Responding to Distress and Changes in Behavior in Residential Long-Term Care in Viet Nam: Unmet Needs, Safe De-escalation and Timely Clinical Escalation

Responding to Distress and Changes in Behavior in Residential Long-Term Care in Viet Nam: Unmet Needs, Safe De-escalation and Timely Clinical Escalation

An older woman living in a residential care facility becomes upset when a care worker approaches to help her get dressed. She raises her voice, pushes the worker's hand away, and refuses assistance. The worker knows that she usually accepts help without difficulty, but the morning routine is already running behind schedule.

It would be easy to describe the resident as uncooperative and ask another employee to complete the task. A more useful response begins with a different question: what might have changed for her that morning?

Perhaps she is in pain, frightened, or uncomfortable. She may not recognize the worker, understand what is being asked, or feel ready to receive personal care. She may be experiencing an acute medical problem, or the way the task was introduced may have contributed to her distress.

The immediate priority is to keep everyone safe. How staff respond in those first moments, however, can influence whether the situation settles, becomes more difficult, or results in avoidable harm.

Situations like this arise in residential long-term care. Older residents may become anxious, withdrawn, restless, angry, or reluctant to accept particular activities or assistance. Some changes develop gradually, while others appear suddenly. They may reflect unmet needs, environmental stress, communication difficulties, emotional distress, or health conditions requiring medical assessment.

Not every expression of frustration is a clinical symptom, and not every refusal of care represents a behavioral problem. Residents remain individuals with preferences, concerns, and the right to be treated respectfully.

For residential long-term care providers in Viet Nam, the challenge is to recognize distress without automatically labeling someone as difficult, respond safely without unnecessary coercion, and identify when changes require timely professional assessment.

The goal is not simply to stop behavior that employees find challenging. It is to understand what may be happening, protect the people involved, and provide appropriate support while preserving the older person's dignity and rights.

Understanding Distress Before Trying to Change Behavior

Behavior can provide information about how someone is experiencing a situation, particularly when expressing needs through ordinary conversation becomes difficult.

An older person may repeatedly call for assistance because they feel frightened or uncertain about their surroundings. Another may resist personal care because an activity causes discomfort, feels intrusive, or has not been adequately explained. Someone may become restless in a noisy communal area, while another resident may withdraw when unfamiliar people enter their room.

These responses can have different meanings. They should not automatically be treated as symptoms of the same condition or managed through one standard approach.

The National Institute for Health and Care Excellence (NICE) addresses this principle in guideline NG97, Dementia: Assessment, Management and Support for People Living with Dementia and Their Carers.

Recommendation 1.7.1 advises a structured assessment before starting non-pharmacological or pharmacological treatment for distress in people living with dementia. The assessment should explore possible reasons for the distress and identify clinical or environmental contributors, including pain, delirium, or inappropriate care.

Recommendation 1.7.2 also recommends psychosocial and environmental interventions as part of initial and ongoing management.

These recommendations are intended for people living with dementia and should be interpreted within that clinical context. They do not mean that every distressed older person has dementia or needs dementia-specific treatment. Nor do they require a formal clinical assessment before a worker can offer ordinary reassurance, respectful communication, or appropriate assistance.

Distress may occur in people without cognitive impairment. It can reflect grief, loneliness, fear, frustration, disagreement, dissatisfaction with care, or difficulty communicating a preference.

In some circumstances, a resident may be distressed because something inappropriate is occurring in the care environment. An interaction may feel threatening, disrespectful, or unsafe, even when the employee believes they are providing routine assistance.

Care workers should therefore approach the person with curiosity and respect rather than assume that the behavior itself is the problem to be corrected.

Why Changed Behavior Has Become an International Care Quality Priority

In August 2026, the Australian Aged Care Quality and Safety Commission identified De-escalating Changed Behaviours as one of four sector risk priorities for 2026–2027.

The Commission emphasized compassionate, person-centered support, prevention, early intervention, and effective approaches to reducing distress and harm.

This development places responses to changed behavior within wider responsibilities for care quality, safety, residents' rights, and organizational leadership.

Australia's strengthened Aged Care Quality Standards, particularly Outcome 5.6 on cognitive impairment, also emphasize understanding factors that may contribute to changes in behavior.

The guidance encourages providers within its regulatory scope to consider clinical, situational, psychosocial, and environmental contributors, identify unmet needs, involve people who know the resident, and develop individualized approaches.

It also recognizes that changes in behavior may require clinical or specialist assessment rather than an exclusively behavioral response.

Australia has specific regulatory requirements concerning behavior support planning and restrictive practices for providers and residents within the relevant scope. These requirements should not be interpreted as identical legal obligations for residential care facilities in Viet Nam.

Nevertheless, the underlying quality principles are relevant.

Instead of focusing only on stopping behavior considered disruptive, residential care organizations can seek to understand what residents are experiencing, reduce avoidable distress, and help employees respond safely.

This provides a useful foundation for improving everyday practice through individualized care, appropriate professional assessment, and organizational learning.

Recognizing Changes From a Resident's Usual Condition

The significance of a particular behavior often depends on what is usual for the individual.

A resident who regularly walks around the facility may simply be following a familiar routine. Someone who enjoys quiet surroundings may naturally spend considerable time alone.

By contrast, a person who is normally sociable but suddenly becomes withdrawn may be experiencing an important change. A resident who usually accepts assistance but begins resisting familiar activities may also need closer attention.

Understanding the person's usual communication, routines, preferences, and functional abilities helps staff recognize these differences.

This knowledge may come from the resident, regular caregivers, family members, care records, or healthcare professionals who know the person.

Temporary employees and newly recruited workers may be less familiar with these patterns. They need access to useful information without being encouraged to rely on stereotypes or negative labels.

For example, describing someone as "usually difficult during bathing" provides little practical guidance. A more useful account might explain that the resident becomes anxious when approached unexpectedly, prefers assistance from a familiar worker, and responds better when the activity is explained before it begins.

Such information helps employees understand how to approach care without reducing the person to a behavioral category.

It is equally important to recognize that significant changes do not always involve agitation.

A resident who becomes unusually quiet, sleepy, disengaged, or less responsive may be experiencing a serious change in health. Sudden or fluctuating changes in attention, awareness, or behavior can indicate delirium or another acute medical condition requiring prompt assessment.

Recognizing a meaningful departure from the person's usual condition is therefore an important part of resident safety.

Exploring Unmet Needs and Environmental Contributors

A care activity that appears routine to an employee may feel unfamiliar, uncomfortable, or threatening to the person receiving assistance.

Personal care provides a common example. A worker may approach to help with dressing, toileting, or bathing while the resident experiences pain, embarrassment, fear, or confusion. The person may be unable to explain the difficulty clearly, particularly when communication or cognitive abilities are affected.

Other unmet needs may be less obvious. An older person may be hungry or thirsty, need assistance reaching the bathroom, or feel uncomfortable because of clothing, positioning, room temperature, or another physical concern.

Someone may also be distressed by noise, unfamiliar surroundings, disrupted sleep, or changes to an established routine. Emotional concerns, including loneliness, bereavement, or worries about family members, may influence how a person responds.

Several factors can occur together. Physical discomfort may increase anxiety, while communication difficulties or unfamiliar care arrangements may make an already uncomfortable situation more distressing.

NICE Quality Standard QS184, Dementia, describes structured assessment of distress as a multifactorial process involving clinical causes, environmental factors, medication issues, communication difficulties, and sensory needs.

This approach provides a useful framework for considering possible contributors, although identifying medical causes requires appropriate professional assessment.

The care environment itself also deserves attention.

Excessive noise, bright lighting at night, unfamiliar employees, limited privacy, or several people speaking simultaneously may increase anxiety or confusion for some residents.

Residential facilities need routines to organize staffing, meals, personal care, and other services. However, arrangements that work efficiently for employees may not always suit the people receiving care.

A resident may feel more comfortable receiving personal assistance later in the morning, being approached by a familiar worker, or having time to understand what is happening before an activity begins.

Such adjustments should reflect the individual's preferences and circumstances rather than become universal rules.

Organizations should also consider whether residents have reasonable opportunities to express concerns before those concerns become more difficult to manage.

Someone who repeatedly waits too long for toileting assistance, for example, may become increasingly frustrated. Improving the reliability of ordinary care may address part of the problem without requiring a specialized behavioral intervention.

Understanding unmet needs must not, however, delay medical assessment when signs of acute illness or significant deterioration are present.

A person who suddenly becomes confused may need urgent clinical evaluation even when an environmental trigger is also suspected.

The role of non-clinical care workers is to observe relevant circumstances, provide appropriate assistance, and communicate concerns rather than determine a definitive medical diagnosis.

Safe De-escalation Begins With Respectful Communication

When a resident becomes distressed, the immediate response can influence what happens next.

A worker who speaks sharply, argues, approaches too quickly, or insists on completing a non-urgent task may unintentionally increase the person's fear or frustration.

A calmer approach may allow time to understand the concern and identify a safer way forward.

De-escalation refers to approaches intended to reduce tension and the likelihood of harm while preserving the person's dignity.

NICE guideline NG10, Violence and Aggression: Short-Term Management in Mental Health, Health and Community Settings, includes principles concerning respectful communication, personal space, recognition of early warning signs, and non-confrontational responses.

Although NG10 applies to particular healthcare, mental health, and community settings, its general communication and safety principles can inform residential care practice.

A worker may help reduce tension by acknowledging the resident's discomfort, speaking calmly, explaining an activity, allowing additional time, or offering a reasonable choice.

Where circumstances permit, temporarily pausing a non-urgent activity may be safer than insisting on immediate completion.

Reducing unnecessary noise, limiting the number of people involved, or allowing more personal space may also help when someone appears overwhelmed.

However, no communication technique works for everyone. Some residents welcome reassurance or conversation, while others may find repeated questions intrusive. A familiar activity may comfort one person but frustrate another.

Staff should pay attention to the resident's responses and adapt their approach accordingly.

De-escalation must remain proportionate to the situation and the employee's training. An employee should not be expected to remain in an unsafe situation or manage a potentially dangerous incident alone. Where there is a credible risk of injury, additional support and appropriate protective action may be necessary.

The purpose is to reduce distress and prevent harm, not to obtain compliance at any cost.

Refusal of Care Is Not Automatically a Behavioral Problem

An older resident may decline bathing, dressing, a scheduled activity, or another form of assistance.

The refusal may reflect personal preference, discomfort, misunderstanding, or a wish to maintain control over everyday life. It may also indicate an unmet need or concern about how care is being provided.

A person who does not want to participate in a recreational activity should not automatically be described as uncooperative. Likewise, someone who declines assistance from a particular employee may be expressing an important preference or concern that deserves attention.

Where essential care is refused, the organization needs to consider both the resident's rights and the potential consequences of not receiving assistance.

Staff should seek to understand the reasons, explain relevant concerns within their role, and explore appropriate alternatives.

An older person's ability to participate in decisions should not be determined solely by age, disability, care dependency, or a diagnosis of dementia.

Questions involving consent, civil legal capacity, lawful representation, or urgent clinical necessity must be considered under applicable Vietnamese law and relevant professional requirements.

Family members may provide useful insight and support, but their agreement does not automatically authorize employees to override the resident's wishes.

Physical force, threats, humiliation, or other coercive practices should not be used simply to complete routine care tasks.

Where serious health risks or uncertainty about consent arise, appropriately qualified healthcare professionals and management should be involved. Complex legal questions may also require qualified legal advice.

Respecting personal choice does not mean overlooking serious risks. It means responding to those risks without unnecessarily disregarding the person's autonomy and dignity.

Sudden Changes May Require Clinical Assessment Rather Than Behavioral Management

De-escalation can help reduce tension, but it does not treat the medical causes of behavioral change.

An older person who suddenly becomes confused, restless, unusually sleepy, or markedly different from their usual state may be experiencing an acute illness.

Possible contributors include infection, medication effects, dehydration, pain, metabolic disturbances, and other conditions requiring clinical assessment.

Delirium is particularly important because its presentation may fluctuate and involve either increased activity or reduced responsiveness.

Someone experiencing delirium may become restless and disoriented, but another person may appear unusually quiet, withdrawn, or drowsy.

A resident does not need to be shouting or visibly agitated to have a clinically significant change in mental status.

The United Kingdom's National Health Service advises immediate medical attention when someone develops sudden confusion because the underlying causes may be serious or potentially life-threatening.

For residential care employees, the essential responsibility is to recognize and communicate a meaningful change rather than independently diagnose delirium or determine its cause.

Relevant information may include when the change began, how it differs from the person's usual condition, whether it fluctuates, and whether other concerning symptoms or circumstances have been observed.

Sudden confusion, significant changes in consciousness, suspected serious illness, injury, or other urgent concerns require prompt medical attention according to the person's condition and applicable emergency arrangements.

In Viet Nam, emergency medical services can be contacted through 115 when urgent assistance is required.

Calm communication may still be helpful while clinical assessment is being arranged. De-escalation and clinical escalation are not competing approaches; a person may need both reassurance and urgent medical care.

A resident becoming quieter after reassurance does not necessarily mean that an underlying medical problem has resolved.

Similarly, repeated episodes of distress should not automatically be attributed to a known diagnosis of dementia without considering whether something new has changed.

Medical diagnosis, treatment decisions, and medication adjustments remain the responsibility of appropriately qualified and authorized healthcare professionals.

Protecting Residents and Staff Without Unnecessary Restriction

Some episodes of distress may involve actions that create a risk of injury to the resident, employees, or other people.

A person may push away someone providing personal care, strike out when frightened, or move unpredictably through a crowded area.

Such situations can be stressful for everyone involved, and a person-centered approach does not mean ignoring the safety of staff or other residents.

Organizations should have arrangements for recognizing when a situation exceeds what can safely be managed through ordinary communication and assistance.

Employees need to know how to request help, protect themselves and others, and obtain appropriate professional intervention when necessary.

Any protective response should reflect the immediate risk, the person's condition, the employee's competence, and applicable legal requirements.

Restrictive practices raise particularly important concerns.

Physical restraint, seclusion, sedating medication used for behavioral control, and other restrictions on a person's freedom require careful consideration of legal authority, clinical necessity, consent, professional responsibilities, and potential harm.

They should not be treated as routine responses to distress, refusal of care, staffing difficulties, or operational pressure.

NICE NG10 contains detailed recommendations concerning restrictive interventions within its specified settings. Australia's aged care framework also regulates restrictive practices and establishes safeguards for providers within its scope.

These foreign requirements do not automatically authorize equivalent interventions in Vietnamese residential care facilities.

Non-clinical employees should not undertake specialized restraint procedures or independently decide to use sedating medication simply because a resident appears distressed or is difficult to manage.

Where an immediate danger arises, the facility must respond appropriately under Vietnamese law and its lawful emergency arrangements, involving qualified professionals or emergency services where necessary.

The organization should also support workers who report feeling unsafe rather than automatically blame them.

At the same time, a review of an incident should consider whether unmet resident needs, communication difficulties, environmental factors, or staffing arrangements contributed to what happened.

Protecting everyone requires understanding the circumstances rather than assigning a simplistic label to either the resident or the employee.

Repeated Distress Requires an Individualized Support Approach

When similar situations occur repeatedly, relying on different employees to improvise a response each time is unlikely to provide consistent care.

One worker may know that a resident becomes distressed during rushed morning routines, while another may be unaware of the pattern.

A family member may understand what usually provides reassurance, but that information may not be available to employees working at night.

An individualized support arrangement can bring this knowledge together.

It may describe the resident's usual communication and preferences, circumstances associated with distress, approaches that have appeared helpful, and situations requiring additional support or professional assessment.

The information should remain factual, respectful, and open to review.

Labels such as "aggressive resident" or "difficult patient" provide little practical guidance and may influence how future staff approach the person.

A more useful description explains what occurred, the surrounding circumstances, how the resident responded, and which approaches appeared to improve or worsen the situation.

Australia's aged care guidance on behavior support plans emphasizes individualized assessment, possible unmet needs, clinical and environmental contributors, suitable support strategies, and ongoing review.

Within the Australian regulatory framework, behavior support plans are required in specified residential aged care circumstances, including relevant situations involving changed behavior or restrictive practices.

These requirements should not be described as identical legal obligations for all residential care providers in Viet Nam.

Nevertheless, individualized support arrangements can help organizations improve continuity and reduce unnecessary variation in responses.

They should be reviewed when the resident's health, preferences, environment, or behavior changes.

An approach that helped previously may become inappropriate if the person develops new pain, experiences acute illness, or begins responding differently.

The purpose is not to assign a permanent behavioral classification. It is to help employees understand the individual and respond more consistently.

Families Can Provide Insight Without Replacing the Resident's Voice

Family members and other trusted supporters may know a resident's history, routines, communication preferences, and emotional responses better than employees who have only recently begun providing care.

They may recognize that a particular expression suggests discomfort or that an unfamiliar situation is likely to cause anxiety.

This information can be valuable, especially when the resident has difficulty communicating.

However, family involvement should support rather than automatically replace the older person's own preferences.

A resident may wish to receive care differently from the way relatives would prefer. Where the person can express a preference, employees should seek to understand and respect it within the applicable care and legal framework.

Families may also become distressed when a resident's behavior changes. They may worry that someone familiar has become unusually withdrawn, confused, or frightened, or that the facility is not providing adequate support.

Clear communication can help explain what has been observed, what remains uncertain, and what assessment or assistance is being arranged.

The organization should avoid premature explanations that attribute changes to dementia, personality, or normal aging without appropriate evidence.

Where concerns suggest possible mistreatment, the facility must consider its protective responsibilities and any appropriate reporting or safeguarding action.

Such responsibilities should not depend solely on family agreement.

Information shared with relatives or other supporters must also respect the older person's rights, lawful representation arrangements, and applicable confidentiality and personal data protection requirements.

The aim is to draw on the knowledge of people who understand the resident while keeping the individual's rights and preferences central.

Staff Competence and Organizational Conditions Influence the Response

A residential care facility may have written procedures for responding to distress without ensuring that employees can apply the underlying principles during difficult situations.

Staff need to understand how ordinary interactions may contribute to distress, what changes may indicate a clinical problem, and when additional assistance is necessary.

The required competencies vary according to the employee's role.

A care worker may need to recognize changes from the resident's usual condition, communicate respectfully, provide agreed assistance, and escalate concerns appropriately.

A qualified healthcare professional may be responsible for assessing possible clinical causes and determining treatment.

Managers need to ensure that staffing arrangements, supervision, information sharing, and access to professional support are suitable for the services provided.

Training should not focus exclusively on stopping visible agitation. It should also help employees recognize quieter forms of distress, understand the possible effects of pain and communication barriers, respect individual preferences, and distinguish ordinary disagreement from situations requiring urgent intervention.

Workers should feel able to describe difficult interactions accurately and seek help early. This requires an organizational culture in which raising concerns is not automatically treated as evidence of poor performance.

An employee who reports that an interaction became difficult may provide information that helps identify unmet needs or improve the care environment.

If workers fear blame, the organization may lose opportunities to recognize recurring problems.

Management should also consider whether employees have sufficient time to deliver personal care respectfully.

Repeatedly requiring workers to rush sensitive activities can contribute to avoidable distress, even when individual employees are trying to provide good care.

Workforce arrangements, organizational culture, and leadership therefore influence how effectively distress can be prevented and managed. Responsibility should not rest entirely with frontline employees.

Viet Nam's Legal and Regulatory Context

Residential long-term care providers in Viet Nam operate under different legal arrangements, and their responsibilities depend on the services they are authorized to provide.

The Law on Older Persons No. 39/2009/QH12, as amended, establishes important rights and protections for older people.

Consolidated Document No. 23/VBHN-VPQH, issued on February 26, 2026, provides an updated official reference.

Article 9 prohibits conduct including insulting, mistreating, humiliating, abusing, and discriminating against older persons, as well as other specified violations of their rights.

These protections are relevant to how employees respond to distress, refusal of care, and behavior perceived as challenging.

However, the Law should not be interpreted as establishing a detailed national de-escalation procedure applicable to every residential care facility.

The Law on Medical Examination and Treatment No. 15/2023/QH15, as amended, is relevant when changes in behavior, cognition, or consciousness require medical assessment or treatment.

Consolidated Document No. 26/VBHN-VPQH, issued on February 26, 2026, provides an updated official reference.

Clinical assessment, diagnosis, prescribing, and treatment decisions must remain within the responsibilities of appropriately qualified and authorized healthcare professionals.

A residential facility providing personal or social care should not assume that its employees may diagnose delirium, prescribe sedating medication, or perform specialized clinical interventions simply because they encounter residents experiencing distress.

Where an organization also provides licensed healthcare services, the corresponding professional and organizational requirements must be considered.

Social assistance establishments operate under a distinct regulatory framework.

Government Decree No. 103/2017/ND-CP, as amended, remains relevant to the applicable framework as of November 4, 2026.

Government Decree No. 395/2026/ND-CP on the operation and management of social assistance establishments was issued on October 23, 2026, and is scheduled to take effect on December 7, 2026.

At the review date, the new Decree has been promulgated but is not yet in force.

Organizations should examine the requirements relevant to their legal classification and prepare for implementation where applicable.

The Decree should not be interpreted as already imposing uniform behavior support procedures on every residential care organization or as providing universal authorization for restrictive interventions.

Questions involving consent, civil legal capacity, lawful representation, and restrictions on personal freedom require consideration under the Civil Code No. 91/2015/QH13 and other applicable Vietnamese laws.

Organizations must also consider relevant occupational safety obligations under the Law on Occupational Safety and Hygiene No. 84/2015/QH13, as amended, when employees or other people may be at risk.

These legal frameworks address different responsibilities. Their application depends on the organization's legal status, the activities actually performed, and the circumstances of the person receiving care.

For HLVN, the appropriate approach is to promote proportionate organizational safeguards informed by evidence and international practice without presenting foreign clinical or regulatory procedures as mandatory Vietnamese requirements.

Documentation Should Support Understanding, Not Stigmatize Residents

When a distressing incident occurs, accurate records can help care teams and healthcare professionals understand what happened and determine whether further action is necessary.

However, the language used in documentation matters.

A statement that a resident "became aggressive for no reason" may conceal uncertainty and discourage employees from exploring possible contributing factors.

A more useful account describes what was happening, the resident's observable actions, when the change began, how it differed from the person's usual behavior, and how staff responded.

It may also record whether the resident appeared uncomfortable, expressed a concern, or required additional support.

Staff should distinguish what they directly observed from what they believe may have caused the behavior.

Possible explanations should not be documented as confirmed medical diagnoses without appropriate professional assessment.

Documentation should remain proportionate to the significance of the event.

Not every expression of frustration requires a formal incident investigation. However, events involving injury, significant risk, suspected mistreatment, or meaningful clinical change may require more detailed review and appropriate escalation.

Information also needs to reach the employees and professionals responsible for subsequent care.

An important observation recorded during one shift but not communicated to the next team may lead to repeated difficulties or delayed medical assessment.

Records must also respect privacy.

Viet Nam's Law on Personal Data Protection No. 91/2025/QH15 and Government Decree No. 356/2025/ND-CP both took effect on January 1, 2026.

These instruments are relevant to the lawful collection, processing, storage, access, and disclosure of personal information, including health-related and behavioral records.

Organizations should establish appropriate legal grounds, access controls, and other safeguards when handling such information.

A resident should not acquire a lasting negative reputation because of an isolated episode described without context.

Documentation should support safe, coordinated care and learning rather than assign permanent labels.

Measuring Improvement Beyond the Number of Incidents

Residential care organizations may monitor incidents involving agitation, verbal conflict, physical harm, or other safety concerns.

These measures can help identify patterns, but they provide only part of the information needed to assess care quality.

Fewer reported incidents do not necessarily mean that care has improved.

Residents may become less visibly expressive because their concerns are ignored, opportunities for participation are restricted, or inappropriate restrictive practices have been introduced.

Conversely, an increase in reports may reflect better recognition and a greater willingness among employees to raise concerns.

Quality review should therefore examine how the organization responds to distress and whether its response addresses residents' needs.

Relevant questions include whether meaningful changes from a person's usual condition are recognized, possible contributors are considered, and situations requiring clinical assessment are escalated appropriately.

Where individualized support arrangements exist, the facility can examine whether employees understand them and whether they remain appropriate as circumstances change.

Repeated incidents may also reveal opportunities to improve care routines, communication, staffing, or environmental conditions.

Feedback from residents, families, and workers can provide valuable perspectives.

A resident may report feeling frightened during a care activity that employees considered completed successfully. A family member may recognize a meaningful change that was not obvious during routine observation.

A worker may explain that an agreed approach is difficult to implement because of limited staffing or inadequate access to a suitable environment.

Such experiences should inform quality improvement rather than be dismissed because they do not fit a numerical indicator.

Organizations should also consider the consequences of their responses, including injuries, avoidable distress, unnecessary restrictions, or delayed medical assessment.

These outcomes require careful interpretation and should not automatically be used to assign blame.

HLVN does not propose a universal incident-rate target, behavior scoring system, or mandatory response time for all residential care facilities.

Appropriate measures depend on the population served, relevant risks, organizational responsibilities, and applicable requirements.

The purpose of quality review is to understand whether the organization is improving its ability to recognize needs, prevent avoidable escalation, and provide safe, respectful support.

Using International Standards Responsibly in Viet Nam

International standards and clinical guidance can help residential care providers develop more reliable arrangements for supporting older people experiencing distress.

ISO 25557:2026, Ageing Societies — Care Quality for Older Persons at Home and in Care Facilities, was published in March 2026.

The standard provides requirements and recommendations for health and social care services for older people, including person-centered care, self-determination, participation, safety, workforce responsibilities, and organizational quality.

These principles are relevant to how residential care organizations respond when a person's behavior or emotional state changes.

An effective response depends not only on what employees do during an incident but also on individualized care planning, communication, workforce support, professional coordination, and organizational review.

However, ISO 25557 does not establish a universal de-escalation protocol, determine clinical treatment for behavioral symptoms, or authorize restrictive interventions.

Similarly, Australia's strengthened aged care requirements and its 2026–2027 sector risk priorities offer useful approaches to prevention, risk recognition, and person-centered support within that country's regulatory framework.

NICE NG97, QS184, and NG10 provide relevant guidance within their defined clinical and service populations.

WHO's second edition of Integrated Care for Older People (ICOPE): Guidance for Person-Centred Assessment and Pathways in Primary Care, published on September 22, 2025, provides a broader framework for individualized assessment and coordination of care.

ICOPE is not a dedicated residential de-escalation protocol. Its relevance lies in supporting integrated, person-centered assessment and care planning.

These resources should be used for informed comparison rather than treated as interchangeable or automatically binding requirements in Viet Nam.

Implementation must reflect the provider's legal status, workforce competence, resident population, access to healthcare professionals, and practical capabilities.

A smaller residential facility may need straightforward support arrangements and dependable access to external clinical advice.

A larger organization caring for residents with complex cognitive or behavioral needs may require more specialized staff competencies, structured support planning, and formal coordination with healthcare professionals.

In either case, organizational procedures should be based on the needs of the people receiving care rather than the assumption that one generic approach is suitable for everyone.

Looking Beyond the Immediate Incident

A moment of distress can be difficult for everyone involved.

The resident may feel frightened, misunderstood, or overwhelmed. Employees may be uncertain about the safest response. Other residents may be disturbed, while family members may worry about what the incident means.

The immediate priority is to protect people and respond appropriately, but the quality of care is also reflected in what happens afterward.

A facility should consider what may have contributed to the incident, whether medical assessment is necessary, and whether the person's preferences or circumstances have been adequately understood.

It should also consider whether employees have the information, competence, and support needed to respond more effectively if a similar situation occurs again.

These questions move the focus from controlling behavior toward improving care.

For residential long-term care in Viet Nam, this approach offers a practical opportunity to strengthen person-centered support without turning every expression of distress into a medical diagnosis or every difficult interaction into a disciplinary matter.

Older people should be able to express discomfort, disagreement, and personal preferences without automatically being labeled as problematic.

At the same time, significant changes in behavior, attention, or consciousness should not be dismissed as normal aging or attributed to dementia without appropriate consideration of other causes.

Safe care requires recognizing both the person's humanity and the clinical or safety risks that may be present.

Ultimately, a good response to distress is not simply one that makes a resident quieter or more cooperative. It is one that seeks to understand what has changed, protects everyone involved, and connects the person with the support or clinical assessment they actually need.

Key References and Regulatory Context

Australian Aged Care Quality and Safety Commission. (2026). Commission Targets Key Risks for 2026–27 to Strengthen Aged Care Outcomes. Media release. Published August 18, 2026.

Australian Aged Care Quality and Safety Commission. (2026). Sector Risk Priorities 2026–27. Including De-escalating Changed Behaviours.

Australian Aged Care Quality and Safety Commission. Strengthened Aged Care Quality Standards Guidance — Outcome 5.6: Cognitive Impairment.

Australian Aged Care Quality and Safety Commission. Behaviour Support Plans. Guidance concerning individualized assessment, support strategies, restrictive practices, and review.

National Institute for Health and Care Excellence. (2018). Dementia: Assessment, Management and Support for People Living with Dementia and Their Carers. NICE Guideline NG97. Particularly Recommendations 1.7.1–1.7.2 concerning assessment and management of distress.

National Institute for Health and Care Excellence. (2019). Dementia. NICE Quality Standard QS184. Particularly Quality Statement 6: Managing Distress.

National Institute for Health and Care Excellence. (2015). Violence and Aggression: Short-Term Management in Mental Health, Health and Community Settings. NICE Guideline NG10.

National Health Service, United Kingdom. Sudden Confusion (Delirium). NHS patient and public information.

World Health Organization. (2025). Integrated Care for Older People (ICOPE): Guidance for Person-Centred Assessment and Pathways in Primary Care. Second edition. Published September 22, 2025.

International Organization for Standardization. (2026). ISO 25557:2026 — Ageing Societies — Care Quality for Older Persons at Home and in Care Facilities. Published March 2026.

National Assembly of Viet Nam. (2009). Law on Older Persons No. 39/2009/QH12, as amended. Particularly Articles 3 and 9 concerning older persons' rights and prohibited conduct.

Office of the National Assembly of Viet Nam. (2026). Consolidated Document No. 23/VBHN-VPQH — Law on Older Persons. Issued February 26, 2026.

National Assembly of Viet Nam. (2023). Law on Medical Examination and Treatment No. 15/2023/QH15, as amended.

Office of the National Assembly of Viet Nam. (2026). Consolidated Document No. 26/VBHN-VPQH — Law on Medical Examination and Treatment. Issued February 26, 2026.

National Assembly of Viet Nam. (2015). Civil Code No. 91/2015/QH13. Particularly relevant provisions concerning civil legal capacity, representation, and personal rights.

National Assembly of Viet Nam. (2015). Law on Occupational Safety and Hygiene No. 84/2015/QH13, as amended.

Government of Viet Nam. (2017). Decree No. 103/2017/ND-CP on the Establishment, Organization, Operation, Dissolution and Management of Social Assistance Establishments, as amended and applicable on the review date.

Government of Viet Nam. (2026). Decree No. 395/2026/ND-CP on the Operation and Management of Social Assistance Establishments. Issued October 23, 2026; scheduled to take effect December 7, 2026.

National Assembly of Viet Nam. (2025). Law on Personal Data Protection No. 91/2025/QH15. Effective January 1, 2026.

Government of Viet Nam. (2025). Decree No. 356/2025/ND-CP Detailing Certain Articles and Measures for Implementation of the Law on Personal Data Protection. Effective January 1, 2026.

About Healthy Longevity Vietnam

Healthy Longevity Vietnam (HLVN) is an independent initiative focused on advancing quality, safety, and implementation in age-friendly, integrated, and long-term care for older people in Viet Nam. Through evidence-informed approaches, quality improvement, measurement, and collaboration, HLVN supports healthcare and care organizations in developing safer, more coordinated, and person-centered care across settings.

Disclaimer

This article is intended for general education, quality improvement, and organizational development. It does not constitute individualized medical or legal advice, a clinical diagnostic or treatment protocol, a physical restraint or crisis-intervention procedure, an official regulatory interpretation, or a mandatory national accreditation or certification standard.

Expressions of distress, refusal of care, and changes in behavior should be considered in the context of the individual's preferences, usual condition, environment, and potential health concerns. They should not automatically be attributed to dementia, mental illness, or inappropriate behavior.

Sudden changes in cognition, attention, consciousness, or behavior may require urgent medical assessment. Decisions concerning diagnosis, medication, treatment, and clinical escalation must remain with appropriately qualified and authorized healthcare professionals.

De-escalation principles discussed in this article are general educational concepts. They do not authorize untrained or non-clinical employees to use physical restraint, seclusion, sedating medication, or other restrictive interventions.

Any restrictive or emergency intervention must be considered according to the circumstances, relevant professional responsibilities, residents' rights, and applicable Vietnamese law. Foreign regulatory arrangements concerning restrictive practices should not be treated as authorizing equivalent practices in Viet Nam.

Age, disability, care dependency, or a diagnosis of dementia does not automatically establish that a person lacks civil legal capacity or should be excluded from decisions about care.

Resident safety and the protection of employees and other people must be considered together. The use of force, intimidation, humiliation, or inappropriate restrictions must not be normalized as a response to ordinary disagreement, distress, or refusal of routine care.

The organizational practices described should be adapted to each provider's legal status, authorized services, workforce competencies, resident population, and access to qualified healthcare professionals.

Government Decree No. 395/2026/ND-CP was issued on October 23, 2026, and is scheduled to take effect on December 7, 2026. It must not be treated as already effective on the review date or as establishing universal behavioral intervention procedures for all Vietnamese residential care providers.

International guidelines, quality standards, and foreign regulatory requirements are provided for educational and comparative purposes. They do not automatically establish equivalent Vietnamese legal duties, clinical authorizations, restrictive practice requirements, or mandatory behavior support plans.

Personal information concerning residents' behavior, health, care preferences, and related incidents must be processed and protected according to applicable Vietnamese confidentiality and personal data protection requirements.

Organizations should develop setting-specific arrangements with input from appropriately qualified healthcare, nursing, psychological, social care, occupational safety, quality management, and legal professionals where necessary.

Information and regulatory context reviewed as of November 4, 2026.