Practice implications

Dignity 

A culture in which care staff respond with sensitivity and respect to the different needs and preferences of each individual must be established. This requires both systems for communicating the different requirements for each person and modelling of good practice.

Training

Providing access to training for night-time care staff can be difficult in terms of logistics. It is important, nonetheless, that staff receive both generic training, for example in how to respond to people with dementia, and training specific to night-time support for example the management of incontinence.

Consistency

Continuity and consistency between day and night-time provision in care homes should be established, both for the benefit of the individual resident and to avoid confusion between different shifts and schedules.

Management involvement

Promotion of features such as dignity and consistency require active participation from management. They need to be proactive in the establishment and supervision of appropriate night-time routines and in the development of responsive support patterns suited to each individual. Guidelines for appropriate intervention need to be clearly understood and monitored.

Problem solving

Creative and imaginative solutions for issues such as night-time waking or disturbance need to be explored. For example external lighting may be making rooms too bright or individuals may have spent their working lives on night shift.

Regulation

The regulatory agencies should ensure that their inspection activities address and observe the specifics of night-time care. Particular attention should be paid to avoiding unnecessary routines and to ensuring sensitive and appropriate interventions. Requirements in respect of staff training should recognise the need for qualified staff on both day and night shifts.