Family and friends What to look for in a good care homeIn a good care home: There is a warm and welcoming atmosphere Your relative/friend feels safe and speaks fondly of staff and other residents Your relative/friend has opportunities to do activities and have responsibilities around the home e.g. caring for plants or pets The home has activity coordinators, it welcomes volunteers and organises trips and events Your relative/friend has been asked about their cultural and spiritual needs and the home is actively helping to meet them. If your friend or relative can’t tell you how they are feeling, you can look for signs of wellbeing, such as: A relaxed posture Ability to express emotions Humour Pleasure Connections with other people. If you have concerns about the care homeWhat are the warning signs that the care home could be better? You don’t feel welcome. You hesitate to approach staff to discuss your relative’s/friend’s care. Residents routinely appear to be sitting with nothing to do. Television is on but no-one is watching. Staff are always busy with no time to talk. Your relative/friend may speak positively about the home in public, but complain about it in private. Your relative/friend appears bored, irritable, in a low mood and possibly depressed. Your relative/friend tells you they want to die. You have concerns about how equipment, like a wheelchair or hoist, is being used and maintained. Your relative/friend is not supported comfortably when seated. Ask to be referred to an occupational therapist. They can offer advice and guidance on how to make your friend or relative more comfortable. If your relative has difficulties with communication, look out for the following signs: Anxiety and fear Withdrawal Despair Anger Physical discomfort or pain. It is really important to have a conversation with the care team. There may be a reasonable explanation. For example, if your relative or friend is spending lots of time alone, it may be that they have chosen to. Talking to staff means that you may be able to work with them to improve the situation for your relative/friend. What if I suspect my relative may be in physical pain or discomfort? You can check if they are comfortable by: Noticing the atmosphere: the temperature, noise levels and smells. Look for signs of discomfort or stress. Can you or care staff make adjustments to make them more comfortable? Is there a quiet space they can spend time in? Looking at their seating and positioning: are they sitting comfortably? Are they well supported in their chair or in bed? Checking their clothing or footwear: do they fit comfortably on the body? Check for tightness or rubbing. Noticing their drinking and eating: checking and assisting to ensure regular habits. What action can I take if I have concerns about the care home? Talk to individual staff members. Talk to the care home manager and follow up in writing if this helps. Share your ideas and suggestions. Is there a residents' and relatives' meeting? Or a suggestion book? Consider how you can contribute to the life of the home. Do activities together (see our suggestions below). I still have concerns. What can I do? Use the home’s complaints procedure – and remember complaints are an opportunity to improve. Tell the regulatory body about your relative’s experience. What you can do when you visitActivities you could do together Helping your friend/relative select an album, scrapbook or book to look at. Sharing a poem, article or short story you think they might like (‘I saw this and thought of you…’) Listening to music, the radio or watching the television. Playing a game of cards/word game/board game. Reading a newspaper or magazine together. Reading out loud. Going for a walk in the garden or exploring other rooms in the home. Supporting your friend/relative to keep a scrapbook or photo album and helping them to add pictures, mementos or photos. Offering a hand massage or manicure. Looking at bookshelves and where activities are kept: Is there something your friend/relative would like to borrow? Does anything spark a memory? Helping your relative with small jobs, for example dusting their room or refilling the bird feeder. Attending events and volunteering to go on trips. Bringing in a take-away for a special occasion. What you can do when you visit someone in the later stages of dementia Activities you can do with people in the later stages of dementia When people are in the later stages of dementia, we use the terms sensory ability and reflex ability (Pool 2012)[1]. Here are some suggestions of activities you can do with a relative or friend at these ability levels. Sensory ability level Your friend or relative may hum, chuckle, moan or call out. They may pace and keep repeating actions. People at this level of dementia are aware of others, but they are mainly concerned with their own needs and sensations. Typically they respond to conversation through body language, for example by turning towards you or reaching forward. Your friend or relative will respond to sensations. You can help them by using touch, and being warm and reassuring. When talking to them, keep your language simple and use short sentences. Using actions can also help to show them what you are talking about. You could try: Singing, clapping, dancing or rocking to music Activities that involve single step movements – sweeping, polishing, folding, winding wool Walking together Encouraging them to hold and turn the pages of a book, tablet, magazine or newspaper Stroking the back of their hand or arm or cheek and using moisturising lotion to massage Stroking a pet or a toy pet Listening to music they enjoy Watching favourite television programmes Looking at pictures, photographs and postcards Holding and feeling different objects – you could make an activity or memory boxes by wrapping up objects in tissue paper and placing them in a box, then encourage your relative to unwrap, explore and rewrap Smelling herbs, plants and flowers Sharing favourite food, snacks or drinks. Reflex ability level Your relative or friend may call, rock, cry, hum, or mumble to themselves. They may not be aware of their surroundings or their own body. But they may respond to direct sensory stimulation, such as touch. Here are some activities you could try: Make direct eye contact, use touch and give single word directions. For example, to support the person to drink, place their hands around the cup, put your hands over the top of theirs, and guide the cup to their mouth saying ‘Drink’ Reassure them by smiling and nodding Stroke the back of their hand, arm or cheek, keeping pressure gentle but firm Singing, swaying, clapping and rocking to music Stroking a pet or a toy pet Gently fan their face Play music that you know they like Hold and feel objects of different colours, shapes, weight, textures and size Eat and drink; for example, you could share pieces of fruit, sweets, and cheeses. References Pool J (2012) The Pool Activity Level (PAL) instrument for occupational profiling: a practical resource for carers of people with cognitive impairment. 4th ed. London: Jessica Kingsley.
