Why Ordinary Life Matters in Dementia Care

I wrote a column for The Carer (Issue 307) that I want to share here too, because it's about something I feel very strongly about: the small, ordinary things that make a day feel like your own.

In England, there's no blanket rule that says a person living with dementia must be kept out of a care home kitchen. And yet, in some services, the kitchen door might as well carry a sign saying: ordinary life ends here.

"Safety" matters. It just isn't the whole story.

The reasons are familiar. Health and safety. Food hygiene. Insurance. Hot equipment, sharp utensils, and the need for supervision. All of them deserve proper attention. But they don't justify keeping every person out of every kitchen task. When a diagnosis becomes the risk assessment, we've stopped looking at the individual.

Think about your own morning. You probably choose your breakfast, make a cup of tea, pop the toast in, wash up afterwards. They look like ordinary chores, but they draw on decisions, skills and habits you've built over a lifetime. They give us purpose, conversation, something to do with our hands, and a sense that we're a part of our own home, not waiting for somebody else to do life for us.

So when I think about breakfast in a care setting, I ask a simple question. Was the toast placed in front of someone, already buttered and cut, because that was quicker? Or were they supported to choose their bread, use the toaster, spread the butter and carry their plate to the table, doing as much as they could for themselves?

It's usually the clock, not the law

In practice, the barrier is rarely the law. It's the morning routine. Breakfast needs to be served, medication given, personal care completed, the dining room cleared. When everyone's working to the clock, it's quicker to make the toast than to stand beside someone while they make it themselves.

But what saves a few minutes can take away one of the few ordinary choices a person still has. It might make the service more efficient. But whose morning is it, the organisation's or the person's?

The Health and Safety Executive's guidance is helpful here. It encourages people to do what they can for themselves, and says risk assessment should help someone live well rather than simply restrict them. Nobody is arguing for unrestricted access. Some equipment will be out of bounds. But a blanket ban isn't the only answer.

Assess the person, not the diagnosis

The question to ask is about this person doing this task, not about dementia in general. What do they want to do? What can they already manage? Could we reduce the risk by moving a piece of equipment, using a different utensil, or having someone stay close by? And alongside the possible harm, we should weigh up what the person might gain: confidence, enjoyment, independence, familiar skills, and time with other people.

It's also about capacity. The Mental Capacity Act is clear that we can't treat someone as unable to make every decision just because they have dementia. Capacity relates to a specific decision at a specific time, and people should be supported to decide for themselves wherever possible. "They have dementia, therefore they can't" isn't a lawful capacity assessment, and it certainly isn't person-centred care.

Taking part will look different for everyone. One person might safely make a whole sandwich. Another might peel vegetables, stir a cake mixture, choose the fruit, or sit at the table while a familiar meal is prepared. Someone else might simply want to smell the ingredients and talk about the food. The aim isn't to push everyone into the kitchen. It's to stop automatically keeping everyone out.

The woman who planted bulbs with her bare hands

The same idea reaches well beyond cooking. I once supported a 93-year-old woman with dementia who loved gardening. She would kneel down, put her bare hands in the soil, and plant bulbs. That was how she gardened. She didn't need a scheduled session, a plastic apron, a trowel handed to her ceremonially, or someone insisting on gloves. She needed bulbs, soil, freedom, and people who understood why doing it her way mattered.

Every life worth living carries some risk. We can fall in the garden, burn ourselves cooking, trip on a pavement, or cut a finger doing arts and crafts. We don't respond by giving those things up. We make sensible adjustments and carry on. So why should a diagnosis of dementia turn that principle on its head?

A better question

It's easy for any care environment to drift towards being tidy, organised and efficient, with very little room left for people to contribute. The bedrooms look immaculate, the meals arrive on time, the paperwork is complete. On paper, everything looks fine. But in daily life, something important can go missing. Safety matters, of course, but it can't be the only measure of a person's life.

So I'd like us to stop asking only, "What could go wrong?" and start asking: "What could we change so this person can still do it?"

Move the dangerous equipment. Offer a safer utensil. Break the task into stages. Provide supervision. Choose a quieter time. Adapt the environment. And accept that it might take a bit longer, and the kitchen might get a little messier.

In those few minutes, the person has done far more than take part in an activity. They've made a choice, used a skill, and contributed to the place where they live. For a moment, they've stayed in charge of an ordinary part of their own life.

That isn't keeping someone occupied, and it isn't something to tick off on a chart. It's letting a person carry on being part of everyday life, rather than simply being cared for within it.

That, surely, is what personalisation was always supposed to mean.

You can read my full column in Issue 307 of The Carer: https://issuu.com/thecarer/docs/the_carer_digital_-_issue_307?fr=sZDgwYTkwNzczOD.

If you'd like to understand how this thinking shapes everyday 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.