A Good Day in Dementia Care Starts With a Blank Plan

In my last piece on personalisation, I said that care can't honestly be called personalised when the day is still shaped around routines, timetables and what suits the service. I promised to follow it up with what needs to change.

The answer isn't another policy, or another costly activity programme. It's a shift in culture: giving staff the freedom to respond, making a meaningful day everyone's responsibility, and letting the person, not the service, shape the day.

What personalisation means to me

My own take is quite simple. Personalisation is helping people live a life that still feels like their own.

For someone living with dementia, that comes down to freedom. Being able to move around, join in, make choices, take sensible risks, and do what they can for themselves, with support when they need it.

A full timetable doesn't prove a full life

Care homes have become very good at producing activity timetables. The sheet is colourful, the noticeboard looks busy, and at a glance it seems that plenty is happening.

But the number of organised activities on offer proves very little. Being present isn't the same as taking part, and taking part isn't the same as enjoying it. What matters is whether the activity meant something to the person, and whether they stayed free to choose. If they wanted to leave, do something else, or find a quiet moment alone, did someone notice, and were they able to respond? Or was the person encouraged to stay because the timetable said this was the activity?

I want to be clear: there's nothing wrong with organised activities. A visiting singer can bring enormous pleasure. Trips, performers and events give a day welcome shape, and families understandably like to see that there's plenty to enjoy.

The problem starts when the timetable begins to drive the day. A programme planned weeks in advance starts with the organisation, then asks people to fit around it. And nobody can know on Sunday evening what someone will feel like doing at half past ten on Wednesday morning. They might want to join in. Or they might want a quiet cup of tea, a walk, a chat, or a little longer in bed.

Why "right now" matters so much

As dementia progresses, the ability to remember future plans and imagine future events can become much harder. For many people in the middle to later stages, what matters most is what's happening now: how they feel, what interests them, and what they want at that moment. Research also shows that the emotional effect of an experience can stay with someone even when they can no longer remember the experience itself.

That's one of the strongest arguments I know for what I call the blank activity plan.

What a blank plan actually means

It doesn't mean nothing happens. It means the day isn't treated as settled before the people living it have had any say. Staff bring knowledge, imagination and possible choices, then respond to the person, the weather, an unexpected visitor, a change of mood, or an idea that comes up as the day unfolds.

That's much closer to how life really works. The sun comes out, so someone waters the plants or sits in the garden. A person mentions the newspaper, so a member of staff walks with them to the shop. Someone hears a favourite song, starts tapping their foot and chooses the next record. Another person fancies tea and toast and helps to make it.

Most of these moments cost next to nothing. Sorting the post, feeding the birds, wiping the table, choosing flowers for a vase, pairing socks, sweeping a path, or simply walking freely around the home and taking in life going on around you. What they need isn't an entertainment budget. They need staff who notice the opportunity, and a culture that lets them act on it.

Trusting the people who know them best

For this to work, staff need real flexibility within clear values and sensible safeguards. A care worker shouldn't need a manager's permission every time someone wants to go into the garden, make a sandwich or walk to the shop. If every ordinary decision has to climb a hierarchy, the moment has usually passed before the answer comes back.

Care workers are skilled people. They know the individuals they support, notice changing cues, and can use sound judgement. Managers need to be clear about what staff can decide, back that up, and give them the confidence to respond to the person in front of them. And if something takes longer than expected, or one activity naturally leads into another because someone's enjoying it, nobody should be criticised for a routine task running a little late.

It also makes the work more rewarding. Helping someone make a choice, enjoy a moment or take part in something ordinary can be far more satisfying than finishing a task and moving on to the next one. These are the moments staff talk about afterwards, the stories they tell friends and family, and often the parts of the day that made the job feel truly worthwhile.

Life is an activity

If life is being lived, then it's an activity from the moment someone chooses their breakfast, lays the table and butters their toast. Those moments are easy to overlook because they don't make impressive photographs or fill an hour on a schedule.

Folding three towels might look less exciting than a themed event. But for someone who has always taken pride in contributing, those few minutes can mean far more. Purpose, contribution and belonging are part of life too.

A word of caution

A more spontaneous way of working must never become an excuse for too few staff, limited opportunities or a lack of imagination. Managers still need to know what's happening across the home, who's joining in, who's being missed, and whether everyone is getting a genuine chance to be part of everyday life. A blank plan only works when the culture around it is full of observation, relationships, ideas and conversation, with staff who know people well enough to spot an opportunity and act on it.

The evidence can come afterwards, rather than being prescribed in advance. What did the person choose? What support helped make it possible? Did they smile, concentrate, talk, relax, lose interest, or want to carry on? Those answers tell us far more than "attended music" or a tick in a box.

Planned and spontaneous moments belong side by side. The singer booked for Tuesday may be wonderful, and so may an unplanned pint on a Monday afternoon, a walk to the shop, or ten minutes choosing seeds for the garden. The question isn't which matters more. It's whether the moment meant something to the person, rather than simply filling time for a group of people labelled "residents".

Everyone's job

This can't depend on one activities coordinator. It has to involve everyone: care staff, cooks, domestic and kitchen teams, and managers, each spotting the chances within ordinary daily life and helping people take part.

The strongest activity plan starts completely blank. Not because nothing will happen, but because the day is still unfolding, and it belongs to the people living it.

If you'd like to understand how this thinking shapes life in our homes, you can read more about dementia care at Hale Place, or get in touch and we'll talk it through, with no pressure to have decided anything first.