Originally published 2019-09-02.
At the Old Vicarage nursing home in the UK, the night shift does not arrive in tunics and name badges. Staff working overnight wear pyjamas and dressing gowns instead. The idea is simple: when residents living with dementia see the people around them dressed for bed, it gives a clear, friendly signal that the day is over and it is time to rest.
The home's approach drew wide attention in 2019 because it turns a small, cheap change into a gentle form of communication. It also connects to a bigger shift in dementia care, away from hospital-style routines and toward homes that feel like homes. Here is how the idea works, where it comes from, what the evidence says about sleep in dementia, and what families can take from it.
What the Old Vicarage does
The home's owner, Kamal Siddiqi, explained the policy in comments reported by the aged-care news site HelloCare. Day staff no longer wear uniforms. Each was reportedly given 30 pounds to buy ordinary, casual clothes for work. At night, carers change into pyjamas and dressing gowns.
The practice grew out of staff training with Dementia Care Matters, the organisation founded by Dr David Sheard, whose Butterfly approach to care homes puts residents' emotions and sense of belonging at the centre of daily life. According to Siddiqi, dropping uniforms helps staff relate to residents as people rather than patients, and makes the building feel less like an institution. He reportedly summed up the goal as helping residents feel "like home, instead of a care home."
Why clothing can work as a bedtime cue
Dementia often damages short-term memory and the ability to follow spoken explanations. Telling someone that it is late and time for bed may not land, and repeated reminders can feel like pressure or even provoke distress. Visual cues tend to work better, because they do not rely on remembering what was said a minute ago.
Seeing a carer in a dressing gown carries a message most people learned decades ago: this is what people wear when the evening winds down. It invites residents to follow along rather than being told what to do. The hope is that it also softens encounters during the night. A person who wakes confused at 3 a.m. may be less alarmed by someone in slippers and pyjamas than by a figure in a clinical uniform.
The same thinking drives other visual prompts used in dementia-friendly design: pictures on bathroom doors, a familiar image of someone brushing their teeth near the sink, or a calm film of people settling into bed at the end of a movie evening. Each one shows rather than tells.
The Butterfly approach and the end of uniforms
Dr David Sheard developed the Butterfly model through Dementia Care Matters as a way of changing the culture of care homes. Its central idea is that how residents feel matters as much as whether tasks get done. Homes following it are encouraged to create smaller, household-style living spaces, fill them with everyday objects people can touch and use, and train staff to respond to emotions instead of correcting confusion.
Uniforms are one of the most visible things such homes rethink. A uniform helps visitors identify staff, but it also draws a line: one group is in charge, the other is being managed. Removing it is meant to make carers feel more like companions or family. Dozens of care homes in the UK and Ireland have worked with the model, with validation schemes that look at how residents actually spend their day.
Not everyone agrees on every element. Some families and staff prefer clear identification, especially in larger homes, and infection control rules can affect what staff wear. Homes usually adapt the approach to their own setting.
Sleep problems and sundowning in dementia
Sleep trouble is common in dementia. Many people experience what carers call sundowning: increasing confusion, restlessness or agitation that begins in the late afternoon or evening. Studies cited in reviews suggest that somewhere between 20 and 45 percent of people with Alzheimer's disease show some form of it, most often in the middle stages.
The causes are not fully understood. Researchers point to damage to the brain's internal clock, reduced production of the sleep hormone melatonin, tiredness at the end of the day, too little daylight, side effects of medication, and changes in the environment such as shift changes and fewer staff in the evening. Night-time waking, wandering and day-night reversal are all common.
Because sedating medicines carry real risks for older people, including falls and greater confusion, care guidelines generally favour non-drug approaches first. Those that have some support include:
- Plenty of daylight and activity during the day, including walks or light exercise at regular times.
- A steady routine for meals, activities and bedtime.
- Limiting long daytime naps and caffeine later in the day.
- Reducing noise and bustle in the late afternoon and evening.
- Soft lighting at night so that people can find their way without being fully woken.
Pyjama-wearing night staff fit neatly into this picture. They make the evening routine visible and calm, and they reduce the clinical feel of the building at exactly the time of day when many residents struggle most.
What the evidence can and cannot say
It is worth being clear about the limits. The Old Vicarage's experience is a care-practice story reported by the home itself, not a clinical trial. There are no published studies measuring whether staff pyjamas specifically improve sleep. The idea is plausible because it builds on well-supported principles, routine, visual cues and a calm, homely environment, but it is not a treatment for sleep disorders, and it will not suit every resident. Some people may find unfamiliar night clothing confusing, and someone with severe sleep problems needs a proper medical review.
Experienced dementia carers often stress that small changes work best when they come from knowing the person: their old routines, what time they used to go to bed, what helped them relax.
Ideas families and carers can borrow
- Dress for the time of day. At home, changing into night clothes together at the same hour each evening can work as a shared cue.
- Use pictures and objects. A toothbrush laid out by the sink, a dressing gown on the chair or a bedside lamp switched on at the same time each night can say more than words.
- Keep the evening calm. Lower the television, dim the lights and avoid busy visits late in the day.
- Get daylight early. Morning light and activity help set the body clock for the night ahead.
- Talk to a doctor if sleep problems, night-time agitation or wandering are getting worse, so that medication side effects, pain or infections can be checked.
The appeal of the Old Vicarage idea is that it costs almost nothing and treats residents as people who still read the world around them. A carer in pyjamas is not a cure. It is a kind, practical way of saying goodnight.
Sources: Healthy Food House, citing HelloCare and owner Kamal Siddiqi; Dementia Care Matters, the Butterfly Model; Sundowning (Wikipedia).
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