Aggression in Dementia: When a Care Home Gives Notice and What to Do Next

Few calls are harder than the one from a care home saying your parent hit a caregiver, pushed another resident, or cannot stay. Aggression is not a character flaw. It is a symptom of dementia, often triggered by fear, pain, infection or confusion. But when it puts others at risk, California care homes can and do give notice. This guide explains why dementia aggression happens, what a care home must do before asking your parent to leave, what your rights are, and how San Diego families find the next right place, including when a geriatric psychiatric unit can help.

Our companion guide on California’s 30-day notice rules for board and care homes covers eviction law in detail. This article focuses on what to do when dementia aggression in a care home is the reason.

Why Do People With Dementia Become Aggressive?

Aggression in dementia is usually a form of communication. A person who can no longer explain that they are in pain, frightened, overstimulated or being rushed may push, hit or shout instead. Common triggers include infections, pain, constipation, poor sleep, medication side effects, personal care like bathing, and noisy or unfamiliar surroundings.

Common causes care teams look for:

• Medical problems: urinary tract infections, pneumonia, constipation, dehydration, dental pain, untreated arthritis pain
• Medications: new drugs, dose changes, or drug interactions that cause agitation or confusion
• Personal care: showers, toileting and dressing can feel like an attack to someone who does not understand what is happening
• The environment: noise, crowds, shadows, mirrors, televisions, unfamiliar caregivers
• Sundowning: late afternoon and evening restlessness and agitation
• Unmet needs: hunger, thirst, boredom, needing the bathroom, feeling lost
• Changes in routine: a recent move, a new roommate, a caregiver leaving

California requires RCFE caregivers to be trained to recognize symptoms that may create or worsen behavior, such as dehydration, urinary tract infections and swallowing problems (Title 22 Section 87705). Our guide to RCFE dementia training requirements explains what that training covers.

What Should a Care Home Do Before Giving Notice for Aggression?

Before giving notice, a good care home looks for medical causes, involves the doctor, adjusts the care plan and caregiving approach, holds a care conference with the family, and documents what it tried. California also requires a formal reappraisal before a home can evict because it cannot meet a resident’s changed needs.

What a thoughtful home tries first:

1. A medical check. Ask the doctor to rule out infection, pain, constipation and medication problems. A simple urine test or a pain plan sometimes changes everything.
2. A medication review by the doctor or pharmacist, including anything new.
3. Behavior tracking. When, where and with whom does it happen? Often there is a pattern, such as showers or a certain time of day.
4. Changing the approach. Different bathing times, a familiar caregiver, a calmer room, more activity during the day.
5. A care conference with the family to share history, triggers and what has worked before.
6. Outside help, such as a geriatric psychiatrist or a mobile behavioral health consult.

Families can help by sharing your parent’s life story, routines and calming strategies. A note that says “Dad was a Navy man; he calms down when you call him Chief and talk about ships” can be more useful than any medication.

Can a Care Home Evict a Resident for Dementia Aggression in California?

Yes, in some situations. California allows an RCFE to evict a resident when, after a formal reappraisal, the home determines it can no longer meet the resident’s needs. The home generally must give 30 days’ written notice. A 3-day notice is allowed only with prior written approval from the licensing agency, when the resident’s behavior threatens health or safety.

The rules are in Title 22 Section 87224 and Health and Safety Code Sections 1569.682 and 1569.683. Key points for families:

• Allowed reasons include nonpayment, failure to follow state or local law after written notice, violating reasonable written house rules, a determination after reappraisal that the home cannot meet the resident’s needs, and a change in the home’s use.
• 30 days’ written notice is the standard. The notice must state the reasons with specific facts and the effective date, and include resources for finding other housing and care.
• A 3-day notice requires prior written approval from the licensing agency, which must find good cause, meaning the resident’s behavior threatens the health or safety of the resident or others.
• Court is required if your parent does not leave. The home must file an unlawful detainer action in court before it can remove a resident who has not moved out.
• The home must report the eviction to the licensing agency within five days (Section 87224(f)).
• The responsible person must be notified, such as an adult child or conservator.

These protections exist even when the home is right that it can no longer care for your parent. They give the family time to find a safe next place. For a deeper explanation of each step, read our full guide to board and care eviction rules in California.

What If the Home Sends Your Parent to the ER and Will Not Take Them Back?

Sometimes a home sends a resident to the emergency room after an incident and then says it will not take them back. Families should ask for the reason in writing, ask whether proper notice was given, and contact the Long-Term Care Ombudsman and Community Care Licensing if the home skipped the required process.

What to do if this happens:

• Ask the home for its position in writing. Is it giving notice? On what grounds? Was licensing approval obtained for a short notice?
• Talk to the hospital social worker or case manager right away. Tell them the situation so they do not discharge your parent to an unsafe place.
• Call the San Diego County Long-Term Care Ombudsman at 800-640-4661. Ombudsmen advocate for residents of care homes for free.
• Contact Community Care Licensing if you believe the home did not follow eviction procedures. You have the right to file a complaint.
• Consider legal advice if the home refuses to follow the process.

Even if you plan to move your parent anyway, insisting on the proper process can buy time to find the right next home instead of the first available bed.

Geriatric Psychiatric Units: When They Help

A geriatric psychiatric unit (often called a geri-psych or senior behavioral health unit) is a short-term hospital program for older adults whose behaviors are severe or dangerous. It can adjust medications under close supervision, look for medical causes and stabilize behavior, often making a successful return to a care home possible.

A geri-psych stay may help when:

• Aggression is frequent, severe or escalating despite changes in care
• Your parent is at risk of seriously hurting themselves or others
• Medication changes need close monitoring that a care home cannot provide
• The doctor suspects a psychiatric condition such as severe depression or psychosis in addition to dementia

Stays are usually short, often days to a few weeks. Admission typically comes through a hospital ER or a physician referral. Medicare may cover inpatient psychiatric care when criteria are met. Our guide to geriatric psychiatric units in San Diego explains how admissions work and what to expect.

Plan the next step during the stay. Ask the unit’s social worker to share the discharge medication plan and behavior notes with potential care homes. A home that understands what worked in the hospital is far more likely to succeed.

Finding the Next Dementia Aggression Care Home

The next home should be chosen for behavior experience, not just an open bed. Look for small dementia board and care homes or memory care with low resident counts, awake night staff, consistent caregivers and real experience with aggression. Share the full history honestly so the new home can plan, and so the same problem does not repeat.

What tends to work for residents with aggression:

• Small homes. A 6-bed dementia board and care home is quieter, less crowded and less overwhelming than a large building. Fewer residents means fewer triggers.
• Consistent caregivers who learn your parent’s triggers and calming strategies
• Experienced administrators who have cared for residents with similar behaviors and can describe how
• Awake overnight staff, especially if behaviors happen at night
• Secure exits if your parent also wanders. California sets rules for delayed-egress and locked perimeters in Title 22 Section 87705.
• Behavioral health support, such as a geriatric psychiatrist who visits or consults

Be honest. It is tempting to downplay what happened to get a yes. That usually backfires. A home that knows the full story can say no if it is not a fit, or yes with a real plan. A home that is surprised often gives notice again.

In 2026, small dementia board and care homes in San Diego typically cost about $6,000 to $9,500 per month, and memory care communities about $7,500 to $14,000. Residents with significant behaviors often fall at the higher end. See our memory care facilities in San Diego page and our guide to memory care homes vs. memory care communities.

When a Nursing Home or Other Setting Is Needed

Most people with dementia aggression can be cared for in a skilled dementia board and care home or memory care once triggers are managed. A skilled nursing facility may be needed when aggression comes with complex medical needs. Some severe, persistent behaviors require specialized programs, which a placement advisor or hospital social worker can help identify.

Situations that may point beyond a typical RCFE:

• Medical needs that are prohibited in RCFEs, such as feeding tubes or stage 3 or 4 pressure injuries
• A need for daily skilled nursing care alongside behaviors
• Behaviors that remain dangerous despite treatment and a well-matched home

Nursing homes also face limits on caring for residents with severe behaviors, so this is not an automatic answer. Our overview of nursing homes in San Diego explains skilled care, and our guide to restricted health conditions in RCFEs covers what small homes can handle medically.

Taking Care of Yourself Through a Crisis

A notice for dementia aggression can make families feel guilty, angry or ashamed. Remember that behavior is part of the disease, not a reflection of your parent’s character or your caregiving. Lean on the ombudsman, your parent’s doctor, support groups and a placement advisor so you are not handling every decision alone.

Practical steps:

• Keep a simple log of incidents, calls and what the home has told you
• Ask for copies of incident reports and the notice
• Gather medical records, medication lists and the physician’s report for the next home
• Use local support. Our guide to caregiver support in San Diego lists resources, and dementia respite care in San Diego covers short breaks.

How Elder Answers Helps

When a care home gives notice for dementia aggression, Elder Answers helps families find homes that genuinely handle behaviors, not just homes with a vacancy. Our advisors personally visit board and care homes and memory care communities across San Diego County and know which administrators have real experience with aggression and sundowning.

Our help is free for families because care homes pay us after move-in, and that does not change your rate. We share information only with homes you choose, and urgent moves can often happen within a few days. Contact Elder Answers to talk with a local advisor.

Frequently Asked Questions About Dementia Aggression in a Care Home

Can a care home kick out a resident with dementia for aggression?

A California RCFE can evict a resident if, after a formal reappraisal, it determines it can no longer meet the resident’s needs. It generally must give 30 days’ written notice with specific reasons, and it must go to court if the resident does not leave. A shorter 3-day notice requires prior written approval from licensing.

How much notice does a board and care home have to give?

The standard is 30 days’ written notice under Title 22 Section 87224. A 3-day notice is allowed only with the licensing agency’s prior written approval, based on good cause such as behavior that threatens the health or safety of the resident or others.

What causes sudden aggression in someone with dementia?

Common causes include urinary tract infections, pain, constipation, dehydration, poor sleep, medication changes, fear during personal care and noisy surroundings. Always ask the doctor to look for medical causes before assuming the dementia has simply progressed.

Who can help if a care home will not take my parent back from the hospital?

Contact the San Diego County Long-Term Care Ombudsman at 800-640-4661, tell the hospital social worker right away, and contact Community Care Licensing if the home skipped required procedures. Ask the home for its decision and reasons in writing.

What is a geriatric psychiatric unit?

A geriatric psychiatric unit is a short-term hospital program for older adults with severe behavioral or psychiatric symptoms. It can adjust medications under supervision and look for medical causes. Many residents return to a care home afterward with a better plan.

Will another care home accept my parent after an eviction for aggression?

Often, yes. Small dementia board and care homes and memory care communities with behavior experience accept residents with a history of aggression, especially when behaviors have been evaluated and a plan is in place. Share the full history so the new home can prepare.

Does aggression raise the cost of dementia care?

Usually. Residents who need extra supervision or one-on-one support often fall at the higher end of the range. In 2026, small dementia board and care homes in San Diego typically cost $6,000 to $9,500 per month and memory care $7,500 to $14,000.

Should we use medication to control dementia aggression?

Medication can help some people, but it carries risks for older adults with dementia, including falls and sedation. Most experts recommend looking for causes and changing the approach first, and using medication carefully under a doctor’s supervision when needed.