Examples of Unmet Needs for People with Dementia Living in Care Homes
Below are examples of areas of unmet needs for people with dementia living in care homes. The list includes possible interventions that can be
implemented to help meet these needs. The list is not exhaustive and just gives a sample of ideas. Interventions should however be person centred and
promote good practice.
1. Accommodation:
Possible intervention
Unmet need

No suitable place to live

Availability of personal effect and interests

Repairs on home or redecoration needed

Room size, personal storage, appropriate furniture, heating, bedding,

Rooms of insufficient size or dimensions to meet individual
access, radios, televisions? Fire egress.
requirement

Provision of good quality and modern décor and furnishings
Significant risk: fire hazard, stairwells, exits, access to assistance,

Application of the Home Care Standards.
dampness, wet room, unclean furnishings

Purpose built accommodation - single storey

Odour

Provision of aids and adaptations i.e.: stairlift, handrails, ensuite

Lack of aids and adaptations – restricting full use of property

Lack of appropriately trained or skilled staff to meet the needs of

Private areas to allow time spent on own or with visitors
person – inappropriate placement

Furnishings that promote the maintenance of privacy and dignity –


facilities
Inadequate staffing levels
use of appropriate curtains and screens

Provision of a safe and secure environment
2. Household activities:
Possible intervention
Unmet need

Not permitted or not assisted to do household tasks

Inadequate standards of hygiene and lack of appropriately trained

Involvement in household tasks, dependent on abilities and risk
assessment i.e. table setting, laundry folding
domestic staff

Provide assistance/supervision when and where needed

Poorly maintained facilities

Occupational therapist -sequencing/rehab program

Unsupervised access to restricted areas i.e. kitchen

Assess ability to look after own possessions i.e. clean/tidy own room,
make bed

COSHH and food hygiene training for staff
3. Food:
Unmet need
Possible intervention

Culturally inappropriate food

Culturally appropriate food, variety of diet, healthy options

Inadequate portion size

Flexibility in times for eating

Lack of choice and flexibility of meal times

Provision of snacks,

Marked weight loss or weight gain

Monitoring of weight gain or weight loss

Special requirements needed, i.e. therapeutic diets, food

Medical doctor/District Nurse – physical screen for contributing
supplements
illnesses

Difficulty eating food – swallowing, chewing, holding cutlery

Dietician – nutritional / dietary advice

Choke risk

Prescribed therapeutic diet/ supplements

Need for assisted feeding / PEG feed

Speech-language therapist – assessment of swallow, rehab program

Behavioural problems

Dentist – ensure dentures fit, good mouth-care

Occupational therapist – sequencing, environmental evaluation,
rehab program

Provision of aids – plate guards, cutlery handles, lidded beakers.

Psychologist – behavioural assessment

Provision of separate dining areas

Assistance with feeding
4. Self-care:
Unmet need
 Poor hygiene – self-neglecting.
Possible intervention

 Resistance to interventions
Increased care needs – increased personal care time and assistance,
appropriate time for self-care assistance, culturally appropriate care
 Inadequate staffing levels and skill

Standards for maintaining privacy and dignity
 Lack of equipment to meet and maintain individual personal

Effective communication skills training

Occupational therapist assessment - provision of aids/adaptations to
hygiene needs
 Limited movement, restricted in ability to coordinate tasks
assist with personal hygiene – hoists, shower stools, therapeutic
baths

Involvement and assistance of carer or relatives
5. Caring for Another:
Unmet need
Possible intervention

Significant level of carer burden and distress

Access to support groups, education, advocacy services

Inability to care for person adequately - high risk factors

Community Nurse involvement i.e. Admiral, Macmillan, Marie Curie

Grief and Bereavement Counselling

National Carers Organisation, Liaison workers

Voluntary Organisations – Alzheimer Society, Age Concern

Charitable Organisations – Vitalise Holiday, Cheshire Homes

Carers assessment

Duel placement
6. Daytime Activities:
Unmet need
Possible intervention

Low level of stimulating or unsuitable activities


Lack of variety and options with activities
games, books, videos, crafts, clubs, newspapers, sequencing of

Risk of harm when doing activities
tasks, sensory equipment

Lack of staff skill and ability to undertake activity

Lack of staff time and availability to undertake activities

Lack of access to day centres, local clubs/organisations

A planned and rolling programme of activities – group and individual

Inadequate budgets

Education and training for staff

Lack of equipment and resources

Access to day centres, luncheon clubs, community support groups

Lack of staff time to plan and undertake activities

Organised outings and trips out within the locality

Use of local transport – Dial-a-ride, taxis, voluntary drivers

Occupational Therapy – advice on suitable activities program,

Appropriate level of stimulating activities and range of resources,
Use of life review to identify personal history, interests and previous
hobbies
education for staff

Appointment of activities organiser

Designated staff time for undertaking activities

Use of assisted technology

Dementia Care mapping

Use of volunteers and befrienders
7. Memory:
Unmet need

Disorientation, wandering and frequently getting lost due to lack of
Possible intervention

signposting and environmental cues.

Distress caused by insight memory problems.

Level and pace of cognitive deterioration.

Lack of staff skill in managing memory problems.
Adequate signposting, reality orientation prompts, calendars,
timetables, memory boards.

Staff education re the care of people with memory problems and/or
challenging behaviours.

Cognitive stimulation exercises, reminiscence, life history review,
access to family history, dosette boxes.

Memory Clinic referral – diagnostic assessment and screen, memory
rehabilitation, anti-dementia medication. CT/MRI scans.

Inpatient admission for assessment.

Education re Dementia Care.

Use of Dementia Care Mapping.

Use of reality orientation techniques and 24 Hour RO
8. Communication:
Unmet need
Possible intervention

Impaired hearing, eyesight

Hearing aid check, new batteries/ hearing aid

Inarticulate or slurred speech

Eye test, new glasses

Speech loss, lack of communication ability

Education about clear communication, hearing and visionary aids,

Comprehension problems

Non-provision of aids i.e. glasses, hearing aids

Audiology – hearing assessment

Lack of support and assistance

Ophthalmology – visual assessment

Speech-language referral – communication assessment/ rehab
local organisations
program

Dentist – ensure good fitting dentures and healthy mouth-care

Voluntary/charitable organisations and/or daycentres for the deaf and
blind

Communication skills training
9. Mobility:
Unmet need
Possible intervention


Environment not suitable for mobility problems or aids

Not receiving appropriate assistance with mobility

Restricted mobility around the local environment

Risk of falls assessment, provision of mobility aids, hip protectors

Significant pain on movement

Modification of environment, wheelchair access

Access to public transport – dial-a-ride, taxicards

Physiotherapy – assessment of motor ability/ rehab

Occupational therapy – assessment of environment, rehab, aids for
Increased assistance/monitoring from care staff, appropriate level of
exercise
mobility
10. Continence:
Unmet need
Possible intervention

Incontinence of urine/faeces

Urine specimen for C&S, regular physical check-up

Secondary discomfort from incontinence

Continence advisory service and provision of appropriate continence

Lack of individualised continence assessment and careplan

Recurrent urinary tract infections

Bladder retraining

Prostate problems

Prescription of medication – antibiotics, or to reduce overactive
aids, continence education, behavioural program/ memory prompts
bladder
11. Physical Health:
Unmet need
Possible intervention

Current untreated illness


Need for assessment and/or follow up
appointments available, regular medication review and physical

Pain
health check

Outstanding appointments

Specialist consultation – for further assessment by specialist service

No regular GP/Health centre contact

District Nurse involvement and health monitoring

Inadequate health promotion and monitoring

Provision of equipment i.e. pressure relieving mattresses etc
Access to primary care services; access to a GP of choice, regular
12. Drugs:
Unmet need
Possible intervention

Risk of overdose or poor-compliance

Medication review

Over sedation and significant detrimental side-effects

Use of dosette boxes

Polypharmacy

Adequate guidelines for the dispensing and administration of

Difficulty with administering or taking medications

Inadequate knowledge of medication – dosage, purpose and
medication

efficacy

Maladministration of medication

Prescribing errors
Monitoring and management of side effects, appropriate care plan for
reviewing medication, change in route of medication

Specialist local drug rehab - Drug rehab/withdrawal program
13. Psychotic symptoms:
Unmet need
Possible intervention

Untreated hallucinations or delusions

Education regarding management of residual psychotic symptoms

Increasing distress from symptoms

GP or specialist – mental state assessment and medication review

Side-effects from medications

Psychosocial interventions to manage psychotic symptoms

Lack of monitoring or follow up care by health professional

Inpatient assessment and treatment of psychotic symptoms
14. Psychological Distress:
Unmet need
Possible intervention

Depressed, anxious, frequently tearful, lability of mood
 Mental State Examination

Experiences panic attacks,
 Education about staff management of distress, care plan alteration

Negative effects of trauma
 GP/specialist – medication review
 Counselling / psychological assessment- therapy, behaviour
management program
 Inpatient/Day Hospital admission
15. Information:
Unmet need


Not received and/or not understood information about their
Possible intervention

Provision of information at appropriate level for the individual,
condition or situation
update of information when necessary, advocacy services, local
Information not provided in a format that aids retention
education services

Contact with Alzheimer’s Society pamphlets or groups
16. Safety (deliberate self-harm):
Unmet need
Possible intervention

Active suicidal ideation/intention.


Self harming - cutting, burning.

Refusal to accept interventions i.e. diet, treatment.

GP/specialist – medication review

Self neglect - not removing self from known source of danger (e.g.,

Counselling / psychological assessment- therapy, behaviour
observation.
walking out on busy road, not eating).

Wandering.
Plan for minimisation of risk. Emergency procedures, increased
management program

Psychogeriatric referral for assessment and treatment.
17. Safety (accidental self-harm):
Unmet need
Possible intervention

Leaving gas, heating, water on


Kitchen and bathroom safety

Risk of falling

Preventative measures to decrease risk in the future

Interference with potential harmful objects

Baffle/coded locks on doors, increased observation

Wandering – frequent attempts to leave the home – risk of getting

Safety features i.e. gas tap and shut off valves, water modulator
lost

Sensible positioning of furniture – use of room management

Smoker, fire risk

Appropriate levels of observation

Reduced perceptual awareness

Use of hip protectors

Occupational therapy – consultation of safety equipment
Care plan to acknowledge risk and minimise/reduce immediate
harm
18. Abuse / Neglect:
Unmet need
Possible intervention

Verbal abuse - shouting, swearing, use of insults, threats


Physical aggression – manhandling, pushing, restraint

Physical assault - striking person i.e.: hitting, kicking

Social worker - carer advocacy

Bullying, withholding, non-provision of interventions

Education re ethical, moral and legal aspects of care i.e. rights of

Financial misappropriation

Restricting access to money

Non receipt of benefits
Plan for ensuring immediate safety of the person, legal
investigation, police involvement, behaviour modification program
the resident, use of restraint
19. Behaviour:
Unmet need

Possible intervention
Violent behaviour towards other, threats, seriously disruptive

Care plans incorporates safety of others
behaviour,

Psychosocial interventions to reduce behaviour

Interfering with property of others, stealing, hoarding

GP/specialist – medication review

Displays challenging behaviours

Counselling / psychological assessment- therapy, behaviour
management program

Psychogeriatric referral for assessment and treatment
20. Alcohol:
Unmet need
Possible intervention

Regular alcohol misuse

Care plan incorporates protocol for safety from alcohol

Drinking behaviour causing harm to self or others

Referral to helping agency (i.e., Alcoholic Anonymous, drug abuse

Frequent attempts to withdraw
centre)

Inpatient treatment - Detoxification unit
21. Company:
Unmet need
Possible intervention

Significant feelings of loneliness

Organisation of group activities

Company at inappropriate level for the individual

Planning of 1:1 intervention

Lack of social contact i.e. someone to talk to frequently

Room Management

Befriender service

Psychological assessment
22. Intimate Relationships:
Unmet need
Possible intervention

Lack of personal confidant

Provision of suitable confidant, provision of spaces for privacy

Lack of skills to maintain relationships

Counselling - grief

Distress at loss of previous relationship

Education – bereavement and loss

Use of validation therapy

Education on touch and intimate relationships, education about
boundaries for staff, family, and the individual
23. Money:
Unmet need


Possible intervention
Inability to manage own money, no suitable person providing

Help with paying bills, advocacy
assistance with money management

Family contributions to top up fees, power of attorney
Can not afford basic personal requirements

Budgetary advice organisation - education and information about
budgeting

Allocation of money management to other external agencies (i.e.,
power of attorney, enduring power of attorney)
24. Benefits:
Unmet need

Unable to apply for correct benefits, unable to collect benefits,
Possible intervention

unable to understand and update current benefit status and no one
Assistance with completion of forms and claiming benefits,
incorporation in care plan
currently in charge of benefits

Care manager put in touch with appropriate benefit agencies

No allocated social worker or carer to claim benefits

Social worker – assessment/action for benefits

Home manager unaware of benefit status.

No review since change in circumstances
A. Carer’s need for information:
Unmet need


Carer has not obtained appropriate level of information about user’s
Possible intervention

Provision of information about the user’s condition in a suitable
condition
manner for the carer (i.e., written material and conversations),
Carer unable to comprehend users current situation or difficulties
provision of suitable contacts to provide further information when
and where necessary

Contact with Alzheimer’s Society information or groups

Establish Carer Support Group within the home or network with
other homes
B. Carer’s Psychological Distress:
Unmet need

Carer has symptoms of depression or anxious,

Currently not able to care fully because of level of personal distress.
Possible intervention

Referral to appropriate helping agency, carer support, education on
caring.

Formal or informal respite care.

Psychology – assessment and treatment of distress

Formal counselling – Loss & Bereavement