Supporting someone with memory difficulties at home

Someone with memory difficulties is doing constant work to make sense of their surroundings. Every unfamiliar face adds to that work. A rota of different people, however skilled, is genuinely harder than one familiar person who arrives at the same time each week and already knows how they take their tea.

This is the strongest argument for choosing your own helper and keeping them. It is also why the same time of day, in the same order, is worth protecting even when it looks inefficient.

Rather than reminding someone repeatedly, change the surroundings so the reminder is unnecessary. A large, clear clock showing the day and date. Labels or glass-fronted cupboards so contents are visible. A well-lit route to the bathroom at night, which prevents more falls than almost any other single change.

Reduce noise and clutter. Background television, several conversations, or a busy patterned floor all add to the sense-making load and can produce distress that looks like deterioration but is really overload.

For safety, consider an isolation switch on the cooker, a thermostatic valve to prevent scalding, and a key safe so someone can get in without your relative needing to answer the door.

Short sentences, one idea at a time, and plenty of space for a reply. Questions with two options rather than open ones — tea or coffee, rather than what would you like.

Avoid testing memory. Asking do you remember who I am puts someone in the position of failing. Saying it is Sarah, I have brought the shopping removes the test entirely.

When someone says something that is not true — that their mother is coming, or that they must get to work — arguing rarely helps and usually distresses. Responding to the feeling underneath, rather than the fact, almost always works better.

And look for causes when someone becomes agitated. Pain, needing the toilet, hunger, thirst, being too hot, or a urinary infection are behind a great deal of what gets described as behaviour.

Home most often stops working because the family carer is exhausted, not because the person has deteriorated past the point of being at home. A regular few hours that you can rely on is not an indulgence; it is what makes the arrangement sustainable.

Arrange breaks before you are desperate, and make them regular rather than emergency. A carer’s assessment from your council is free and available to you in your own right — separate from any assessment of your relative.

Admiral Nurses, through Dementia UK, offer a free helpline staffed by specialist dementia nurses, and it is one of the most useful resources available. The Alzheimer’s Society helpline is similarly good.

A Witho helper provides company and practical help, not personal care. When washing, dressing, toileting or medication become the issue, that is regulated care and needs a registered provider. The same is true if there is night-time wandering that cannot be made safe, or if two people are needed to help someone move.

Bringing in regulated care, or deciding on a residential place, is not a failure and not an abandonment. Practical support and personal care often sit together perfectly well — a home care agency for the mornings, a Witho helper for the shopping and the company.