Analysis: ‘Strange faces and unfamiliar routines can worsen dementia’

LAST week a man with dementia died after a year at home during which 106 different named people tended to his needs. Graciously, his widow says that she has no complaints about the care, but it ruined any semblance of dignity at the end of his life.

Although it requires a reasonable sized team to provide care four times a day, seven days a week, this must be an unusually large number of staff.

But even so, for many households the number of strangers through the door is probably unacceptably high. We can have no idea unless families complain and if care workers often come and go while the family is not in, there is no-one to notice. It is important to realise that the nature of dementia is such that unnecessary change is very damaging. This effect is so extreme in many cases that strange faces and unfamiliar routines actually make the dementia worse.

A major aim of keeping people at home is to avoid change. It is to avoid the person having to cope with new things. Change and unfamiliarity are the main reasons why hospitals are so damaging for people with dementia.

Care workers do difficult and sometimes heavy work that not many other people are prepared to do, and it must be dire if you never become familiar with any client or his family or the layout of his house.

It is easy to demonise agencies that employ care workers who seem to profit from people in need, but those organisations only exist where local authorities are not prepared to provide these services directly, or to take direct responsibility for the low wages and extremely challenging contracts that provide a sort of care at minimal cost. If the contracts are set so that the tenders are won by agencies using the smallest number of people then you’d get different models of care. It might cost more, but the real cost of care at home is disguised by these fragmented and rushed services. Perhaps the idea that care support provided at home is always better than care in a care home has to be challenged when the level of need is high. In this case someone should have been listening to the carer, who could have told them what was happening.

• Professor June Andrews directs the Dementia Services Development Centre at Stirling University.