Arts in Care Homes: Who Delivers It, and What Is Actually Expected of a Home

Arts in care homes almost always sits within activity provision: delivered by activities coordinators, visiting artists and volunteers, funded from the home’s own budget or a small grant, and inspected as part of the home’s wider obligations rather than as clinical care. It is not therapy, it is not treatment, and understanding which of those it is changes what it is reasonable to expect from it.

I run a weekly session in two homes, and the thing that predicts whether a session works is not the singing. It is the staffing. In one of the homes, the activities coordinator is contracted for enough hours that somebody brings residents down before I arrive, stays in the room throughout, and knows who wanted to come and who was asleep. In the other, the same role is half a post shared with reception, and roughly one week in four the residents are not brought down at all, so I sing to four people in a room set out for fourteen. Same songs, same hour, same fee. The difference is a rota. Inspection week is the exception in both places, and I have learned to distrust anything I see during it.

Where a claim about effect appears below it carries a tier (Tier 1 supported, Tier 2 promising but limited, Tier 3 practice and anecdote), explained on reading arts in health research.

Who actually delivers it

Three roles, and only one of them is regulated.

Activities coordinators. Employed by the home, and the backbone of everything. There is no required qualification for the role, no register, and a very wide range of experience within it. The good ones know every resident’s history, which songs belong to which decade of somebody’s life, and who cannot hear across a room. The role is frequently under resourced and under paid relative to what it does.

Visiting artists and musicians. Booked weekly, monthly or for a block, freelance, insured by themselves or by an arts organisation. I am one of these. We are not clinical staff, and we know less about the residents than the coordinator does, which is worth remembering when we are quoted about what a session achieved.

Volunteers. Often the most consistent presence in a home over years, and the least supported. Volunteers usually get less induction than a visiting artist and are asked to do more unsupervised.

And, rarely, a registered arts therapist. Music therapy, art therapy, art psychotherapy and dramatherapy are clinical interventions delivered by practitioners holding titles protected in UK law, and in July 2026 the Health and Care Professions Council register listed 6,103 arts therapists across all four¹. That is a very small workforce spread across every setting in the country, so most homes do not have one and never have. Where one is involved, they are working to assessed goals with named residents, keeping clinical notes and taking the work to supervision. See music therapy and art therapy.

Asking which of these is in front of you is a fair question. The honest answer in a care home is almost always that it is an activity rather than a therapy, and there is nothing wrong with that answer. What is wrong is a brochure implying otherwise.

What is actually required

Less than families assume, and the regulation works differently from clinical care.

In England, activity and occupation sit within a care home’s wider regulated obligations rather than being inspected as a clinical service². There is no minimum number of sessions, no required qualification for the person leading them, no register of approved providers, and no national standard for what a programme must contain.

The practical consequence is that provision varies enormously between homes of similar size and price, and the variation is driven by staffing rather than by budget. A home with a full time coordinator and a deputy runs a different life from a home where activities are added to somebody’s existing job, whatever either spends on visiting entertainers.

The other consequence is that the burden of checking falls on families, which is why the questions section below is the practical heart of this page.

What the evidence actually supports

The strongest evidence anywhere near this work concerns music in dementia, and it is narrower than the claims made for it in the sector.

The 2025 Cochrane review of music based therapeutic interventions in dementia covers 30 studies and 1,720 participants randomised. Its findings:

• Depressive symptoms: SMD -0.23 (95% CI -0.42 to -0.04), moderate certainty. Tier 1, and a small effect: roughly a fifth of a standard deviation.
• Agitation and aggression: SMD -0.05 (95% CI -0.27 to 0.17), moderate certainty. Tier 1, null result. A narrow interval centred essentially on zero, from evidence the reviewers trusted reasonably well.
• Any effect persisting four weeks after treatment ends: no evidence of one. Tier 3.
• Quality of life: the review contains no separate estimate at all³.

Three things follow for a care home, and they are more useful than a general endorsement would be.

Agitation is the outcome homes claim most often, and it is the one that came out null. Moderate certainty evidence of essentially no effect is a strong statement rather than an absence of one. A home selling a music session as a way of managing behaviour is selling something the evidence does not support.

The depressive symptoms effect is real and small. That is worth having. It is not transformation, and a page that reported only significant improvement in mood would have told the truth and left a false impression.

Nothing persisted four weeks after the sessions stopped, which is an argument for regular ongoing provision rather than for a monthly visiting entertainer, and an argument against treating a block of six sessions as having achieved something durable.

Anything citing 22 studies and 1,097 participants is quoting the superseded 2018 version of that review. The detail is on music therapy for dementia and the practice implications on creative activity in dementia care.

The citation that will be in the brochure

At some point you will read that NICE recommends music therapy in dementia. It does not.

A full text search of the guideline NG97 returns zero occurrences of music, art, dance, drama or creative activity⁴. The claim appears in home brochures, training material and funding bids, and almost everybody repeating it is sincere.

Two balancing points, because a bare correction is easy to misuse. Absence from a guideline is not a finding that something is ineffective, only that the guideline does not address it. And there is real evidence about music in dementia, as set out above; it just does not come from NICE. The right response is to stop making the citation, not to conclude that activities are worthless. How claims like this propagate is the subject of creative health policy and reports.

For scale, the WHO dementia fact sheet, updated 3 July 2026, gives 57 million people worldwide living with dementia in 2021 and carries no current 2050 projection⁵, so any figure attributed to it for 2050 has come from somewhere else.

What good provision looks like

Six things, drawn from working in homes rather than from a standard.

Regular and predictable. The same day, the same time, every week. Predictability does more for attendance and for settling a group than variety does, and it matters most for the residents with the least memory for what is coming.

Small and repeated rather than large and occasional. A twenty minute session with six people three times a week beats an hour with thirty people once a month, and it is harder to photograph.

Staffed. Somebody who knows the residents in the room throughout, not dropping in. This is the single biggest determinant of whether a session works.

One to one as well as group. The residents who cannot come to a group are usually the ones with the least going on, and a five minute visit with a song at a bedside is provision even though it does not appear in a programme.

Person specific. Music from the right decade of somebody’s own life, materials suited to what their hands can do, an activity that connects to what they used to do for a living. This is where a good coordinator’s knowledge is irreplaceable.

Honest about its purpose. It is there because people enjoy it and because a day with something in it is better than a day without. That is enough.

The practical side of setting a programme up, including insurance, safeguarding, infection control and who owns it internally, is on starting an arts programme in a care setting. The sector’s own case studies are gathered in one place⁶, usefully read as descriptions of practice rather than as evidence of effect.

Consent, capacity and the photograph

The sharpest ethical problem in care home arts work, and it comes up every time something goes well.

Somebody sings a verse they have not sung in years, a relative wants a photograph, the home wants it for the newsletter, and everybody in the room is moved. That is exactly when the constraints matter most.

Capacity is decision specific and can fluctuate, so a person may be able to decide whether to join in and unable to decide whether to appear on a website indefinitely. Enjoying a session is not consent to being recorded. A relative’s agreement does not reliably extend to publication, because consent to publication is not a decision another person can usually make on somebody’s behalf. And a photograph, once shared, cannot be recalled from the people who saw it.

The default where there is doubt is not to publish, and that constraint binds this site’s own imagery as much as anybody’s. It also governs physical assistance, which comes up constantly in seated activity: offering a hand is different from taking one, and somebody who has not responded may be declining rather than unable. The full account is on consent and safeguarding in arts in health, and the seated formats themselves on seated and chair based dance.

The questions to ask a home

Five, and the second one is the one that discriminates.

1. How many staff hours a week are rostered for activities? A number, not a description.
2. What happens when that person is off sick? If the answer is that activities stop, activities are an afterthought rather than a role.
3. Can I see a week’s actual programme, and last week’s? The difference between the two is informative.
4. Who comes in from outside, how often, and are they the same people each time? Continuity matters more than variety.
5. What happens for residents who cannot come to a group? This is where the least visible provision is, and where the greatest need usually is too.

Then visit at three in the afternoon on a weekday, not at eleven in the morning, and not during an inspection. Look at whether anybody in the communal areas is doing anything at all. That single observation is worth more than any brochure, and it is the one I trust after several years of turning up in these buildings.

Nothing on this page is a reason to change, delay or decline any part of anybody’s care, and no arts activity substitutes for it. For the related picture inside hospitals, see arts in hospitals, and for the end of life, creative work at the end of life.