We have a number of residents in our dementia care home who for one reason or another don’t sleep too well at night. Now we have been given a list of 13 of them who are to have medication in the morning an hour before food. So we have to start at around 6.30 and wake them all to give them medication. I feel awful doing this as I certainly would not appreciate being woken from a deep sleep and then be expected to swallow tablets. Is this right? Why can’t they have them once they’re up and then wait an hour for their breakfast? It’s purely to fit in with the routine of the home and to me that is institutional abuse! Please help

Answered by Jackie Pool

Thank you for raising this question: is it acceptable to wake residents at 06.30 to give medication in order to accommodate the home’s routine? It sounds as though you already know the answer that any institutional routines are not following the best practice of evidence-based person-centred care and I am sure that you are really looking here for some support that you can use to change the practice in your care setting. So, let’s look at some of the reasons why this is not acceptable and also why a home might make the mistake of working in this way.

Sleep disturbance should not be taken lightly as it can certainly result in distressed behaviour as an emotional response that can have an impact on the person’s whole day and, of course that will equally impact on those around the person including other residents, visitors and the team.

But also sleep is important to brain health and cognitive function. So, by regularly disturbing sleep, you could be adding to the person’s symptoms of dementia. By viewing sleep an integral part of the care support that you provide, you will be enabling each individual to be closer to their optimum level of ability in every-day activity. Just think what a difference that can also make to the person’s emotional state and to others in the home too!

We also know that sleep is important to the whole body system: supporting immune responses and the healing process. So there are many good reasons for enabling an individual to sleep well and to wake up when ready.

Here is a link to just one of many articles on the subject of sleep and brain health: https://www.ageuk.org.uk/information-advice/health-wellbeing/mind-body/staying-sharp/looking-after-your-thinking-skills/sleep-and-brain-health/ that I think you will find interesting and useful.

It can of course be the case that individuals need to take a medication at a set time, often this is relating to taking it with food but sometimes it can be to keep a condition, or pain relief, stable. I have often found it to be the case that the underlying reason that a care provider falls into this medication routine is to fit with meal times so there possibly needs to be a bigger conversation, not only about medication times but also about the timing of all meals and therefore possibly the rota for the kitchen team. You can see from this how easy it is to forget the needs of the individuals who use the service in the pressure to manage everything.

Starting with the individual, I recommend that each resident is reviewed for their medication needs, their sleep pattern and their preferences. Some individuals might wish to be woken and to have their medication early and this might continue a lifelong pattern. Others might prefer a longer sleep and a later breakfast. The GP will be able to review the medication prescription and advise if the medication can be offered later. All individuals wishes and their holistic needs should be considered and personalised care plans developed that reflect this. These truly person-centred care plans, a home that is managed to deliver the planned care and team actions that evidence it in practice will all take your home on the pathway to being outstanding in your service to your residents.

I do hope that this reply has been helpful to you and well done for advocating for the residents who use your service.