Starting an Arts Programme in a Care Setting: The Practical Page for Managers

Arts programmes in care settings fail on logistics far more often than on the quality of the work. Staffing, insurance, safeguarding, infection control, room booking, money, and above all who owns the thing when the person who started it leaves. This page is the administrative version, written for whoever has to make it exist.

The second care home I work in took four months to arrange and about twenty minutes of that was about music. The rest was insurance certificates, a criminal record check, a conversation about which room, a longer conversation about who would bring residents down, a question about whether my guitar could be wiped, and an unexpectedly difficult negotiation about the time, because the only slot that suited the rota was the one immediately after lunch when half the people I most wanted to see were asleep. None of that appears in any case study I have ever read. All of it determined whether the sessions happened, and the time slot alone probably determined half of whether they worked.

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.

Decide first what you are buying

An activity or a registered therapy. They are different offers, differently regulated, and the confusion between them causes more trouble than any other single thing in this field.

An activity is a session people enjoy, run by an artist, musician, activities coordinator or volunteer. No assessment, no clinical goals, no notes about individuals, no protected title, no register to check. This is what almost every care setting actually wants and it is a perfectly good thing to want.

A registered arts therapy is a clinical intervention: assessment, agreed goals, notes forming part of a record, clinical supervision, planned ending, delivered by somebody holding one of four titles protected in UK law. In July 2026 the Health and Care Professions Council register listed 6,103 arts therapists across all four titles¹, which is a very small workforce spread across every setting in the country. If you want this, you are recruiting or commissioning a clinician and the arrangements are different throughout.

Whichever you choose, describe it accurately in every document: the rota, the brochure, the family newsletter, the website. A home describing an activity as therapy will generate complaints, and it is trivially avoidable. The distinction is set out on music therapy against community music and art therapy against an art class.

The succession question, which comes first

Who owns this when the person who started it leaves.

Programmes built around one individual’s enthusiasm end when that individual moves house, changes job or retires, and after funding this is the commonest cause of closure. The protections are unglamorous:

• Name a substantive post, not a person. Whoever holds that post inherits the programme.
• Write the session into the rota, so that bringing people to the room is somebody’s task rather than somebody’s kindness.
• Keep a one page handover: who the provider is, what they are paid, when the insurance expires, which residents particularly benefit, what the room needs.
• Have two people who know how it works. One is a single point of failure.

This is the section managers skip and the one I would spend the first hour on.

Staffing, which decides whether it works

The single strongest predictor of whether a session lands is whether a member of staff is in the room throughout.

Not passing through. In the room, from before the start, knowing who wanted to come, who is asleep, who cannot hear from the far side, and who becomes distressed and needs to leave. A visiting practitioner does not know any of that and cannot learn it in an hour a week.

The corollary is a budget line most people forget: the staff time to bring people to the room and stay with them. A session that costs eighty pounds for the artist and requires ninety minutes of a care assistant’s time costs more than eighty pounds, and pretending otherwise is how programmes quietly become resented by the people asked to absorb the difference.

Two further staffing points. Protect the slot from being the first thing cancelled when the shift is short, or accept that it will be. And choose the time deliberately: immediately after lunch is the worst slot in most care homes and is frequently the only one offered.

Insurance, checks and infection control

Settle all three in writing before the first session, and diarise the renewals.

Insurance. Public liability at minimum for anybody delivering sessions, and professional indemnity where somebody is working clinically. Freelance policies lapse quietly, so record the expiry date rather than the fact that a certificate was once seen.

Safeguarding checks. Apply the same standard you apply to anybody else working with residents or patients, which usually means a criminal record check appropriate to the role and level of supervision. Volunteers need this as much as paid practitioners and are frequently the group where it is missed.

Induction. Whatever your induction is for agency staff, a visiting artist needs a version of it: fire procedure, who to tell if somebody becomes unwell, how to report a concern, what to do if a resident discloses something. Most visiting practitioners have had none of this anywhere they have ever worked.

Infection control. Instruments, materials and props have to be cleanable or disposable. Soft furnishings, shared paintbrushes, fabric props and wind instruments all need a specific answer. Ask your infection prevention lead rather than deciding at the door.

In England, activity provision sits within a home’s wider regulated obligations rather than being inspected as a clinical service², which means the standard you are working to is your own governance rather than a published minimum. That is a reason to write things down, not a reason to relax.

Consent, capacity and photographs

Settle this before the first session, because it will come up during it.

Capacity is decision specific and can fluctuate: a person is assumed to have capacity, and it is assessed for the particular decision in front of them³. Somebody may be able to decide whether to join in this afternoon and unable to decide whether they appear on your website indefinitely. Consent to take part is not consent to publish, and a relative’s agreement does not reliably extend to publication, because publication is open ended, cannot be undone and benefits the publisher.

Practical arrangements that work:

• A standing rule that no photography or recording happens in sessions unless it has been specifically arranged in advance for a specific purpose.
• A named person who decides, who is not the visiting practitioner and not the person who wants the photograph.
• Physical assistance treated as a consent question rather than a teaching technique: offer a hand, do not take one, and treat no response as a possible no.
• A route for a resident, a relative or a member of staff to say stop, that does not run through the person leading the session.

The full account is on consent and safeguarding in arts in health, and the seated formats where physical assistance arises most are on seated and chair based dance.

Money, and what to say to whoever holds it

Budget realistically, and build the case on what is documented rather than on what would be persuasive.

Costs to include: the practitioner’s fee, planning and travel time, materials, any equipment, the staff time described above, and a small contingency for the sessions that get cancelled and still get paid for. For a sense of scale on the community side, the one traceable UK figure on this site is a scheme costing £180,000 across roughly 500 patients referred between 2009 and 2012, which is £360 per patient⁴. That is one scheme in one county and not a price list. For individual music therapy, the British Association for Music Therapy recommends a floor of from £52.00 upwards⁵, which is a recommended minimum rather than a going rate.

The case to make: people enjoy it, a day with something in it is better than a day without, and the current evidence supports a small effect on low mood in dementia.

The case not to make, all three of which will fall over when somebody checks:

• Not savings. The economic figures in circulation trace to one uncontrolled evaluation, of 90 patients out of roughly 500 referred, whose author wrote that it “does not imply causality”⁴. See does arts on prescription save money.
• Not agitation. The 2025 Cochrane review reports agitation and aggression at SMD -0.05 (95% CI -0.27 to 0.17) at moderate certainty, which is a null result from evidence the reviewers trusted, and agitation is the outcome care settings claim most⁶.
• Not NICE. The dementia guideline does not mention music, art, dance, drama or creative activity, and the claim that it recommends music therapy is the most repeated false citation in this field. See creative activity in dementia care.

What the same review does support is depressive symptoms at SMD -0.23 (95% CI -0.42 to -0.04), moderate certainty, which is Tier 1 and small, from 30 studies and 1,720 participants randomised. It also found no evidence of anything persisting four weeks after treatment ends, which is a direct argument for continuous provision rather than a block of six sessions.

Frequency, size and shape

Regular, small and repeated beats occasional, large and impressive.

Weekly, same day, same time. Predictability does more for attendance than variety, and it matters most for the residents with the least memory for what is coming.

Small groups. Six to ten in a care home. A room of thirty is an event, not a session, and the people who most need contact are the ones who disappear in it.

Short. Forty minutes is plenty in most care settings. Sessions that overrun end with people wanting to leave, which sours the following week.

One to one as well as group. The residents who cannot come to a group usually have the least going on, and five minutes at a bedside is provision.

Blocks are for courses, not for homes. In community settings, arts on prescription courses typically run 8 to 10 weeks with a fixed ending, which the 2024 systematic review found across its 25 included programmes⁷. That model suits a referred course: see what a ten week arts course involves. Inside a care home, where people live, a fixed ending has much less to recommend it.

Evaluate honestly

Record what you can defend, and do not dress it up.

Attendance, who came and who did not, what people said, what staff observed, what had to be cancelled and why. That is a description of a service and it is worth having. What it is not is evidence of effect, because a before and after measurement with nothing to compare against cannot separate the activity from time passing, from who chose to attend, or from who was still there at the end.

That is not a reason to skip it. It is a reason to label it accurately, particularly in anything sent to a funder, and the habit of reading reports as descriptions rather than as evidence is the subject of creative health policy and reports. The sector’s own case studies are gathered in one place⁸ and are useful for how others have organised things.

A starting checklist

Twelve things, in the order I would do them.

1. Decide: activity or registered therapy. Write it down.
2. Name the substantive post that owns it.
3. Agree the slot with whoever runs the rota, and avoid straight after lunch.
4. Identify the staff member who will be in the room, by name and by rota.
5. Get insurance certificates and record expiry dates.
6. Complete safeguarding checks.
7. Run an induction: fire, escalation, reporting, disclosure.
8. Ask infection prevention about instruments and materials.
9. Agree the photography rule and who decides.
10. Set the budget including staff time and cancellations.
11. Agree what you will record, and what it does and does not show.
12. Write the one page handover before you need it.

Related pages: arts in hospitals for what these programmes are and who runs them, arts in care homes for what families should ask and what good looks like from the outside, live music on hospital wards for the acute setting, arts for carers and health staff if the programme is aimed at staff, and who pays for arts on prescription for the funding cycles that end most programmes.

Nothing on this page is a reason to change, delay or decline any part of anybody’s care or treatment, and no arts programme substitutes for either.