Do you worry when visiting your loved one at the care home whether your views, as attorney on the dementia care plans is good enough?

I can see you nodding your head.

You are not alone.

Every attorney has doubts about his or her supervision of their loved one in a care home. The person with dementia no longer has capacity to make most of those care related decisions.  The carers often do not recognise that the attorney has a legal and moral duty to act in the person’s best interests.

The good thing is that supervision of the many dementia care plans of your loved one leads to becoming an expert by experience. Every view you input as attorney in all of the decisions made by the care home and clinicians is a step along the road and makes you a more skilled attorney. The benefits are timely comfort and dignity for the person and appreciation by the family of the consequent risks of harm if any of the care plans are not followed.

Whilst travelling along this road, you can either travel the long road – or use shortcuts.

Using shortcuts means learning to spot and fix mistakes in order to make the dementia care plans better.

Below, Reeta Ram, family representative describes in a two part blog how to successfully inject the attorney’s views in the care home plans of a person with dementia.

What is a ‘good’ attorney’s view in the dementia care plans? How does the attorney know when to ask for an update?

Inexperienced attorneys think that ‘good’ caring is complex. It can be if your views are not acted on.

No, providing your good views is simple.

After all with the progressive dementia condition there are problems and care plans in many areas of need:

  • Behavioural Care Plan – problems resisting care, unpredictable behaviour, restlessness, wandering
  • Cognition Care Plan – Memory problems and severe disorientation
  • Emotional Care Plan – Being anxious, frightened, withdrawn
  • Communication Care Plan – Total needs being anticipated because of being unable to communicate reliably etc.


1: The art of being most familiar with needs and wishes


Consider an example of what the detailed picture on the mobility care plan could look like.

This is the story about a man, John with Mixed Vascular Dementia and Alzheimer’s as the main medical condition when a fall has just occurred. The nurse calls the attorney (wife) to inform her of a fall in the bedroom and explain John had hit his head.

Notice the difference between an observation of an agency nurse and the wife below:

Here is how the agency nurse described the scene

Nurse:I am sorry to tell you that he just fell over and hit his head. He seems ok.”

Wife: “How did it happen?”

Nurse: “It happens with dementia.”

Wife: “What happened to John?”

Nurse: “He seems ok, we gave him a cup of tea?”

Wife: “I don’t understand how it happened. Are you sure he is ok?”

Nurse: “He is ok, we have been with him for a few hours and there are no problems.”

Here is how the Attorney described the scene at wife arranged an appointment to ask more questions.

Wife:The care plans say that John needs close supervision because he is at high risk of falls in the care plan, please describe how he fell even though he is closely supervised.

Nurse:He refused to let us shave him or wash this morning so after breakfast two carers asked him to come along but he got distressed, it usually happens. He then ran away so quickly that he tripped over the handbag of a visitor and fell and hit his head. He has a red bruise but no pain. There is swelling.

Wife:I wasn’t aware he got distressed. This should be in the behaviour care plan.  As he usually gets distressed when asked, would it be possible to try another intervention plan such as asking him to come to his room to listen to his favorite classical music in his room and then encouraging him to wash after that using his favourite green towels?”

Nurse: “Yes.”

Wife: “How do you know he is not in pain after the fall?”

Nurse: “I checked for pain. He did not complain even when we touched his bruise. He has rubbed his jaw a few times today and is very agitated but nothing else. This is what happens to people with dementia we know.”

Wife: “In the communication care plan I notice that John needs nurses and doctors to fully anticipate his needs because he is unable to communicate reliably, verbally or non verbally. The GP anticipates the level of pain with the nurse because of the need in communication. I visit regularly and know he doesn’t usually rub his jaw and is not usually so agitated so we still need to anticipate pain levels. I would like you to ask the GP to consider if he needs pain relief because rubbing his jaw or an increase in agitation may be a reaction to pain. I visit regularly and know he doesn’t usually rub his jaw and is not usually so agitated.  I am very familiar with his needs”

Nurse: “Ok”

Wife: “In the pain level care plan, I notice there is no mention of anticipating pain.  Please add the need to observe for signs of pain and the need to anticipate pain relief because John is unable to communicate pain, he cannot point to the site of pain.  In the falls care plan, please record the fall.

Wife:Thank you. We have agreed to update the plans when offering a wash and observing for signs of pain generally. I understand you will update the care plans for behaviour, pain, falls and communication discussed in this meeting to try and prevent the same fall and reduce upset and resistance to washing. Please summarise the updated plans so I can sign them off to confirm I agree the changes as wife/attorney”.

Nurse: “I shall have them ready tomorrow”

Wife: “Please also ask the GP to visit asap as I would like to attend the visit. If not possible, please ask the GP to call me with an update on any pain relief he anticipates is needed or problems especially with John’s jaw”

Nurse:The GP usually makes calls so I will ask him to call you asap”

The fix

If you want to keep the care staff interested in your views, you need to explain the problem and request the solutions as simply as possible.

2. Supervise agreed action points


Do follow up to check the action plan agreed. Did the GP visit? Did you read the changes to the care plans asap?


3. Get the care home used to your supervision role


From the outset, read the care record updates each month and add any more views needed in meetings. The Care Quality Commission and Adult Social Care nationwide recommend care records should be updated monthly and that the attorney should always be invited to be involved in commenting on those updates.

Let your views on trying to improve care plans be transparent, be open to further review if they do not work.

Put your suggested fixes and views aside, wait for at least one day. Then apply the nine instant fixes above – and transform your views into a thing of great assistance to the dementia care plan belonging to your loved one.

If you are wondering how to inject your views in the care plans – follow these tips and you will be amazed how your input improves the quality of care received.

If you experience great resistance from a nursing home to even listen to or consider your views in care planning, consider engaging an advocate who will help you with the process of pushing for the rights of the person with dementia to be respected and actioned.


Thoughts? Examples? Please share in the comments

For more see Part 2 of this Blog

About the author: 

Reeta Ram is Family Representative and Director of Dementia Partners. Alzheimer’s Society warns us that one person every 3 minutes will develop dementia this year with funding lagging. Is it time for attorneys to closely supervise dementia care plans? Reeta helps attorneys inject their views in the dementia care plan in any setting. The attorney has a legal duty under the Mental Capacity Act 2005 and a moral obligation to inject views in the best interest decision making for the person with dementia. This is where the person no longer has capacity to make those care related decisions.