Mrs Bowler has dementia but is keen to continue living in her own flat. Physically, she can manage most daily tasks such as getting up and dressed, and using the kitchen, but she is unable to tell her daughter what she has done in the day.

She has two home care visits a day, at breakfast and teatime. Her daughter, Elaine, lives some 10 miles away, and calls in during her lunch break twice a week. Elaine does the shopping, and organises cleaning and maintenance of her mother’s home.
A hairdresser calls once a week.

Mrs Bowler does not like people going in and often asks home care staff to leave as soon as they arrive. Her daughter says that she has always been a private person.

There was concern that Mrs Bowler might not be eating much. The home carers reported that she often refused to eat during their visits in the morning and early evening, and it wasn’t clear if she was eating any lunch. The social worker was considering a further home care visit at lunchtime. Elaine often found her mother asleep in the chair and thought she spent much of the day asleep. She wondered if her mother was up a lot in the night. The Just Checking system was installed.

It showed that Mrs Bowler usually gets up at around 8am, and spends time in the kitchen preparing breakfast. By the time the home care team visits, Mrs Bowler has had breakfast and doesn’t wish to eat again. She visits the kitchen just after 12 noon, to make lunch. If the evening home care visit is earlier than 5pm, Mrs Bowler does not wish to eat then, but goes in to the kitchen later to prepare a meal. Regular visits to the bathroom indicate that she is eating and drinking.

There are periods of quiet and periods of activity. Mrs Bowler was more active than her family thought. She goes to bed at around 9pm. There are night visits to the bathroom, but she returns to bed. Over the weeks Mrs Bowler’s daily living pattern was much the same.

The social worker concluded that there was no need at this stage for a further home care visit. Indeed the home care visits had little effect on Mrs Bowler's mealtimes; she prepares regular meals anyway. In consultation with Elaine she decided to withdraw the teatime visit. Elaine was keen to retain a daily visit, but they agreed to change the emphasis. Elaine had noticed that there was rarely much washing and her mother was not changing her clothes. The focus of the morning visit was changed to ensuring that Mrs Bowler had two showers a week and that she changed her clothes regularly.

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