Ann

She has a care package four times per day helping to keep her in her own home. She also has family who live five minutes away and call in daily.

Her dementia has impaired her ability to communicate well with others but visits from her family still produce smiles and genuine warmth. At her best, Ann can make her needs known and make her own choices from a range of options.

Messages have been recorded by her carers that she is shouting out on their arrival and neighbours have complained to family that they have also heard noises through the night. Her family have tried to talk to Ann about her shouting, but she does not appear to understand their questions. They are worried that she is lonely and suspect she might be at risk when on her own.

It seems as if Ann may be moving from living with middle stage dementia towards later stages.

Her ability to manage her life and to take decisions are being closed down for her, both by her condition and by care that is increasingly taking responsibility away from her. She may be increasingly at risk, though the evidence is vague.

Ann seems to be reacting to her position by becoming increasingly passive.

The probability is that Ann will need increasing help, though it is worth consulting a GP about any possible underlying physical cause.

If she does need more help there will be practical and financial decisions to be taken: would Ann benefit from regular visits from a carer at night, or for some form of live-in carer? Would she accept such an arrangement and is it affordable? Might finding a care home be a better option – and how will Ann feel about the suggestion?