Mrs PW is 104 years old and lives in her own home with her beloved dog, Sky. Remaining at home, surrounded by familiar memories and with Sky by her side, is deeply important to her wellbeing and quality of life. Following a fall at home, although she was not physically injured, concerns increased about her overall safety and vulnerability. The incident highlighted growing risks linked to reduced mobility, periods spent alone, and the potential for further falls, particularly overnight when support was not available. After discussion with her family and GP, it was agreed that live-in care was the safest way to help Mrs PW remain at home while reducing these risks.
Before care began, Mrs PW relied heavily on the kindness of a friend and neighbour who visited daily to assist with meals, personal care, walking Sky and helping her settle for the evening. While this support was valued, there were still long periods where Mrs PW was alone and at risk, especially when mobilising around the home or needing support during the night. A managed live-in care arrangement was introduced with a clear focus on keeping her safe while preserving her dignity, independence and established routines.
Support was tailored around Mrs PW’s individual needs and preferences. Carers assisted with personal care, continence management, meal preparation, hydration and safe mobility around the home. Mrs PW uses a three-wheeled walker and receives supervision and reassurance when mobilising to reduce the risk of falls. Gentle prompting to use the toilet, together with support managing continence products, helped maintain comfort, dignity and skin integrity. Having a carer present throughout the day and overnight also meant changes in her health, mobility or wellbeing could be noticed quickly and acted on promptly.
One of the most effective improvements came through a personalised bedtime routine. Mrs PW would sometimes choose to sleep in her chair rather than go to bed, increasing risks linked to poor positioning, discomfort, continence issues and unsafe movement during the night. Instead of challenging her choice directly, the live-in carer introduced a calm and respectful evening routine built around companionship and reassurance. After supper, Mrs PW was encouraged to sit in the kitchen for conversation before being supported to walk to the bathroom, complete personal care, change into nightwear and then walk through to bed. This thoughtful approach quickly became an established part of her routine and has continued successfully.
The outcomes have been significant. Risks during the evening and overnight periods reduced, and Mrs PW’s overnight continence improved, with family and carers reporting that the bed was no longer wet during the night. This improved comfort, dignity and sleep quality, while reducing the need for disruptive night-time interventions. Mrs PW has also settled positively into having a live-in carer and has said she is happy with how things are going. Rather than spending long periods alone waiting for visitors, she now benefits from regular companionship, reassurance and immediate support whenever needed.
Her son has praised the support provided, particularly around continence care, nutrition and the way the home environment has been organised to make day-to-day life easier and safer for his mother. This case demonstrates strong Safe practice through early recognition of increasing risk, proactive care planning, effective falls prevention, close monitoring and personalised support. By adapting care around Mrs PW’s wishes while managing risks sensitively, the team has enabled her to remain safely in the home she loves, with dignity, comfort and the companionship of Sky.
