What Should A Dementia Care Plan Include
A care plan is often described as the backbone of good dementia care.

If your loved one has recently moved into a dementia care home, or is about to, you’ve likely heard about care plans and might have been asked to contribute to one or sign one off.

This article discusses what a dementia care plan should include and why each part matters to the resident living with dementia and the family supporting them.

What Should a Dementia Care Plan Include?

A dementia care plan should include a personal life history, current cognitive and physical abilities, daily routines and preferences, communication guidance, medication and health information, falls and wandering risk assessments, emotional wellbeing support, nutrition needs and a clear framework for family involvement. Most importantly, it should be reviewed and updated regularly as needs change.

Dementia Care Plans in More Detail:

Personal History

A care plan for residents with dementia should capture who someone is past their diagnosis, including their previous occupation, family, habits, what they find funny and what they find upsetting.

This information has direct practical use because carers who know a resident grew up on a farm, spent their career as a nurse or always watched the evening news at 6 can use that to connect with them in moments when it becomes difficult to do so. It also guards against the kind of depersonalised care that occurs when staff only know your loved one through their medical notes, ensuring dignity and respect for the resident receiving care.

Dementia Type and Stage

A care plan should account for the fact that not all dementia is the same.

For example:

  • Someone living with Alzheimer’s disease will typically experience gradual memory loss first, with other abilities remaining relatively intact in the early stages.
  • Vascular dementia can cause more uneven decline, where certain functions are affected sharply while others are preserved.
  • Lewy body dementia often involves significant sleep disturbances, visual hallucinations and fluctuating alertness, all of which require specific responses from carers.
  • Frontotemporal dementia frequently affects personality and behaviour before memory, which can be particularly difficult for families to navigate.

And the stage of dementia is just as important as the type, when creating a care plan:

  • In the early stages of dementia, a care plan should prioritise supporting independence and recording the person’s own preferences and wishes while they can still express them.
  • For the moderate stage, greater detail is needed around communication, routine and managing changed behaviour.
  • In advanced dementia, the focus shifts toward comfort, sensory experience and end of life preferences.

Current Abilities

Some questions to ask before putting together a care plan at your loved one’s care home are:

  1. What can your relative manage on their own?
  2. What do they need prompting with?
  3. Where do they need hands-on support?

And a care plan should answer all three honestly because documenting the resident’s capabilities alongside their needs means carers can support independence where it exists rather than taking over unnecessarily, which is essential for both for dignity and for slowing functional decline where possible. This section of the care plan should look very different for someone in the early stages of Alzheimer’s compared to someone in the advanced stages of vascular dementia.

Daily Routine and Preferences

This part of the care plan is where it gets specific and granular to ensure carers can use it to provide personalised care to your loved one.

Some information it should include:

  • Wake-up time and whether they take time to orientate in the morning
  • Bathing and dressing preferences, including time of day and level of privacy
  • Food likes, dislikes, allergies and texture requirements
  • Activities that engage them and ones that don’t
  • Whether they prefer company or quiet during unstructured time

Communication

How does your relative currently communicate? Do they struggle to find words but understand what’s said to them or do they respond better to slow speech?

If there are any phrases or tones that cause anxiety, a care plan should document all of this so that every member of staff (including someone new to the role or covering a shift) knows how to approach your loved one in a way that is beneficial and doesn’t cause distress.

Communication needs will significantly change across dementia stages as it develops. For example, a resident in the early stages might be able to communicate almost normally but lose their thread of thought mid-conversation.

In moderate dementia, word-finding difficulties and repetition become more pronounced. And in advanced stages, verbal communication can be minimal, so carers need clear guidance on reading non-verbal cues.

The care plan should reflect wherever the resident is in that progression currently.

Health, Medication and Risk

  1. All current diagnoses and how each affects daily life
  2. Full medication schedule, including what each medication is for
  3. Guidance on recognising pain — particularly important for residents who can no longer express discomfort verbally
  4. Falls risk assessment and what preventative measures are in place
  5. Wandering risk and the agreed protocol if it happens
  6. Nutrition and swallowing needs, which often require closer attention as dementia progresses

Emotional Well-being

When a resident with dementia becomes agitated, withdrawn or distressed, there is usually a reason, even if they can’t articulate it well.

A suitable dementia care plan helps staff understand what those signals mean for this specific person and how to respond properly in a way that fosters good emotional well-being. It also records what can actually help them, including particular music, a walk outside or a familiar item from life before moving into the home. These details allow staff to make daily care decisions in ways that make a measurable difference to your loved one’s quality of life.

Family Involvement

Families often know things about a resident than any formal assessment picks up. And they’re usually the first ones to notice a change, which is why they are always encouraged to be involved in care plans.

You should know how you’ll be kept informed, who to contact with concerns and how your input feeds into reviews. It should also reflect any wishes your relative expressed about their care while they had capacity to do so.

Regular Review

As mentioned earlier, dementia changes over time and a care plan needs to keep pace with that. Reviews should happen at least every three months, and sooner if there’s a significant change such as a hospital admission, a fall or a noticeable shift in mood or cognition.

A Care Plan For Dementia is Only the Beginning

A care plan is only as good as the information in it — and how consistently it’s used.

When it’s detailed, up-to-date and actually read by the people caring for your loved one, the difference shows in how settled and comfortable they are, how well staff know them and how much less you have to repeat yourself every time you visit.

It’s worth asking to see it and making sure your knowledge of your loved one is reflected in it.

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