happen in a vacuum. That’s why we always speak to a variety of sources—nursing staff, social services, activities aides, family members, and most importantly, the patient themselves. We also ask how behaviors show up across different shifts and times of day. These diverse insights reveal patterns that a single observer might miss.
3. Ask ‘Why?’—Not Just ‘What?’
The most powerful question in behavioral psychiatry is simple: Why is this happening?
Too often, we see a symptom and reach for a medication. But stacking medications in response to isolated behaviors can lead to polypharmacy without progress. Understanding the deeper cause—be it emotional distress, environmental triggers, cognitive decline, or an untreated medical condition—gives us a map, not just a list of symptoms.
4. Rule Out Medical Causes
Not all behavioral symptoms are psychiatric in origin. Medical conditions—from infections to neurological changes—can manifest as agitation, hallucinations, or mood instability. One patient I worked with, for example, began having intense nightmares. It turned out to be an early sign of Parkinson’s disease, not a psychiatric illness. Once we addressed the Parkinson’s, the psychiatric symptoms improved.
This is why we must look holistically—at the body, brain, and environment—before jumping to conclusions.
5. Use Evidence-Based Medications Thoughtfully
When medications are needed, we focus on preventative, long-acting treatments, not just short-term “as-needed” meds. PRNs may mask behaviors temporarily, but they often come with side effects and don’t address root causes. Our goal is to align the medication plan with the patient’s full medical picture, psychiatric diagnosis, and long-term wellbeing.
6. Prioritize Non-Pharmacological Interventions
Staff-driven interventions are often more effective than medications alone. From structured routines to sensory supports and personalized activities, these strategies empower staff to redirect behaviors and foster meaningful engagement. We help facilities identify realistic interventions that can be integrated into daily care routines.
7. Monitor, Educate, and Partner
Once a plan is in place, ongoing monitoring is essential. Are side effects emerging? Is the patient adherent? Is the intervention making a difference?
And just as critical: educating the care team. During rounds, we don’t just review charts—we share insights with frontline staff about each resident’s condition, what’s working, and why. This shared understanding improves outcomes and builds a stronger care culture.
If your facility is reevaluating how it approaches behavioral and psychiatric symptoms, let’s talk. At Bespoke Psychiatry, we bring medical rigor, human empathy, and a commitment to long-term solutions—not just quick fixes. Together, we can ensure your residents get the right care, at the right time, in a way that honors who they are and the lives they’ve lived.
Reach out today to explore how we can support your team and your residents.
Medically Written and Reviewed by Dr. Jacob Fyda MD.
