Carers Week: View from a Dementia Specialist Admiral Nurse

“Caring about Equality” is the theme of Carers Week 2025. As Carers Champion at the QICN my role involves raising awareness of unpaid carers of all ages including sharing resources, for example this resource on ‘Identifying and supporting unpaid carers in England to improve integrated system working’ published earlier this year, and sharing innovative practice led by Queen’s Nurses.

In this second blog for Carers Week 2025, I met Queen’s Nurse Rachel Murray, who works as a dementia specialist Admiral Nurse in Purbeck to hear about the invaluable role she plays in supporting people living with dementia and their family carers.

What is the most rewarding part of working in the community?

I would say it is the opportunity to make a real difference. You have the honour of being invited into people’s homes, quite often at their lowest ebb or in times of crisis. To have that trust from another human being to welcome you in is immense. It makes such an enormous difference, doesn’t it? You feel as if you can actually make a change. It gives you the prospect to build up a trusting relationship going forward not just for the care of that particular moment, but it’s also about looking onwards. It is not just for the patient, it’s not just for the family, it’s possibly for future family generations. And I think that is the joy of working as a community Admiral Nurse, investing for the future for people to be able to put their trust in healthcare and the NHS.

Can you tell me about a time when you made a difference to family carers?

I could go on for hours! As an Admiral Nurse, my role within the community is to help support the family carers of those living with dementia. I receive referrals from GPs, district nurses, rehab teams, the integrated team for the area, as well as from the memory assessment services, the community mental health team and dementia crisis teams.

I had one case which came straight from the memory assessment service for a lady who lived alone. She had been given an Alzheimer’s diagnosis but because of the disease she had no insight and no acceptance or understanding of having that diagnosis. Her family lived abroad and so the referral came to me because the memory assessment services had to discharge her because there was no medication, she had refused. Also, the referral was sent to the Admiral nurse service due to the potential complexity of the case. The dementia coordinator service tends to only make telephone contact and their input would have been declined –  “no, I’m fine thank you very much, yes, I’m living independently, I’m at home and I wish to stay there, thank you goodbye.”

I started visiting as an Admiral Nurse and made a connection very gradually, over a period of time I was able to gain her trust and her consent to contact her family overseas. There was no power of attorney in place for her health or finances. The family did not have legal power of attorney. I was interacting between all the relevant services at key points within this lady’s dementia journey and I have held her hand the whole way.

It has really been quite remarkable. Every time the family would come over and do everything they possibly could to help to support mum. It was great because the family would let me know if there had been any changes. I was able to be the advocate for the family and could support their journey and that transition from their mum not being able to remain in her own home, that helplessness that they felt from being overseas and that reassurance as well. But the fact that she trusted me enough to allow me access then in a timely manner to introduce the right people at the right time whilst listening to the family and supporting them.

She is now in a care home, and I continue to support the family. They are struggling to manage those feelings of guilt, having to sell their mum’s home, and coming to terms with all these changes. And that is not the future that they planned – dementia steals not only memories from people, but it also steals people’s goals, their aspirations. It is vital the information that the carers share with us. I often come across carers who just do not feel they are heard unfortunately.

What one piece of advice would you give other community nurses to identify and support family carers?

I would say that it is important to recognise that family carers are the experts. They are living 24/7 with their loved one. They are getting up at night, providing those care needs, identifying when things are not right and responding accordingly. That needs to be acknowledged by community nurses.

Why do you think many carers aren’t recognized by nurses and other professionals?

Well, I don’t understand it myself because it’s been estimated that unpaid carers save the UK economy £184 billion each year. That’s phenomenal. Family carers have been and are undervalued.

Admiral Nursing was established in the 1980’s when a man called Joe Levy was diagnosed with vascular dementia. His nickname was Admiral Joe, and his family wanted to care for him at home. His family identified then that there was a paucity of information and understanding about dementia, and that families’ needs were not considered. And so that’s where Admiral Nurses and the ethos, the understanding of the importance of the family carer was founded.

I would like to think that things are changing. I work very closely with social services, building bridges from within the integrated team from health to social care.

Community nursing can be challenging at times; what motivates and inspires you?

It is an opportunity. A real, genuine opportunity to not only improve services, but to improve the health of the nation in many respects. Down here in Dorset we are looking at the integrated neighbourhood teams’ model and that is a chance to be proactive. Research suggests that up to 45% of cases of dementia could be prevented or delayed by addressing a number of risk factors in our lives. These include things like social isolation, alcohol intake, smoking, maintaining a healthy lifestyle, taking exercise and eating well. There is a wonderful opportunity for healthcare professionals to collaborate and work across services. You can make such an enormous difference, that motivation to try to empower and improve people’s lives and wellbeing can be tremendously rewarding.

The QICN is also motivational. It values community nursing and provides opportunities for community nurses to have a voice and to make changes.

Visit the QICN’s Supporting Carers webpage.

Visit the Dementia UK website.