Supporting people living with dementia in care homes to thrive

We’re marking Dementia Action Week by highlighting how care teams are supporting people to live well with dementia in care homes.

When living with dementia, it can be difficult for an individual to recognise relationships, environments can be disorientating, and self-identity can feel diminished or lost.

An estimated 70% of people living in residential care are living with dementia (Alzheimer’s Society, 2024). For our ‘Thriving in Residential Care’ research we spoke to older people, families and care teams across the UK, and we heard many positive strategies that are enabling people living with dementia to thrive.

Innovative environments

We noticed innovative environmental layouts across many of the care homes we visited as part of our study, which supported people living with dementia to feel at ease. These included:

An unlocked door from a dementia community’s floor which led into a walled garden with a circular loop pathway – which facilitated walking with purpose both inside and outside.
Handrails painted different colours to help older people to navigate their way around the building.
Personalised bedroom doors – including images chosen by older people which were laminated to their doors and, in one care home, small, glass cabinets which contained a small personal item such as a book, doll or framed photo. These items helped in multiple ways; creating a talking point, personalising space, and helping people to correctly identify the right room.
In another home, every new older person was given a leaflet with pictures of each member of staff which they could keep, and this helped to learn names/faces, and acted as a refresher when people were unsure.

Involvement in appropriate, person-centred activities

Meaningful engagement and well thought through person-centred activity are integral to supporting physical, mental and social wellbeing.

We found that some people living with dementia required encouragement to participate in activities and complete tasks – which carers regularly gave. Lorraine told us how, her mum lacked stimulation when living at home, but at the care home, she was encouraged to engage:
- “Her default setting would be to sneak into her bed and cover herself up… But she’s got books. She’s got her TV. She’s got her CD… [and the carers] do really try and encourage her to do those things – and it just keeps her on her feet and keeps her active.”
We saw people being supported to adapt their interests to their current abilities and environment, including Pali who previously enjoyed cooking, and was now included in her home’s cooking activities, including making chapatis with a rolling pin. Pali also enjoyed being able to sit in the home’s prayer room each morning and listen to the music of Bhajan (Hindu devotional songs and prayers).
Older people were also asked about their favourite foods and so that these could be incorporated into meals – with one manager purchasing steak out of her own pocket!

Promoting independence and supporting ‘risky’ decision making

In our research, we heard stories of people being supported to retain their independence, and have their wishes respected, even if it might seem ‘risky’:

Manager Victoria described supporting a gentleman to go on a solo walk out of the care home. A carer would follow from a safe distance behind, explaining to the gentleman that they happen to be “going home” and “live in this direction”. The gentleman would tire fairly quickly and “sit on the wall” not far from the home, before gladly coming back with his wish for a walk fulfilled.

Language support

For those whose first language was not spoken in the care home, including those who had “reverted back to their original language because of their dementia”, care teams asked family members to “write down on paper little simple words” that staff could show/verbalise.
Picture boards were another useful communication tool, so people could point to the image that represented their need.

Validating experiences, safe touch and reassurance

As manager Lynette told us, “A lot of people living with dementia don’t understand why they’re here and they want to go home”. Her solution to this challenge was “a continuous process of just gently reminding them that they stop in with us for a few days. They weren’t feeling so well, so we’re just trying to get them better. And slowly, just gradually, they will come to accept that this is where they now live. It’s a very, very gentle process”.
We saw examples of people ‘entering into the world of the person’ to validate rather than challenge their experiences – including a lady who was “happily confused” and thought she was “always on a cruise with her husband taking care of her”, which those around her didn’t refute.
Other tips included involving family members to support with reassurance, and working together as a care team to figure out the best way to support an individual, discussing cases in team meetings and passing on information.
Care teams also described how safe touch – such as a holding a hand, or giving a consensual hug especially when upset – was particularly important in bringing a sense of reality, grounding and reassurance to some older people living with dementia.

Our ‘Thriving in Residential Care ‘ research was funded by Hallmark Foundation and independently engaged a range of care home providers.

My Home Life England is always on the look out for examples of great practice and evidence of what is working well in care settings. If you have any examples to share, we’d love for you to get in touch with us!

Contact the team