Dementia and Living Alone: A Practical Guide to Staying Safe, Independent and Happy at Home
A guide for families, friends and carers supporting someone living with dementia.
Living alone with dementia can bring challenges, but it doesn't automatically mean someone has to leave their home.With the right support, adaptations and planning, many people can continue to enjoy familiar surroundings and retain agood degree of independence.
The good news is that there is a great deal of help available. Technology has developed considerably, community services offer valuable support, and relatively small changes around the home can make a significant difference.
The aim should always be to support the person to retain as much independence, choice, dignity and enjoyment in life as possible, while recognising when additional support is needed.
Through my work visiting people in their own homes, I've seen how small changes can make a real difference.Sometimes it is a simple piece of equipment, a regular visit or a small change to the home that makes everyday life much easier.
This guide brings together practical suggestions for families who want to help someone with dementia remain safe, comfortable and happy at home.
Planning ahead: The Herbert Protocol
One of the first things I'd recommend to families is completing the Herbert Protocol. This is a scheme supported by Devon and Cornwall Police to help locate vulnerable people, including those living with dementia, should they go missing.
The form is completed in advance and contains useful information about the person, including their full name, date of birth, physical description and a recent photograph. It also asks about previous addresses, places they have lived or worked, favourite places they may be likely to visit, important family contacts, medication and relevant medical information.
Having this information ready means family members don't have to try to remember everything during an already distressing situation. It can also help the police understand the person's history, routines and habits, which may provide useful clues about where they could have gone.
Keep the form somewhere safe but accessible, make sure relevant family members know where it is, and update it when circumstances change.
If someone goes missing and you are concerned for their safety, call 999 immediately. Tell the police that a HerbertProtocol form has been completed.
Devon & Cornwall Police
You can download the form and find out more here:
Supporting someone who wants to go outside: Purposeful walking and wandering
Someone with dementia may sometimes feel the need to go outside, walk somewhere familiar or look for some where they remember. This is sometimes referred to as wandering, although I prefer to think of it as purposeful walking.There may be a reason behind the behaviour, even if it isn't immediately obvious.
They might be looking for a previous home, feel they need to go to work, be searching for a family member, feel restless or simply want some exercise and fresh air. They may also become confused about where they are or what they originally intended to do.
Rather than automatically trying to prevent someone from going outside, it is worth exploring what they might be trying to achieve. Could a regular walk with a family member or carer help? Would they enjoy sitting in the garden, visiting somewhere familiar or having a regular activity to look forward to?
Fresh air, movement and time outdoors can be incredibly beneficial for physical and emotional wellbeing. However, if someone is at risk of becoming lost, additional safety measures may be needed.
Door sensors and lifeline alerts
There are door sensors that can be connected to a telecare or lifeline system. These can alert a family member, carer or monitoring centre when an external door is opened. Some systems can be programmed to alert people at particular times, for example overnight, when the person may be more vulnerable.
Some lifeline providers can link door sensors to a personal alarm system, allowing family members or a monitoring center to receive alerts if someone leaves the property. It is worth speaking to a local telecare provider about what is available, as not all systems offer the same features.
Importantly, these devices don't prevent someone leaving the house. They simply provide an alert so that someone can respond.
GPS watches and tracking devices
There are wearable GPS devices, including watches, that can help family members locate someone if they become lost.Some are designed specifically for people living with dementia and can offer location tracking, safe-zone alerts, notifications if someone leaves a familiar area and emergency call functions.
Apple AirTags and compatible Android tracking devices can also be useful, although they are not the same as dedicated GPS trackers. They generally rely on Bluetooth and nearby compatible devices to update their location, rather than providing continuous live GPS tracking.
An important consideration with any tracking device is that the person needs to actually take it with them. A tracker left on the bedside table is not going to help if someone goes out! Think carefully about where it is attached. A bag, coat, keys or another item they routinely take with them may be useful, although habits can change.
A GPS watch or tracker can provide valuable reassurance, but neither prevents someone from leaving home. Their purpose is to help locate someone if they become lost or don't return when expected. They should be considered alongside an appropriate safety and support plan, rather than as a replacement for supervision where this is needed.
Lifeline alarms and falls detectors
A personal lifeline can be extremely useful for someone living alone. Traditional lifeline systems usually involve wearing a pendant or wristband and pressing a button if help is needed. This connects the person to a monitoring centre or, depending on the system, a family member.
However, dementia can make these systems less effective if someone forgets to wear the pendant, forgets how to operate it or cannot remember what it is for. A device can only help if the person remembers to wear it and is able to use it when needed.
A falls-sensing pendant may be a better option for some people. These devices can automatically detect certain falls and send an alert without the person needing to press a button.
There are limitations, though. They do not detect every fall. A sudden collapse or impact may be detected, but a slow slide down a wall or a gradual lowering to the floor may not trigger the alarm. They should therefore be considered anadditional safety measure rather than a guarantee of help.
When choosing a system, check whether the pendant needs charging, whether it works outside the home, who receives the alert and what happens if the person doesn't respond.
Some lifeline systems can also incorporate additional sensors, including door alerts, smoke alarms, gas alarms and flood detectors. These can be particularly useful if someone is forgetting to turn off taps, leaving cooking unattended or struggling to manage household appliances.
Technology Enabled Care: Support available through Cornwall Council
Something I would particularly encourage families in Cornwall to investigate is Cornwall Council's Technology Enabled Care (TEC) service.
Technology has developed enormously in recent years, and there are now many devices and systems that can help people with dementia remain safe, connected and independent in their own homes. Cornwall Council recognises the important role technology can play in supporting people of all ages, including older people and unpaid carers.
Technology Enabled Care covers several areas. Assistive technology includes devices that help people manage everyday activities, while telecare uses sensors and alarms to help identify when someone needs assistance. Telehealth can help monitor someone's health from home, and digital support can help people access advice and become more confident using technology.
These tools can be tailored to individual needs and can provide additional reassurance to families and carers.
Cornwall Council
The Andi Hub
One particularly interesting example is the Andi Hub, a smart home service designed to help people remain safe and connected.
The Andi Hub monitors information from other devices and sensors around the home and can alert family members or carers if there are changes in someone's usual habits or activity. This may help identify when someone is not following their normal routine and prompt a check to make sure they are alright.
For example, if a person who normally gets up and moves around the house in the morning has not been active as expected, an alert may help prompt someone to check on them.
The system can be tailored to individual needs, with supporting devices installed as appropriate. Cornwall's service includes a local response and maintenance team. It is worth speaking to the service about current availability, assessment and eligibility.
This type of technology can be particularly helpful for families who live further away and cannot visit every day. It can provide reassurance while allowing the person to continue living in familiar surroundings.
Just Checking
Another system used by Cornwall Council is Just Checking. This is a passive monitoring system that uses sensors around the home to build a picture of someone's daily routines and activities.
It can help show how much someone moves around their home, which rooms they use and when they are usually active. Changes in established routines may help identify where someone is beginning to struggle or whether additional support might be beneficial.
This can be particularly useful when someone has dementia and may not always be able to explain the difficulties they are experiencing. It can help families and professionals understand how someone is managing and identify where additional support might be helpful.
An important benefit of this approach is that it can sometimes demonstrate that a person is managing more independently than originally thought. Rather than automatically increasing care, the information may help identify exactly where support is needed while allowing the person to continue doing the things they can manage themselves.
Other technology available
Cornwall's TEC service also includes more familiar devices such as personal lifeline alarms, movement sensors, falls detectors and smart speakers such as Alexa. There are also apps and other digital tools that can help people manage everyday tasks and stay connected.
The important thing is that technology should be chosen around the individual. It should support independence rather than unnecessarily restrict someone's freedom or privacy. Any monitoring should be proportionate, respectful and appropriate to the person's wishes and decision-making capacity.
How can families find out more?
Cornwall Council has a dedicated website explaining Technology Enabled Care, including examples of how it is helping people across Cornwall.
I'd really recommend having a look:
You can also contact Cornwall Council Adult Social Care on 0300 1234 131 to discuss support and ask about the options available.
Not every device or service will be available to everyone, and eligibility, assessment and funding arrangements can vary. Technology can never replace the reassurance of human contact, but used appropriately, it can be a valuable part of helping someone with dementia remain independent at home.
Making the home easier to navigate
Dementia can affect orientation, memory and the ability to recognise familiar surroundings. Small changes around the home can make everyday tasks much easier and reduce the frustration that can come from forgetting where things are or becoming confused about the time of day.
Orientation and memory clocks
Specialist dementia clocks are available that clearly display the day, date and time, often using words such as Monday morning or Tuesday afternoon rather than relying solely on numbers. These can be particularly helpful for someone who becomes muddled about the time of day or what day it is.
I'd consider having one in the bedroom and another in the room where the person spends most of their time. Some clocks also include reminders and alarms, which can be useful for appointments, meals or other regular activities.
Photographs and familiar surroundings
Family photographs can be lovely reminders of important people and happy memories. Displaying photographs of children, grandchildren, friends and familiar places can provide comfort and encourage conversation.
It can also help to make everyday items easier to identify. Labelling cupboards with pictures or words, using clear signs on bathroom and toilet doors, keeping frequently used items in the same place and having a simple calendar or weekly routine displayed can all make the home easier to navigate.
Avoid making too many changes at once. Familiar surroundings are often reassuring, and significant changes to the home can sometimes increase confusion.
Smart screens, Alexa and staying connected
Devices such as Amazon Echo Show can help someone stay connected with family. The screen allows video calls, meaning relatives can see and speak to their loved one without needing to travel.
They can also be used for playing familiar music, setting reminders, providing weather updates and making calls tofamily members. Some devices can be configured to allow family members to make calls or communicate through them, but privacy settings and the person's wishes must always be considered.
Voice assistants can also be used for medication reminders, appointments and daily prompts. However, this works best when the person can remember how to use the device and understands its instructions. It is worth testing the system before relying on it.
Medication management
Remembering medication can become increasingly difficult as dementia progresses. Someone may forget whether they have taken their tablets, take them twice or forget to take them altogether. This can become a significant concern for families, particularly if the person takes several medications throughout the day.
Automatic medication dispensers
A device such as a Pivotell automatic medication dispenser can be particularly useful. The dispenser is filled in advance by a family member, carer or pharmacist and programmed to release medication at the appropriate times.
At the programmed time, an audible alarm sounds and a light flashes. The correct medication compartment becomes accessible, allowing the person to take the medication. The other medication remains secured until its scheduled time.
The filling frequency depends on how many doses are required each day. Someone taking medication four times daily, for example, will need more frequent refilling than someone taking it once daily.
The dispenser does not eliminate the need for oversight. Someone still needs to ensure it is filled correctly, check that the medication is suitable for the device and monitor whether doses are actually being taken. Always discuss suitability with the pharmacist, particularly if the person takes medication that cannot be placed in a dispensing system.
More information: Pivotell
Pharmacies can also create dosette boxes for medication, although with pressures on pharmacises, this is getting harder to get done.
Medication reminder clocks and Alexa
There are also specialist dementia clocks that provide audible and visual reminders when medication is due. These can be helpful for someone who responds well to prompts but does not necessarily need an automatic dispenser.
Alexa devices can also be programmed with verbal reminders, although this depends on the person being able to understand and respond to them. If medication is regularly being missed, it is important to involve the GP, pharmacist or care team rather than relying solely on reminders.
Eating, drinking and managing the fridge
This is an area I think families should pay particularly close attention to. Dementia can affect appetite, food recognition, memory and the ability to prepare meals. Someone may forget to eat, forget they have already eaten, struggle to prepare food or fail to recognise when food has gone out of date.
One thing I often suggest to families is to look inside the fridge. Is there fresh food? Is food being eaten? Are there lotsof out-of-date items? Is food being left open or going mouldy?
Poor fridge management can sometimes be an early indication that someone is struggling to manage their meals independently. Other signs might include weight loss, unopened food deliveries, food being left untouched, very little fresh food in the house or difficulty preparing even simple meals.
Online shopping can be a great help for someone who finds it difficult to visit the supermarket. Regular deliveries can be arranged, with family members helping to organise shopping lists and ensure the right food is ordered. Easy-to-prepare meals, ready meals that require minimal preparation, clearly labelled food containers and keeping favourite snacks and drinks within easy reach can all help.
It is important to remember that someone may not recognise hunger or thirst in the same way they previously did.Regular drinks throughout the day are particularly important. Dehydration can contribute to confusion, constipation and urinary infections, so families should keep an eye on how much someone is drinking.
Carers and Meals on Wheels
Having a carer visit to prepare or assist with meals can make a huge difference. It also provides another opportunity for someone to check that the person is eating, drinking and generally managing.
Meals on Wheels or other local meal delivery services may also be available, depending on the area. Some meal delivery services provide more than just food. They can offer a regular friendly face and an opportunity to notice if someone appears unwell or is struggling.
Washing, dressing and personal care
Personal care can become increasingly challenging as dementia progresses. Someone may forget to wash, struggle to choose appropriate clothing or become confused about the order in which to get dressed.
You might notice clothes being put on back to front, several layers of clothing being worn, the same clothes being worn repeatedly or a decline in personal hygiene. Buttons, zips and fastenings may become harder to manage, and getting into the shower or bath may become increasingly difficult.
These changes can sometimes be gradual, making them difficult for family members to recognise initially.
Having carers visit to support washing, dressing and personal care can be invaluable. This isn't simply about cleanliness. Good personal care helps maintain skin health, comfort, dignity and general wellbeing.
Carers can also look out for changes such as bruising, skin irritation, pressure areas, unexplained weight loss or signs of infection. It is important to maintain privacy and involve the person in decisions about their care wherever possible.
Reducing falls and making the home safer
Dementia can sometimes be accompanied by changes in balance, coordination, judgement and awareness of hazards.Someone who previously moved around their home confidently may begin to struggle with steps, changes in floor surfaces or everyday obstacles.
As a physiotherapist, this is something I would always encourage families to consider.
Start by looking at the routes the person uses most frequently. Loose rugs and mats, trailing electrical cables, unnecessary furniture and clutter in hallways can all increase the risk of trips and falls. Make sure there is sufficient space to move around safely, particularly when using a walking aid.
Grab rails and handrails
Grab rails can provide valuable support when getting in and out of the shower, using the toilet or negotiating steps.Consider handrails on internal and external steps, grab rails near the toilet and additional support in showering areas.
They need to be positioned correctly and securely fixed. An occupational therapist can help assess where rails would be most useful and whether additional adaptations are needed.
Useful equipment
There are several pieces of equipment that can help someone remain independent for longer.
Shower stools allow someone to sit while showering, reducing fatigue and the risk of losing balance. Raised toilet seats can make sitting down and standing up easier, while perching stools are useful in kitchens, allowing someone to sit while preparing foodor carrying out tasks at a worktop.
Walking aids can provide additional stability when appropriately assessed and used. Bed rails and transfer aids may help in certain circumstances, but require an individual assessment because they can introduce additional risks.
An occupational therapist can assess the home and recommend appropriate equipment and adaptations.
Lighting, particularly at night
Poor lighting can increase the risk of trips and falls. Someone who wakes during the night may become disorientated and struggle to find the bathroom.
Automatic night lights can be very useful. These are available as plug-in or battery-operated devices that switch on when movement is detected and turn themselves off after a short period.
I'd consider placing them along the route between the bedroom and bathroom, in hallways, near stairs and in the bathroom. Good lighting can make a significant difference without requiring the person to remember to switch lights on themselves.
Footwear: A small detail that matters
Good footwear is particularly important for someone who is becoming less steady on their feet. Look for shoes that have a proper back to support the heel, good grip on the sole, a secure fastening, a flat and stable sole and a comfortable fit.
Avoid loose-fitting slippers and footwear that can easily slip off. Crocs-style clogs and similar loose-fitting shoes maybe particularly unsuitable for someone with poor balance. They can be unstable, especially on wet bathroom floors or smooth lino flooring.
Another consideration is that someone with memory difficulties may forget to change their footwear when going outside. Having comfortable, secure shoes that are suitable for both indoor and outdoor use can sometimes be a practical solution.
Keeping connected and reducing isolation
Living alone with dementia can sometimes become lonely. Family members may live a distance away, friends may visit less frequently and the person may gradually stop attending activities they previously enjoyed. Maintaining social connections is incredibly important.
Regular visits from family and friends, telephone calls at familiar times, local dementia groups and community activities can all help. Accompanied walks, gardening and visiting familiar places can also provide something to look forward to.
Getting outside doesn't always have to involve a long walk. Sitting in the garden, watching birds, enjoying a cup of tea outside or spending time with someone in a familiar green space can all provide enjoyment. Nature, fresh air and gentle movement can be valuable for both physical and emotional wellbeing.
Simple telephones and video calls
A telephone with large buttons and photographs can be helpful. Some phones allow family members' photographs to be programmed onto individual buttons, so the person only needs to press the relevant picture to make a call. This can be much easier than remembering telephone numbers.
Smart screens, as mentioned earlier, can also make video calls more accessible and help someone feel connected with family members who cannot visit regularly.
Simple entertainment and familiar activities
It is easy to focus so much on safety that we forget about enjoyment. Someone living with dementia still needs stimulation, entertainment and things to look forward to.
A simple television with an easy-to-use remote control can be helpful. Favourite television programmes, familiar films,music from earlier years, family photographs, gardening, looking through old photo albums and simple puzzles can all provide enjoyment.
Sometimes the simplest things are the most enjoyable. Music in particular can be a wonderful way to connect with someone, even when communication becomes more difficult.
Comfort, companionship and familiar objects
When supporting someone with dementia, it is important to think about emotional wellbeing as well as physical safety.Familiar objects can provide a great deal of comfort, reassurance and enjoyment, particularly for someone who may sometimes feel anxious, unsettled or confused.
Soft toys, teddy bears and realistic-looking companion pets can be surprisingly helpful. Some people enjoy having a teddy or soft toy to hold, cuddle or keep beside them. Others find comfort in realistic interactive cats or dogs, which may respond to touch, make gentle sounds or appear to move and breathe.
These companion pets can provide a sense of purpose and something to care for. Someone who has always enjoyed looking after animals may find comfort in having something familiar to stroke, talk to and spend time with. They can also provide a calming activity during periods of anxiety or restlessness.
For some people, looking after a companion pet can help recreate a familiar routine and provide a sense of responsibility without the demands of caring for a real animal. They can be particularly useful where someone would previously have enjoyed having a pet but is no longer able to manage the responsibilities involved.
There are also specialist robotic pets designed for older people and those living with dementia. These can be worth exploring, although a simple soft toy or teddy may be just as comforting for some individuals.
As with anything, it is important to consider the person's preferences. Not everyone will enjoy these items, and they should never be imposed. However, if someone finds comfort in a familiar teddy, soft toy or companion pet, there is no reason to dismiss this. What matters is how it makes that individual feel.
Sometimes the simplest things can provide the greatest reassurance.
Key safes and emergency access
A key safe is something I would strongly recommend considering when someone lives alone and has additional care or safety needs.
A secure key safe fitted outside the property allows authorised people to access the home if the person cannot answer the door. This can be particularly important if someone has fallen and cannot get up, a carer needs access or emergency services need to enter.
Make sure the key safe is installed securely and that the code is shared only with appropriate people. Let family members, carers, the care agency and relevant telecare providers know where it is and how to access it.
If emergency services are called, tell the call handler that there is a key safe and provide the code when requested. You can also ask the relevant local emergency service about registering the details in advance.
Treatment Escalation Plans: Making sure someone's wishes are known
Something I would strongly encourage families to consider is whether their loved one has a Treatment Escalation Plan (TEP) in place.
A Treatment Escalation Plan is a document completed with healthcare professionals that records a person's wishes, preferences and agreed clinical recommendations about the treatment they would want if they became seriously unwell.
For someone living with dementia, this can be particularly important. If they become unwell, have a serious fall or experience a medical emergency at home, they may not be able to communicate their wishes or explain what treatment they would or would not want.
A TEP can help visiting paramedics, ambulance crews, GPs and other healthcare professionals understand the person's individual circumstances and the agreed approach to their care. This may include whether hospital admission would be appropriate, what treatments should be considered and whether care should be focused on comfort and symptom management.
It is important to discuss these wishes while the person is able to participate in the conversation and make decisions about their care. Their views, values and preferences should remain central, with family members or those close to them involved where appropriate.
A TEP is not the same as a DNACPR decision. A DNACPR relates specifically to cardiopulmonary resuscitation if someone's heart or breathing stops. It does not mean that other appropriate treatment, care or medical assistance should be withheld. A person may have a TEP without a
DNACPR decision, or both documents may be in place.
If a TEP or DNACPR document has been completed, ask the healthcare team how it should be kept and made accessible in an emergency. Ideally, visiting paramedics and healthcare professionals should be able to locate the relevant information quickly when attending the property.
Families should also know where the documents are kept and ensure that any changes in wishes or circumstances are discussed with the healthcare team. A document that is out of date or cannot be found during an emergency may not provide the reassurance it was intended to offer.
Having these conversations in advance can help ensure that someone receives care that is appropriate to their wishes, values and individual circumstances, particularly at a time when they may be unable to express them themselves.
Other useful safety measures around the home
There are a few other things worth considering when looking at the overall safety of someone's home.
Fire and gas safety
Make sure smoke alarms and carbon monoxide alarms are working. Consider specialist telecare-linked smoke, gas and heat alarms where appropriate.
If someone is forgetting to switch off cooking appliances, speak to an occupational therapist or appropriate professional about cooker safety devices and other adaptations.
Flood detectors
If someone is at risk of leaving taps running or forgetting that a bath is filling, water sensors can alert family members or a monitoring centre. These can be particularly useful when linked to an appropriate telecare system.
Warm blankets
If someone has fallen and is unable to get up, keeping a warm blanket somewhere accessible can be useful to help maintain warmth while waiting for assistance.
It is important not to attempt to lift someone after a potentially serious fall. Keep them comfortable and warm, and seek medical assistance where needed.
Simple household arrangements
Keep frequently used items within easy reach. Avoid storing everyday essentials in high cupboards or places that require climbing or stretching. Consider reducing unnecessary complexity around household appliances. Clear instructions and familiar controls can make everyday tasks easier.
Cameras and monitoring loved ones
More families are now considering cameras and monitoring systems to provide reassurance when a relative lives alone.These might include video doorbells, internal cameras or systems that allow family members to check whether someone is up and about.
They can sometimes be helpful, but this is an area where I would advise caution. A person's privacy, dignity and right to make their own decisions must always be respected.
The person should understand what is being installed and agree to it wherever they have the capacity to make that decision. If they are unable to make that particular decision, the Mental Capacity Act 2005 and best-interests principles must be followed. Any monitoring should be necessary, proportionate and the least restrictive option.
Recording in private areas such as bedrooms and bathrooms raises particularly significant concerns. Monitoring should never become a replacement for appropriate visits, companionship or care.
It is also important to remember that a camera cannot tell you everything. Someone may appear to be managing well onscreen while struggling with eating, drinking, medication or personal care.
Communication: Sometimes reassurance matters more than correction
This is something I have learnt through my own work with people living with dementia.
Initially, when someone made a mistake or became confused, my natural instinct was to correct them. For example, someone might ask where their parents were, despite their parents having passed away many years earlier. I would instinctively try to explain what had happened and remind them of the truth.
However, through working alongside mental health nurses and other professionals, I learnt that repeatedly correcting someone can sometimes cause considerable distress.
If someone has little short-term memory, they may not retain the information that their loved one has died. They can therefore experience the grief and shock repeatedly, almost as though they are hearing the news for the first time.
This doesn't mean that every situation should be avoided or that someone should never be told the truth. It means considering how the person is feeling in that moment and responding with compassion.
Sometimes it may be more helpful to acknowledge the emotion behind the question. For example, if someone asks where their mother is, you might say, "You're thinking about your mum today. Tell me a little about her." Or perhaps,"You must miss her. What was she like?"
You can then gently move the conversation towards a happy memory if that feels appropriate.
The important thing is not to argue, repeatedly correct or make someone feel they are wrong. Try to speak calmly, give the person time to respond, use simple language and listen to what they are trying to communicate. Reassurance and understanding can often be much more helpful than correcting every detail.
Sometimes being kind and reassuring is much more important than being factually right in that particular moment.
Night-time support: One of the biggest challenges of living at home
One area that families sometimes underestimate is the difficulty of arranging care overnight. Someone living with dementia may manage reasonably well during the day but experience increased confusion, restlessness or anxiety at night. They may wake frequently, become disorientated, need help getting to the toilet, forget where they are or try to leave the house.
Night-time needs can be particularly challenging if someone is at risk of falling, requires regular assistance or cannot safely be left alone for extended periods. While technology, falls detectors and lifeline systems can provide additional reassurance, they cannot replace a person being physically present when someone needs regular assistance or supervision.
There are different options for overnight care at home. A sleep-in carer stays overnight and is available to provide assistance when needed, although the arrangements and level of support will depend on the care package. This is generally more suitable for someone who is likely to sleep for much of the night and only occasionally needs help.
For someone who wakes frequently, needs regular assistance or requires more continuous supervision, a waking night carer may be more appropriate. This means a carer remains awake throughout the night to provide support as needed.
In some circumstances, live-in care may also be an option, with a carer living in the property and providing support during the day and night, subject to appropriate rest periods and arrangements for overnight cover. It is important to clarify exactly what overnight support a live-in care arrangement includes, as it does not automatically mean someone is awake and available throughout the night.
Unfortunately, overnight care in the community can be difficult to source, particularly in rural areas, and it can be significantly more expensive than daytime care. Waking night support is generally more costly than sleep-in care because a carer is required to remain awake and available throughout the night. If someone requires continuous overnight supervision, the costs can become substantial.
In some situations, the cost of providing extensive overnight care at home can exceed the cost of residential or nursing care. This can be a difficult consideration for families, particularly when their loved one strongly wishes to remain at home. It is worth exploring all available options, including local authority assessments, NHS Continuing Healthcare eligibility where appropriate, and the different types of care available.
It is important to remember that moving into a care home does not mean someone has failed to remain independent.Sometimes a care home can provide a safer environment, with staff available throughout the night, opportunities for social interaction and support that would be difficult or financially unrealistic to replicate at home.
The decision should always be based on the person's individual needs, wishes, safety, quality of life and the support realistically available. Where possible, these conversations are best started before a crisis occurs, allowing families time to explore options and make considered decisions together.
Finding local support: Age UK Cornwall Community Gateway
Families often don't realise just how much support is available locally. One service I would particularly recommend to people in Cornwall is the Age UK Cornwall Community Gateway.
This is a service that helps people access the right support to remain independent at home. The Community Gateway is open 8am–8pm, seven days a week, 365 days a year.
Telephone: 01872 266383
The service can help with a wide range of practical and community support. This includes helping people settle back at home following a hospital stay, planning for independent living, finding local activities and community groups, and accessing support to get out and about.
They can also help with finances and benefits, home safety, end-of-life support and digital and IT advice. Their digital support can be particularly useful for people who need help using technology, connecting with family, accessing services or managing online shopping and bills.
They also have trained volunteers who can provide friendly visits, telephone support and even accompany someone on a walk or to a local group. This is particularly valuable for someone who is becoming isolated.
The service is available to anyone who needs support, including family members, neighbours and people supporting someone else.
Benefits and financial support
Another thing families sometimes overlook is whether their loved one is receiving all the financial support they are entitled to.
Age UK Cornwall has a free and confidential Information and Advice Service that can help with applications for Attendance Allowance and Blue Badges, where eligibility criteria are met.
Attendance Allowance is financial support for people over State Pension age who have care or supervision needs because of a disability or health condition. It is not means-tested, so it is well worth investigating if someone needs help or supervision during the day or night.
With the person's consent, their advisers can also carry out a benefits check to identify additional financial support that may be available, including Pension Credit and other relevant benefits.
This additional financial support may help families fund care, equipment or other services that make independent living easier.
Information and Advice Services
Age UK Cornwall Information and Advice Service
Telephone: 01872 266888
Their Attendance Allowance advice line is available Monday to Friday, 10am–12pm.
Other organisations and services worth knowing about
There are several other organisations that can provide valuable advice and support to people living with dementia and their families.
Alzheimer's Society
The Alzheimer's Society is a fantastic source of information for people living with dementia, family members and carers. They provide advice on dementia, practical support, local services and help with understanding changes in behaviour.
Website: https://www.alzheimers.org.uk/
Dementia UK
Dementia UK provides specialist dementia nursing advice through its Admiral Nurse service, alongside practical information for families. Admiral Nurses can offer valuable guidance to families dealing with complex dementia-related challenges.
Website: https://www.dementiauk.org/
Cornwall Council Adult Social Care
If you are concerned that someone is struggling to manage at home, you can request a care needs assessment. This can look at personal care, eating, mobility, safety, social contact and the support needed to maintain independence.
An assessment can help identify whether home care, equipment or other services may be appropriate.
Telephone: 0300 1234 131
When is it no longer safe to live alone?
This is often the hardest question for families. There is no single stage of dementia at which someone automatically needs to move into residential care. Some people can continue living at home for a considerable time with the right combination of family support, carers, technology and adaptations.
However, it is important to recognise when someone's needs are increasing.
Repeated falls or unexplained injuries, not eating or drinking enough, significant weight loss, medication being missedor taken incorrectly and increasing difficulty with washing and dressing can all indicate that someone needs more support.
Other concerns might include leaving the house and becoming lost, being unable to recognise or respond to emergencies, leaving cooking appliances on, becoming increasingly frightened or distressed when alone, or spending long periods without meaningful contact.
Night-time difficulties are also important to consider. If someone is regularly getting up, falling, leaving the property or requiring assistance throughout the night, the existing support arrangements may no longer be sufficient.
If these concerns arise, it is important to seek professional advice. A GP, dementia specialist, occupational therapist or adult social care team can help assess the situation.
Sometimes a little more support is all that is needed. This might mean additional care visits, a regular meal service or family members checking in more frequently. At other times, a greater level of support may be necessary.
It is not a failure to recognise that someone's needs have changed. The priority is ensuring they are safe, comfortable and receiving the care they need.
Don't forget the family and carers
Supporting someone with dementia can be emotionally and physically exhausting. Family members often take on a huge amount of responsibility, particularly when they are trying to balance their own work, family commitments and caring responsibilities.
It is important to remember that carers need support too. Accepting help from other family members, arranging regular respite, using local services and talking to other people in similar situations can make a real difference.
You cannot do everything yourself, and you shouldn't have to.
A final thought: Independence, dignity and quality of life
When someone is diagnosed with dementia, it can be easy for family members to focus on what might go wrong. Ofcourse, safety is important. Planning ahead, making adaptations and having appropriate support in place can prevent many problems and provide reassurance.
But it is equally important not to lose sight of the person behind the diagnosis. They still have preferences, interests, memories, relationships and things they enjoy.
They may still love their garden, enjoy a walk, listen to music, see friends, watch their favourite television programme or sit outside with a cup of tea.
The aim isn't to remove every risk or take away every responsibility. It is to find ways of managing risks while preserving as much freedom, independence and enjoyment as possible.
Many people do continue to live alone with dementia, particularly when families, carers and local services work together to provide the right support.
Sometimes it is the smallest changes that make the biggest difference. A night light, a familiar photograph, a regular meal delivery, a grab rail, a medication dispenser, a comforting teddy bear or simply having someone pop in for a chat can all contribute to a better quality of life.
There is help available, and families don't have to navigate this alone.
About Physio at Home
At Physio at Home, we understand that maintaining mobility, balance and independence is an important part of helping people remain in their own homes.
Our home-visit physiotherapy service supports people with mobility difficulties, falls risk, reduced confidence and a range of physical conditions.
If you have concerns about a loved one's mobility or ability to manage safely at home, seeking advice early can make areal difference.
The right support can help people maintain their independence and enjoy life at home for as long as possible.
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