Physiotherapy for Dementia: Specialist Home Visits Across England

Compassionate, expert home-visit physiotherapy focused on mobility, comfort and quality of life. HCPC-registered physiotherapists. No GP referral needed.

When dementia starts to take their mobility too

It often starts with something small. Dad stops using the stairs. Mum needs a hand out of the chair she has sat in for twenty years. Then there is a fall, or a spell in hospital, and suddenly the person you know is frailer, frightened and far less steady on their feet. Physiotherapy for dementia will not change the diagnosis. What it can do is help someone keep moving, stay comfortable and safe for longer, lower the chance of the next fall, and keep doing as much for themselves as they are able, at every stage. And we do it where people with dementia move best: at home, or in their care home, in rooms they recognise.

Dementia is not only a memory condition. It changes how a person moves: their balance, their walking speed, how quickly they react when they trip, and whether they can follow what they are being asked to do. In some types, particularly dementia with Lewy bodies, the stiffness and slowness look very much like Parkinson’s, and we treat them with the same techniques we use in our neurological physiotherapy. The thinking and the moving together is the work our team does every week, in family homes and in care homes.

When she can’t follow instructions, or won’t

Most physiotherapy assumes the patient can follow a list of instructions and remember them until next week. With dementia, that assumption often fails on the first visit. So before we set a single exercise, we find out which type of dementia it is and what it has affected. Alzheimer’s, vascular, Lewy body and frontotemporal dementia each change communication and motivation in different ways, and each needs a different approach.

Refusal is one of the hardest things for a family to watch. Often it is apathy, and apathy in dementia is frequently linked to changes in the frontal lobe, the part of the brain that weighs up whether something is worth the effort. When someone says no to moving again and again, it is rarely stubbornness; the brain is simply not registering the reward. So we stop asking them to “do their exercises” and give them a reason instead: the kettle, the garden, a grandchild at the door.

Thinking slows down too, so an instruction with three steps in it can be too much to take in. We set people up to succeed, not to fail. Our physiotherapists are trained to:

Give one instruction at a time. Not “stand up and walk to the kitchen”, but “feet back”, then “lean forward”, then “stand”.
Use the 10-second rule. Wait after each instruction, because the answer is often already on its way.
Show rather than tell. Demonstrate the movement, or point to the chair, the rail, the door.
Guide with touch. A light hand at the hip, or on the back of the chair, can start a movement that words cannot.

Ability can change from one hour to the next, and from one visit to the next. A bad session is information, not failure: pain, a poor night, an infection brewing, or simply the wrong time of day. We look for the reason behind the behaviour before we change the plan. And because we are there for an hour and the family and carers are there for the other twenty-three, we show them what to do, what to say, and when to leave it for another time.

Why falls are more likely, and what we look for

Falls are one of the biggest risks in dementia. In one large study of older people living at home, nearly half of those with dementia fell over the course of a year, against fewer than a third of those without (Okoye et al., 2023). The reasons stack up: misjudging depth and distance, less awareness of where the feet are, medication, and alertness that comes and goes. So a falls assessment at home looks at the person and the house together: the dark rug that reads as a hole in the floor, the unlit route to the toilet at night, the chair too low to stand up from.

Late afternoon and evening bring their own risk. Sundowning, the restlessness and confusion that often build as the light fades, can turn someone who was slow and stiff at breakfast into someone up and moving quickly, and unsteadily, by teatime. That change catches families out, because they plan around the morning version of the person. We watch the pattern over the first few visits, then plan around it: lamps on before dusk, a clear route through the house, and a chair placed where they tend to stop.

What does physiotherapy for dementia include?

It depends on the stage, and on the day. Early on, the work is about strength, balance and keeping up the walks and routines that hold a week together. Later, it may be about getting back on their feet after an illness or a hospital stay. In the advanced stages, when walking has gone, success is measured differently: comfort, how smoothly a transfer goes, and how much of their own care a person can still take part in. Below are the situations we are asked about most.

In a care home: when they stop walking

In a care home, walking can stop quietly. A urine infection, a move to a new room, a week in bed with a cold, and suddenly someone who used to walk to lunch is being wheeled there. Each week in the chair makes the next step harder. We work alongside the care staff to put walking back into the day: to the dining room, to the window, to the garden door, so it happens between our visits and not only during them. It is at the heart of our care home physiotherapy.

Coming home from hospital

Hospital is hard on anyone with dementia. The ward is unfamiliar, nights are broken, delirium is common, and days spent mostly in bed take strength away far faster than it comes back. Wards are there to make people medically well, and there is rarely time for the slow, one-to-one practice someone with dementia needs to walk confidently again. That is where we come in, from the first days after discharge, at home, where the stairs, the chair and the bathroom are the real ones. Our article on why two weeks in hospital can undo a year of walking explains the reasons in more detail.

Sometimes the discharge is to a care home “for now”. A temporary placement does not have to become permanent. If what stands between someone and their own front door is physical, such as the stairs, getting to the toilet at night, or needing two people to help them stand, that is something we can work on, one to one, with a clear goal and an honest view of whether it is realistic. The same goes for a care package set up in a hurry: a care plan written on the day you came home does not have to be forever.

In the later stages

When they can no longer stand or walk

Physiotherapy does not stop when walking does. If someone now needs two carers to wash, dress or move them, the goal shifts to how that care is given, and how much of it they can still do themselves.

Taking part in their own care. Rolling in bed to help the carer, holding the flannel, lifting the spoon, combing their own hair. Small things, and they become the goals.
How carers move them. We review the handling so it is safe and dignified, and so it asks the person to help rather than doing everything for them. Once someone gets used to being moved, they soon stop trying.
Hoists and transfers. Making hoisting calmer and more comfortable, helping the person take part as much as they can and, where it is realistic, working towards a transfer that needs less equipment.
Getting outside. Fresh air, daylight, the garden. It helps mood and sleep, and it is easily lost when moving someone is hard work.

Seating and 24-hour postural care

When someone spends most of the day in a chair or bed, how they are positioned starts to matter as much as any exercise. A chair that lets them slide down or lean to one side leads to pain, sore skin, harder swallowing and joints that gradually stiffen. We assess the chair, the bed and the positions they spend the day and night in, and work with specialist equipment providers to get it right: supported, comfortable, and able to see the room and the people in it. The aim is to protect joints, help prevent contractures and keep them as free from pain as possible.

When our visits alone are not enough, because the risk is round the clock or the progress needs daily practice, there is live-in rehabilitation care. A trained live-in carer lives with your relative and carries out the plan our physiotherapist sets, every day, and we visit to move it on. It is how Kathy G.’s father, 83, living with dementia after a broken hip, was back home within two weeks.

Working with the rest of the team

Physiotherapy is one part of dementia care, and we fit around the people already involved rather than over them. That might be the memory clinic or community mental health team, the GP, an Admiral Nurse (a specialist dementia nurse, where there is one locally), the occupational therapist, district nurses, social workers and, above all, the carers and care home staff who are there every day.

With your permission, we read what they have already written, follow any plan or precautions already in place, and keep them updated on what we are doing and what we are seeing. When something needs a doctor, such as new pain, a sudden change, or a medicine that seems to be affecting balance, we tell you and write to the GP rather than working around it.

Sometimes the answer needs more than one pair of hands. For Christine B.’s husband, Will arranged joint visits with the NHS professionals already involved, and together they found a way to get him safely out of bed each day. That is what we mean by working together: one plan, agreed by everyone, rather than several pulling in different directions.

What to watch for

The most useful thing a family can learn is the difference between dementia and delirium. Dementia changes slowly, over months. Delirium comes on over hours or days: someone who was chatting yesterday is suddenly far more confused, drowsy or agitated, seeing things that are not there, or unable to follow a conversation. It often has a treatable cause, such as an infection (urine infections are common in older people), a new medicine, dehydration or constipation. It is easy to put down to “the dementia getting worse”, which is exactly why it gets missed.

Other changes come on more slowly and are worth telling us or the GP about: walking that has become slower or more shuffling, more near-misses, reluctance to stand, new pain when moving, sleeping much more, or eating and drinking less. There is often a reason, and the sooner it is found the easier it is to put right.

Get help straight away

Call 999 or go to A&E if someone:

suddenly becomes confused, or much more confused than usual
has fallen and may have hurt their head, back, neck or hip, or cannot get up
shows signs of a stroke: a drooping face, a weak arm, or slurred or muddled speech

Call NHS 111 if they have fallen and may be in pain, injured or unwell, and none of the above applies.

If they cannot get up, do not try to lift them on your own. Keep them warm, stay with them, and wait for help. Based on NHS guidance on sudden confusion and falls.

What a visit looks like

The first visit

The first visit is an assessment, at home or in the care home, and usually takes around an hour. We want to talk to you as much as to your relative: what they were like a year ago, what has changed, what a good day and a bad day look like, and what matters most to them. Then we watch how they get out of the chair, walk, turn, and manage the stairs or the bathroom, and we look around the house for the things that make falls more likely. If there are carers or care staff, we like them to be there too.

After that

After that, visits follow a plan we agree together. A session might include walking practice to somewhere that matters to them, standing and balance work built into everyday tasks, exercises the carers can repeat, and a check on equipment, seating and footwear. We pace it around the person on the day: if they tire or become unsettled, the session changes shape rather than pushing on.

How many visits depends on the goal. Getting back on their feet after a fall or a hospital stay is usually a course of regular visits over several weeks. Keeping someone steady and moving through the later stages is often a longer arrangement, with visits spaced further apart. We review progress with you regularly, and we will tell you honestly when it is time to change the plan, space the visits out, or stop.

When you have been told there is no rehab potential

“They told us there was no rehab potential.”

Families often come to us after hearing this, on a ward or from a community team. With dementia it is an easy judgement to reach in a short assessment: if someone cannot follow a three-step instruction, or does not answer in the first few seconds, it can look as if they cannot take part at all. Often the problem is the way the question was asked, not the person answering it.

We start from a different place. We never write a patient off. We take the time a busy ward rarely has: an unhurried assessment, the communication techniques described above, and the same physiotherapist visit after visit, so the person comes to know them. That is often when potential shows itself, as it did for Christine B.’s husband, bed-bound for months, who can now be hoisted out of bed for part of each day. We will always be honest about what is realistic. But everyone deserves a proper, patient assessment before that decision is made.

What families tell us

Where our dementia work began

Our dementia work began in Oxfordshire, with families at home and residents in care homes, and we are listed in the support directory of Dementia Oxfordshire, run by the charity Age UK Oxfordshire. We now bring the same approach to families across twenty counties in England, and the physiotherapists who visit are the people you can meet below.

Meet the dementia team

Our dementia work is led by Will Ferguson, our founder and clinical director, who has spent years working in care homes and training care staff to support people with complex dementia safely. The approach on this page is the one he teaches the team. The people below do most of our dementia work: chartered physiotherapists, supported by physiotherapy assistants who help with the regular practice between sessions. Every Caring Physio physiotherapist is HCPC registered and a member of the Chartered Society of Physiotherapy.

Will

Clinical Director & Founder