When she stops talking
She is not unwell, exactly. She just stops asking for anything. She stays in her room, the television on without being watched, answering you in single words. When you raise it, you are told she has "settled in", or that it is normal at her age.
Both answers are wrong. Depression is not a normal part of ageing. In care homes it is common, under-recognised and treatable — and common is not the same as inevitable, any more than it is with pain.
Three things to rule out first
Withdrawal looks identical whatever is causing it, and getting the order wrong leads straight to the wrong prescription. Ask for these to be excluded, in this order:
- Untreated pain. The leading cause of withdrawal and apathy in older people, and in someone with dementia it is not reported in words. Ask: "Has pain been assessed with an observational tool, and when?"
- Delirium. Withdrawal that came on over days rather than weeks, with fluctuating confusion, is delirium until proven otherwise — infection, dehydration, constipation, or a new medicine. That is a medical urgency, not a mood problem.
- Hearing, sight and teeth. A hearing aid that is broken, flat or simply not put in isolates someone completely within weeks. So do lost glasses and dentures that no longer fit — a person who cannot manage a meal in the dining room retreats to her room.
These three checks are unglamorous, and they resolve a great many "she's depressed" conversations without any psychiatric medication at all.
The NHS service she can still use
Here is the part families are rarely told: moving into a care home does not remove NHS entitlement, and that includes mental health care. She is still registered with a GP and still entitled to a referral.
NHS Talking Therapies accepts self-referral as well as GP referral, and older adults are among the most under-referred groups in the country — not because the treatments work less well for them, but because nobody offers. Ask the GP explicitly, and ask the home to support the referral. Where the picture is more complex, the route is the community mental health team for older adults, and the home can request an assessment.
Ask also about the annual health check and a proper GP review rather than a medication renewal over the phone.
The right treatment and the wrong one
If assessment does show depression, the treatment is an appropriate antidepressant and non-drug support — activity, relationships, movement, routine. What is not a treatment for depression is an antipsychotic.
Check the medicines and ask directly: "Has an antipsychotic been started, for what documented reason, who prescribed it, and when will it be reviewed?" Inappropriate antipsychotic prescribing for people with dementia has been a national priority for years precisely because it increases the risk of falls, stroke and death. Prescribing to make someone quiet is not care.
Ask for a structured medication review covering everything she takes, not just the newest item. Benzodiazepines, some blood pressure medicines and anticholinergics all flatten mood and alertness.
The care plan question
Person-centred care is a fundamental standard, and it explicitly includes emotional and social needs. So this is a documented requirement, not a favour.
Ask for a care plan review and put these questions in writing to the manager:
- What does her care plan say about mood and participation, and who delivers it day to day?
- Which activities has she actually attended in the past month? Ask for the record, not an impression.
- Has anyone screened for depression, when, and what did it show?
- What has been tried to get her out of her room, and what happened?
What you can do, and it counts more than you expect
- Predictable visits beat long ones. Twenty minutes three times a week on the same days gives the week a shape; three hours on Sunday does not.
- Bring a task, not just conversation. Folding laundry, going through photographs with names on the back, podding peas. Someone with a role withdraws less.
- Get her out of the room while you are there, even just into the corridor or the garden. Light and movement act on sleep, and sleep acts on mood.
- Ask about the room itself. A room far from the lounge isolates. Requesting a move is reasonable — put it in writing.
- Check the hearing aid every visit. Battery, switched on, actually in the ear. It is the most effective and most neglected intervention there is.
If nothing happens
- A written request to the home manager for a care plan review, with a date.
- The GP, for a depression assessment, a medication review and a referral. If the practice will not engage, your parent can change practice.
- The home's formal complaints procedure, then the Local Government and Social Care Ombudsman.
- CQC should hear about a home where nobody's emotional and social needs are being met — that goes to person-centred care, which is a fundamental standard.
When the problem is the home, not the person
There is a difference between a home where your mother is sad and one where everybody is in their room. If the lounge is empty at four in the afternoon, if a television plays to ten people who are not speaking, if activities are a poster on the wall rather than a log with names in it, the problem is not your mother's mood.
If that is where you have landed and you do not have another round of phone calls in you, that is the part we do. Tell us the area, your parent's needs and what went wrong here, 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. Assessment and treatment decisions belong to the treating clinicians, and service arrangements differ across England, Wales, Scotland and Northern Ireland. If you are worried about immediate risk to your parent, contact the GP or NHS 111 without delay. Curalune does not allocate beds and does not guarantee availability.
