Communication emerged as a key theme in your study. What types of information or communication strategies do physiotherapists and staff feel families need most? 

Families appear to have the greatest need for communication from physiotherapists at the start, cessation and adjustment of treatment. 

In a previous study, family members reported that occasionally they did not know whether their relative was receiving physiotherapy, what goals were being pursued and when/why treatment was discontinued. 

In addition, many informal caregivers and family members wish to practise exercises with their loved one in addition to the physiotherapy treatment but they require practical guidance to do so. 

This could, for example, take the form of written exercises with images and specifications regarding how often and in what manner the exercises should be performed. 

Furthermore, both physiotherapists and family members need a mode of communication that is accessible. 

In many Dutch nursing homes, family members can access a digital medical record and a communication channel is available within that record. 

This form of communication reduces barriers for both physiotherapists and family members. 

Your participants described several powerful facilitators, including cultural values and strong social networks. How can aged care facilities harness these strengths? 

It begins with recognising the added value of diverse cultural and religious backgrounds. 

Some families visit frequently and are intensively involved in the wellbeing of the resident. 

Participants indicated that this involvement is sometimes embraced but at other times experienced as controlling. 

Aged care facilities acknowledge that family members continue to hold a meaningful and valuable place in the resident’s life even after admission to a facility. 

At present, we observe that the joint celebration of religious events such as Christmas or Ramadan fosters connection and acceptance. 

This openness and sense of welcome should not be limited to a few days per year but should be embedded as a core and ongoing value. 

Your study suggests that family involvement in physiotherapy is often unstructured or informal. What kinds of structures or protocols do clinicians think would help support more consistent collaboration? 

Several participants indicated that it is often unclear what family members are allowed to do and access. 

Informing family members at admission about specific allowances—taking their relative for a walk outdoors or making use of exercise equipment—could support collaboration. 

This information could be shared as standard practice shortly after admission, with periodic evaluations of families’ information needs. 

Many participants expressed concerns about safety when families assist with exercises. What specific risks do physiotherapists worry about and how might these be managed? 

Interestingly, participants were not always able to provide a concrete answer regarding their fears. 

Some participants reported concerns about the correct use of exercise equipment, which could potentially become damaged, while another participant expressed concerns about possible fall incidents. 

However, there were no situations in which the safety of the resident was actually compromised. 

It is now well established that exercising can be safe for residents with dementia and that it does more good than harm. 

Based on your findings, what practical steps can physiotherapists and aged care organisations take to foster a more effective and sustainable collaboration with family caregivers? 

A proactive collaborative approach between both physiotherapists and the organisation and family members is of great importance. 

A passive or wait-and-see approach may create incorrect assumptions among family members. 

Within physiotherapy education, there is not always sufficient attention to how physiotherapists can work together with informal caregivers and this can be even more challenging when residents have dementia. 

These skills need to be taught or further emphasised once physiotherapists are already working in an aged care facility. 

If you could redesign the early stages of admission into aged care, what changes would best support shared decision-making and clarify family roles from the outset? 

In addition to providing early information about physiotherapy and opportunities for collaboration, I believe that jointly setting and discussing goals can promote collaboration and shared decision-making. 

>>Dennis Boer is a physiotherapist and junior researcher whose work focuses primarily on physiotherapy for nursing home residents with dementia. He is affiliated with aged care organisation Kennemerhart in Haarlem, the Netherlands and with Leiden University Medical Center.