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 working daughter, Elaine, 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. The social worker was considering a further home care visit at lunchtime. Elaine sometimes found her mother asleep in a chair and wondered if her mother was up in the night and had lost the sense of time. The Just Checking system was installed.

It showed that Mrs Bowler usually gets up at around 8am, and spends time in the kitchen. 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 it was decided to withdraw the teatime visit. Elaine was keen to retain a daily visit, but to change the emphasis. She 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 encourage Mrs Bowler to shower a couple of times a week and ensure her clothes were regularly changed.