No Uniforms in Dementia Care
Imagine waking to a new day and opening your eyes to a room that doesn’t look or feel familiar. You lie there for a moment, trying to remember where you are, perhaps looking for the window beside your old bed or listening for sounds you know. Most of us have felt that brief confusion after sleeping somewhere new, and the relief that follows when we remember where we are and why we’re there. But for someone living with a dementia, that answer may not come, and as they look around the room and try to make sense of what’s happened, the person who comes through the door becomes part of what they’re trying to understand.
But now imagine that the person coming through the door is wearing a stark white uniform, with a badge pinned to it and a job title you’re trying to read while you’re still trying to work out where you are. You wouldn’t expect someone dressed that way to walk into your bedroom at home, so what does it mean that they’re here now? Perhaps you’re back in hospital, or perhaps something has happened and you’re ill. Even if it’s a team member you know, coming to say good morning and offer a cup of tea, the uniform may be the first thing you see, adding another question at the very moment you’re searching for something familiar.
We haven’t worn uniforms in Evolve’s homes since 2015, and moments like this help explain why. The person who lives here experiences this home every day, and how it feels to them must come first.
Seeing the world through their eyes
Dementia can affect how someone understands where they are and what is happening around them. A family member might wake believing they need to get ready for work, collect their children from school or return to the house they lived in years ago. They may be frightened or worried about someone they love, and telling them that they’re safe may not immediately ease a feeling that is real to them.
In that moment, they’re looking to the people around them for reassurance. A familiar voice and face can help, but so can the everyday details that tell them something about the place they’re in. If everyone around them is dressed alike, a uniform might suggest a hospital rather than a household, or make it harder to recognise the people they see each day as individuals.
One of our Registered Nurses noticed the difference during medication rounds “Without a uniform, I’m just one of the people amongst the family members, someone familiar. A carer in a uniform can bring to mind doctors and hospitals, making someone feel like they’re ill rather than at home.”
She’s still carrying out the same skilled nursing role and giving medication with the same care. What’s different is how that moment may feel to the person receiving it. They’re in the place where they live, with someone they’ve come to know, and we don’t want the sight of her approaching to make them feel like a patient.
Thomas Kitwood’s work on dementia care asks us to look beyond a diagnosis and consider the person’s life, relationships and experience of the world. A uniform may be an ordinary part of a working day to the person wearing it, but to someone who remembers being frightened in hospital, it may carry a very different meaning. Knowing the person helps us understand what that sight might bring back for them, rather than expecting them to see it as we do.
Why does it matter for someone who isn’t living with a dementia?
A person doesn’t need to be living with a dementia for uniforms to affect how they feel about their home. Even after living in a care home for some time, seeing team members in uniforms throughout the day could be a reminder of the care they receive, rather than the continuation of life they’re living in their home.
Think of the places where you’ve felt most at home. You could relax over breakfast, welcome someone in for a chat or spend an afternoon exactly as you pleased. We want
family members to have those ordinary moments here, alongside the care they need. When team members wear their own clothes, they can sit down together without a uniform making every conversation feel like an appointment or every room feel like a place for treatment.
What if a relative needs to find someone?
When someone you love lives in a care home, you want to know who’s there for them and who to speak to when something is on your mind. We understand why a uniform might seem reassuring: at a glance, it shows you who’s a team member.
We want to give relatives that reassurance through relationships. When a family member moves in, we introduce them and their relatives to the team, but getting to know someone takes more than an introduction. Each team member has their own life story and photograph on the walls, giving family members and relatives a way to recognise them and discover something about the person behind the name.
It’s a little like getting to know the neighbours when you move into a new house. You might be introduced to one or two at first, then learn more about them as you see them each day and stop for a chat. Relationships in our homes grow in much the same way.
A CQC inspector once visited one of our homes and said they couldn’t immediately tell who was a team member and who lived there. We’ve always remembered it as one of the best compliments we’ve received: for that moment, they saw a household of people together, just as the family members living there do.
A relative may visit for an afternoon, while their loved one wakes up and goes to sleep in the home every day. We care about how both experience it, and when we make choices about everyday life, we always begin with the person whose home it is.
A gentle clue that it’s night-time
Waking in the night can be confusing for a family member who finds it difficult to tell whether they’ve slept for a few minutes or through to morning. They may look to the people around them, as well as the light and sounds in the household, to understand what time it is.
That’s why we encourage our night team to wear appropriate pyjamas. If a family member wakes and sees someone dressed for bed, it may offer a familiar clue that it’s still night-time, alongside a quieter home and the bedtime routines they know. It may seem like a small choice, but it comes from thinking about what might help someone in that particular moment.
Letting team members be themselves
We ask our team members to get to know each family member as a person: the food they enjoy, the music they love, the clothes they feel good wearing and the interests they want to keep as part of their life. We think about those details because identity doesn’t disappear when someone begins to need care.
Team members have their own identities too, and we want them to feel able to bring their personalities into the relationships they build. When everyone wears the same uniform, some of those little openings for conversation disappear. A favourite colour or a patterned top might catch a family member’s eye and give them something to talk about together.
When we first stopped wearing uniforms, one team member who had been unsure about the change told us that family members began commenting on what she wore. “I love that top” might be a passing remark, or it might lead to a longer conversation and help two people get to know one another. Either way, it’s a moment that wouldn’t have happened in quite the same way if everyone had looked alike.
The care they need, in the home where they live
Not wearing uniforms doesn’t mean the care matters any less; it means we’ve thought about how that care feels to the person receiving it. A family member’s wellbeing isn’t an extra consideration once everyone else is comfortable with our choices. They’re the person living with those choices every day, and their experience always comes first.