"She's just declined"
Three months ago your mother walked to the dining room with a frame. Now she is wheeled. When you ask, you get a version of: "It's the progression, it happens at her age." Sometimes that is true. Very often it is not, and the explanation is more mundane and more annoying: nobody arranged any physiotherapy.
The misunderstanding at the centre of this
Most families assume therapy is part of what the care home provides. You are paying a substantial weekly fee, so movement must be included.
It usually is not. A care home provides personal care, accommodation and — in a nursing home — nursing. Physiotherapy, occupational therapy and speech and language therapy are NHS services, delivered by community therapy teams and accessed through the GP.
Here is the point that matters most, and the one families get wrong: moving into a care home does not remove NHS entitlement. Your mother is still an NHS patient. She is still registered with a GP. She still has the same right to a referral as she did living in her own house. What changes is that at home you would have chased it yourself, and in a home everyone assumes someone else has.
What to ask for, and of whom
Do not raise it with a care assistant in the corridor. Put it in writing to the home manager and, separately, request a GP review. Ask precisely:
- "Please can my mother be referred to the community physiotherapy and occupational therapy team for assessment." That word — referral — is what starts the process.
- "Has a falls assessment been done, and what did it recommend?" Falls services exist in every area and are routinely under-used for care home residents.
- "What is recorded in her care plan about mobility, and who carries it out daily?"
- "Was a mobility baseline recorded on admission, and what has changed since?" If nobody wrote down what she could do in January, nobody can tell you what she has lost.
Ask for a care plan review meeting and ask for the answers to be written into the plan. A verbal promise to "encourage her to walk more" does not survive a change of shift.
The part that matters more than the therapy
Two twenty-minute physiotherapy sessions a week will not keep anyone walking if the other six and a half days are spent in a chair. The decisive factor is what happens daily, and that is the home's responsibility — it falls squarely within person-centred care and meeting a resident's assessed needs.
Ask for these specifically, and ask for them to be in the care plan:
- Walking to the dining room rather than being wheeled, where it is safe.
- A daily short walk with a staff member, recorded.
- Getting up and dressed rather than remaining in nightwear.
- Sitting out of bed for meals.
- Her frame or stick actually within reach — the single most common invisible reason someone stops walking is that the aid is parked across the room.
If you are told therapy "won't help at this stage"
That is often stated too broadly. Even where improvement is not expected, there is a clear clinical purpose: maintaining function and preventing deterioration. The things it prevents are concrete and permanent:
- Contractures — joints that shorten and fix. A stiffened hip or hand makes washing and dressing painful, and it does not reverse.
- Pressure ulcers, because someone who does not move lies on the same points.
- Falls and fractures, driven by muscle loss and balance rather than by age itself.
- Chest infections from prolonged immobility.
If a referral is refused, ask for the reason in writing and ask what the plan is instead for preventing contractures and falls. You can also raise it with the GP practice directly, and your parent retains the right to change GP practice if the current one will not engage.
Also worth asking about
- Occupational therapy, for seating, wheelchair assessment, pressure relief and equipment — a badly fitted chair causes more deterioration than most families realise.
- Speech and language therapy, if there is coughing at meals or a change in swallowing after a stroke. Untreated swallowing problems end in aspiration pneumonia.
- A medication review. Sedatives, antipsychotics and blood pressure medication make people unsteady. Someone who has stopped walking sometimes has a prescribing problem rather than a muscle problem.
- NHS Continuing Healthcare, if needs are substantial — worth a separate look, because it changes who pays for everything.
If nothing happens
- Written request to the home manager and the GP, and ask for a care plan review with a date.
- The home's formal complaints procedure, in writing.
- The Local Government and Social Care Ombudsman for care home complaints, or PALS and NHS complaints where the issue is the refusal of an NHS referral.
- CQC should hear about a home where nobody is mobilised — it goes to whether care is person-centred and needs are being met, which is a fundamental standard.
The question to ask before you choose a home
If you are still looking, do not ask whether the home "does physiotherapy" — every home says yes. Ask: "Which community therapy team covers you, how many of your residents currently have an active therapy referral, and who chases reviews?" The third part of that question is what separates homes.
And if you would rather not make the calls yourself, that is the part we do. Tell us the area, your parent's needs and your timeframe, and you get a shortlist of homes worth calling, for £69. If you don't receive at least 3 homes matching the area and criteria you gave us, we refund you in full. Start here
This article is general information for families, not medical advice. Whether a referral is clinically appropriate is a decision for the treating clinician, and service arrangements differ across England, Wales, Scotland and Northern Ireland. Curalune does not allocate beds and does not guarantee availability.
