Implementing Namaste Care in nursing care homes for people with advanced dementia: a systematically constructed review with framework synthesis

Abstract

Background

Namaste Care is an intervention designed to improve the quality of life for people with advanced dementia by providing individualised stimulation and personalised activities in a group setting. Current evidence indicates there may be benefits from this intervention, but there is a need to explore the practical realities of its implementation, including potential barriers, enablers, and how it is delivered within the context of nursing care homes.

Objective

To systematically assess the factors involved in implementing Namaste Care for people with advanced dementia in nursing care homes. To provide pragmatic suggestions on how Namaste Care can be delivered in the context of nursing care homes.

Design

Systematically constructed review using framework synthesis.

Data sources

Comprehensive searches were conducted in Medline, CINAHL, and PsycINFO databases for studies published between 2018 and 2024. Search concepts included “Namaste Care,” “advanced dementia,” and related terms.

Review methods

Studies were included if they focused on the use of Namaste Care for people with advanced dementia in nursing care homes. Data extraction and quality assessment were performed by two independent researchers using standardised forms and critical appraisal tools. A framework synthesis of the results was conducted, which involves systematically combining qualitative and quantitative data within a structured analytical framework to identify overarching themes and insights.

Findings

Twenty-five studies met the inclusion criteria. Key themes identified were: (1) Frequency and duration of Namaste sessions. (2) Namaste Care environment and personalisation of care. (3) Staff engagement and training needs. (4) Involvement of family members and volunteers.

Conclusions

Implementing Namaste Care in nursing care homes presents various challenges but also significant opportunities for enhancing the quality of life for residents with advanced dementia. Addressing key themes such as the frequency and duration of sessions, the environment and personalisation of care, staff engagement and training needs, and the involvement of family members and volunteers is crucial. Specifically, providing tailored training programmes for staff, creating dedicated Namaste Care spaces, and encouraging active family and volunteer participation can facilitate effective integration. By incorporating these pragmatic recommendations, Namaste Care can be sustainably integrated into daily care routines, leading to improved resident well-being, reduced behavioural symptoms, and enhanced caregiver-resident interactions.

Background

Namaste Care is a holistic, person-centred intervention designed to enhance the quality of life for individuals with advanced dementia [1]. Named after the Hindu greeting “Namaste,” which means “to honour the spirit within,” the aim of this intervention is to create a soothing and respectful environment that acknowledges the humanity and individuality of each participant [2]. The approach emphasises sensory stimulation through touch, sight, sound, and smell, intending to connect with and calm residents, thereby improving their overall well-being [3, 4]. As dementia progresses, cognitive engagement with the world diminishes, leading to increased distress and decreased physical and emotional well-being [5]. Traditional care models often focus on the physical aspects of care, potentially overlooking the emotional and psychosocial needs of individuals with advanced dementia. Namaste Care addresses this gap by integrating sensory-based activities such as listening to music, gentle hand massages, and aromatherapy into daily routines. These activities aim to provide comfort, reduce agitation, and enhance the emotional connection between caregivers and residents [6].

Namaste Care delivery involves operationalising several components within the context of care delivery in nursing care homes to meaningfully engage people with dementia in targeted activities while accounting for their personal history and preferences. The original design of this intervention involves its delivery twice a day, seven days a week, preferably in a separate and dedicated space [7]. Participants are presented, during the session, with gentle sensory stimulation such as soothing music, hand massages, familiar objects and mementoes and with the availability of snacks and drinks to encourage hydration and positive taste moments. Apart from the intervention’s material components and timing and place of delivery, Namaste Care encourages the participation of staff and volunteers, family members, and friends, fostering connection and meaningful moments of care.

Because of the nature and frequency of this intervention, its delivery needs to account for the care home routine and staff availability, in addition to the person’s predisposition and well-being. Previous studies, including the comprehensive realist review by Bunn and colleagues [4], documented the apparent theoretical and practical benefits of Namaste Care. These benefits include indications of improved quality of life, reduced behavioural and psychological symptoms of dementia, and enhanced interactions between residents, their families, and care staff [8]. However, despite these promising findings, implementing Namaste Care in nursing homes presents several challenges [9]. These include staff shortages, rigid schedules, and varying levels of family involvement, which can hinder the consistent delivery of the intervention. This inconsistency is further evident in the delivery of Namaste Care sessions, including the frequency and duration per resident, across several studies investigating its outcomes. Many nursing care homes involved in these studies were unable to deliver the sessions as originally intended [i.e., two hours per session, twice a day, seven days a week; 4]. The aim of the review presented here is to provide a summary of how the elements included in the original design of the Namaste Care intervention (e.g., the number of sessions and their length, staff engagement and training, family involvement, and care home resource management) are managed in the context of care homes and how their design, conceptualisation and presence, might represent a barrier or an enabler for the implementation of and subsequent effectiveness of Namaste Care. Bunn and colleagues [4] emphasised that the success of Namaste Care and similar sensory-driven interventions can be evaluated by examining the key elements of their delivery: context, mechanisms, and outcomes. Their review adopts a theory-driven approach to explain the factors influencing achieving desirable outcomes when implementing these interventions in nursing homes. In contrast, this review aims to provide pragmatic suggestions and critical considerations on how the Namaste Care intervention can be planned and delivered before its implementation in the context of nursing care homes.

Objective and research question

The aim of this review is to provide a systematic synthesis of recent literature to explore the implementation of the Namaste Care intervention in the context of nursing care homes. Furthermore, we seek to provide up-to-date evidence and information on how the elements involved in the planning and delivery of Namaste Care are effectively and pragmatically implemented and how concrete recommendations for implementation can be derived from recent literature focused on this topic.

Review Question: How are the elements of the Namaste Care intervention delivered and implemented in nursing care homes for people with advanced dementia?

Methods

This review follows a framework synthesis approach, integrating existing theoretical frameworks into the systematic review process. Framework synthesis is particularly useful for reviews involving complex interventions, as it allows for the structured organisation and interpretation of diverse data types [10]. The decision to implement a framework synthesis approach was driven by its suitability for synthesising and interpreting contextual information while incorporating quantitative and qualitative findings from previously published literature on Namaste Care. More specifically, the aim of the paper is to explore current knowledge on the contextual elements of Namaste Care in nursing care homes, where interrelated factors such as staff engagement, training, and environmental adaptations significantly influence its feasibility and effectiveness. This approach offers a clear structure for analysis, aiding in the generation of useful insights and practical recommendations, which can support the examination of care interventions in complex settings such as nursing homes.

Search strategy

A comprehensive literature search was conducted across three major databases: Medline, CINAHL, and PsycINFO. The search was performed between February and March 2024, targeting studies published between 2018 and early 2024. The decision of the starting date for the systematic search of papers included in this article is linked to the decision to use the review by Bunn and colleagues [4] as the theoretical foundation of the review presented here. As described above in this paper, Bunn’s review offers a solid theoretical basis for furthering theory-based considerations on the potential barriers and enablers of the planning and delivery of Namaste Care within the context of nursing care homes.

The search terms included “Namaste Care,” “Namaste Program,” “Namaste Intervention,” and related terms for advanced dementia, such as “advanced dementia,” “late-stage dementia,” “end-stage dementia,” and “palliative dementia” (Table 1). Additionally, we conducted citation searching to identify relevant studies by tracking citations of key articles included in our review.

Table 1 Search terms and filters used during systematic literature search

Screening and selection process

Full-text assessments were conducted to ensure articles met the inclusion criteria (Table 2).

Table 2 Inclusion and exclusion criteria adopted during the literature review search

Two researchers independently conducted the selection process to ensure objectivity and consistency. Discrepancies were resolved through discussion or consultation with a third reviewer.

Quality assessment

The methodological quality of the included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. The JBI Checklist for Qualitative Research was used for qualitative studies, the JBI Checklist for Quasi-Experimental Studies for non-randomised quantitative studies, the JBI Mixed Methods Appraisal Tool (MMAT) for mixed-method studies, and the JBI Checklist for Economic Evaluations for cost analysis studies. Quality assessment was conducted for all the papers included in the final sample presented in this article to ensure the validity and robustness of the conclusions drawn by this review.

Data synthesis

The Framework Synthesis approach involves applying an existing framework or theory to organise and interpret the data. The review by Bunn and colleagues [4] provided a comprehensive understanding of the contextual, processual, and outcome aspects of Namaste Care intervention, which informed the adaptation of a suitable framework for this review. In this review, studies were categorised and analysed based on the main themes identified as part of our analysis: frequency and duration of Namaste Care sessions; Namaste Care environment and personalisation of care; staff engagement and training needs; Involvement of family members and volunteers. We extracted data relevant to the Namaste Care intervention from each study and then organised this data according to the identified themes. This approach allowed us to systematically examine how various factors influenced the delivery and effectiveness of Namaste Care in nursing care homes.

Data relevant to the Namaste Care intervention were extracted from each study and organised according to these themes. This systematic approach allowed us to examine how various factors influenced the delivery and effectiveness of Namaste Care in nursing homes. We integrated synthesised findings from previous reviews with primary data from other studies. The reviews focused on Namaste Care interventions within nursing care homes, ensuring relevance to our population of people with advanced dementia. We avoided redundancy by ensuring that review data were not merged with primary data; instead, synthesised findings complemented and enhanced our primary data analysis. Each review was considered independently and in conjunction with primary studies to provide a comprehensive understanding of current Namaste Care intervention findings.

For the theme of frequency and duration of Namaste Care sessions, we assessed session frequency, length, and any deviations from the planned schedule. The theme of Namaste Care environment and personalisation of care focused on the physical setting, sensory components used, and the customisation of care to individual residents’ needs. Staff engagement and training needs were analysed by examining involvement levels, training programmes, and ongoing support for caregivers. Lastly, the involvement of family members and volunteers was explored in terms of participation extent, roles in the care process, and associated challenges or benefits.

Findings

The PRISMA flow diagram (Fig. 1) illustrates the studies’ identification, screening, and inclusion processes. This diagram provides a transparent account of the number of records identified, screened, excluded, and included in the review, along with reasons for exclusions.

Fig. 1

PRISMA diagram including search through the database and snowballing search through citation searching

Twenty-five studies were identified that met the inclusion criteria. The studies were conducted in various countries, including Canada (6), the Netherlands (4), the UK (10), Australia (3), Iran (1), and the USA (1). The methodologies employed in these studies range from qualitative interviews to pre-post-test designs and content analysis, all aimed at evaluating the implementation and outcomes of the Namaste Care intervention for people with advanced dementia in the context of nursing care homes (Table 3).

Table 3 Summary of included studies

Using the framework synthesis approach, four key themes were identified from the analysis of the included studies. The first theme is the frequency and duration of Namaste Care sessions within the context of care homes. Deviance from the original design relative to the delivery of Namaste Care sessions within the context of care homes is explored in this theme while considering pragmatic aspects unique to this context of care, which might hinder effective delivery. The second theme is relative to the Namaste Care environment and personalisation of care. The focus of this theme is on the barriers and enablers involved in the organisation and delivery of Namaste Care within specific spaces within the care home and the implementation of personalised care during the sessions. The third theme is represented by staff engagement and training needs. This theme highlights the need for an organisational approach to the delivery of Namaste Care and more standardised training opportunities for staff. Finally, the fourth theme is focused on the need for family and volunteer involvement in the Namaste Care sessions. This last theme examines the involvement of family caregivers and staff in the Namaste Care program, highlighting the benefits and challenges of their participation.

Frequency and duration of Namaste Care sessions

The original design of Namaste Care, which proposes twice-daily sessions of two hours each, seven days a week, presents significant delivery challenges in the context of care homes. Multiple studies identified considerable challenges in implementing Namaste Care against the planned session schedule. Namely, schedules were reduced in terms of the length of individual sessions [11,12,13], the number of sessions delivered per week [11, 14] and the number of sessions each participant attended within the planned intervention against the original target [15,16,17,18]. Detailed information regarding the delivery of Namaste Care in these studies is reported in Table 4.

Table 4 Summary of Namaste Care Sessions frequency and duration

variability in the delivery of Namaste Care sessions and uneven participation from the residents was reported in additional studies, but without providing explicit information regarding sessions’ average duration or attendance [20,21,22,23,24,25].

The reasons provided for this unevenness in delivery and overall shared difficulty in meeting an initial set target for the delivery of Namaste Care within care homes were generally attributed to staff availability and conflicting scheduling issues with the care home routine [11, 13, 16]. Active and continuous involvement of family members and volunteers was proposed in some of the studies as a possible solution to alleviate staff constraints and shortages [17, 23, 24], while others reported the necessity for flexibility in implementing Namaste Care to practical implementation [21, 25].

Namaste Care environment and personalisation of care

The Namaste Care sessions’ design involved delivering person-centred care in a calming and welcoming environment. Within the context of care homes, this might translate into identifying a separate and dedicated room or space where the sessions are held or utilising shared spaces temporarily converted into Namaste Care spaces during the sessions. The decision to utilise a separate or shared space often comes from the care homes’ availability of space, staff availability and residents’ predispositions [11]. Nevertheless, papers included in this review highlight the benefits of delivering Namaste Care in separate spaces. The identification of a designated space was found beneficial in counteracting session cancellations due to conflicting schedules within the care home [4, 14] and enhancing relaxation and comfort due to the reduction of distractions and background noises external to the ones utilised during the session [11, 26, 27].

Similarly to the identification of unique and separate spaces for Namaste Care, the delivery of tailored and personalised care activities is essential in effectively delivering this intervention. In this context, personalisation of care might involve engaging the person with familiar objects like photographs and their favourite music and by considering their family history in the use of life-like dolls or animals. Difficulties in delivering personalised care according to the initial design of the Namaste Care sessions were reported, in part due to resource constraints and perceived difficulties in effectively communicating with the residents [25]. Different studies reported the need to allow flexibility and avoid too strict and repetitive activities [11, 16], to facilitate implementation, and enhance engagement from participants and staff while considering participants’ predispositions and needs [11, 28]. Conversely, an overfocus by the staff on a particular moment of care within the session (i.e., nutrition through snacks) resulted in residents gaining too much weight [23], emphasising again the need for planning sessions and diverse and balanced moments of care.

Finally, efficient resource management was identified as a crucial factor influencing the delivery of personalised care within the Namaste Care sessions. This was particularly challenging for care homes with limited budgets. The need for sensory materials such as aromatherapy oils, soft music, and tactile objects added to the program’s overall cost, as these materials are essential for creating the multisensory environment integral to Namaste Care [11]. Despite these higher initial costs, several studies suggested potential long-term cost savings by improving resident well-being and reducing medication needs [16, 29].

Staff engagement

Staff involvement, availability, engagement and commitment to the delivery of Namaste Care are central to effectively implementing the intervention in care homes, as staff members oversee its organisation, delivery, quality assurance and upkeep. Across different studies, staff constraints due to shortages and lack of flexibility in care routine have been reported as one of the main barriers to the delivery of Namaste Care [13, 21, 28]. Additional challenges related to staff involvement related to negative attitudes towards Namaste Care, seen as a ‘luxury’ or additional activity instead of an integral part of care delivery [19] and staff burden due to additional responsibilities related to the delivery of sessions [16, 17, 30].

As a way to overcome these challenges and barriers, different studies reported a strong central leadership and organisation approach by the care home towards the implementation of Namaste Care as a fundamental support for the successful implementation of the intervention while supporting staff needs [11, 30].

Training and continuous involvement

Training and continuous involvement were also reported as important resources in facilitating staff delivery of Namaste Care. Across the studies included in this review, different training approaches were utilised. Namely, training focused on enhancing participants’ awareness and understanding of dementia behaviours and symptoms while teaching participants new skills to connect with the residents through physical comfort and sensory stimulation were delivered [22]. Similarly, other training approaches before the implementation of Namaste Care focused on the need to train staff to provide high-sensory care in a therapeutic environment, ensuring they were well-prepared for the intervention [30].

In some cases, the training involved practical demonstrations and personal experiences, where the training program included eight sessions over four days with a combination of theory and live demonstrations​ [30]. Follow-up sessions and the provision of guidance manuals were also common to reinforce learning and support staff​ [2, 14]. Continuous coaching and support played a critical role in maintaining the quality of care. Kaasalainen and colleagues [16] emphasised the importance of ongoing coaching by research assistants to ensure proper implementation and adaptation of Namaste Care​. Furthermore, practical resources, such as toolkits and manuals, were provided to assist staff in delivering the program effectively [15, 23]. Overall, a lack of a standardised training approach for Namaste Care was noted, with some studies highlighting disparity of training opportunities among staff, with some staff members attending formal training courses, while others were unaware of such training opportunities [19].

Finally, in some of the papers included in this review, informational lectures and training materials were provided to family members and volunteers [2, 29], with positive feedback from the attendees reporting sentiments of empowerment and higher levels of engagement towards the Namaste Care sessions [30]. The unique experience of family members of people with advanced dementia living in care homes was also utilised in the design of intervention implementing Namaste Care to gain deeper insights into the reality of lived experience [2, 14, 20].

Involvement of family members and volunteers

Family and volunteer involvement is a critical component influencing Namaste Care’s successful implementation in the context of nursing care homes. Studies reported that family caregivers who participated in the programme noted improved interactions and relationships with their family members [4, 13], in addition to encouraging family members to visit more often following participation in Namaste Care sessions [31]. The design of the Namaste programme, emphasising the participation of family members and volunteers, has shown to be beneficial also in alleviating widespread barriers to its implementation, like staff shortage and burden [17]. Family involvement helped build trust between families and staff, fostering a sense of partnership in care, while volunteers were considered essential in the delivery of Namaste Care sessions, helping to ensure that sessions could be conducted regularly even when staff were limited [17]​.

Nevertheless, involving families in Namaste Care sessions has presented a few challenges [13]. Challenges are represented by feelings of uncertainty by family members regarding their roles within the session and confusion surrounding the objective of Namaste Care [13, 32, 33]. Additionally, conflicting schedules between staff and family members, where, in some cases, the duration of the sessions was perceived as too short (i.e., half an hour) and did not justify the commute from the point of view of the family members, making it less feasible for families to attend [23]. In addition, the emotional burden related to seeing people in more advanced stages of dementia compared to their family members sometimes fostered feelings of anxiety, which discouraged future attendance [32]. Insecurities, difficulties in communicating expectations, and potential anxieties can be alleviated and managed through the promotion of adequate training and information sharing with families and volunteers prior to the commencement of the intervention [13].

Discussion

This review systematically synthesised recent literature to explore the implementation of the Namaste Care intervention in nursing care homes. Five main themes were identified: the frequency and duration of Namaste Care sessions, the care environment and personalisation of care, staff engagement, training needs and continuous involvement, and the involvement of family members and volunteers. While Namaste Care offers substantial benefits, including improved quality of life and reduced behavioural symptoms [18], its implementation frequently deviates from the original design due to various practical constraints. These constraints include staff shortages, rigid schedules, and limited resources, which often result in reduced session frequency and duration [11, 13, 14]. Personalised sensory experiences, a cornerstone of Namaste Care, were highly beneficial but difficult to maintain consistently due to resource limitations [11, 25]. Additionally, the importance of comprehensive staff training and continuous support to ensure effective delivery was emphasised [16, 22, 30]. Finally, the active involvement of family members and volunteers was identified as a crucial enabler, alleviating some of the burden on staff and enhancing the residents’ engagement [17, 31].

The review revealed a common discrepancy between the actual implementation of Namaste Care sessions (i.e., the duration and frequency of scheduled sessions) and the original design, which intended for twice-daily sessions of two hours each, seven days a week [34]. This deviation from the original design reflects not only the nursing care homes’ difficulties in adhering to such a schedule due to various organisational constraints but also a much broader issue relating how an intervention is initially developed. Namaste Care was developed based on experience and clinical practice in US settings, rather than following intervention development guidelines, such as those outlined by the Medical Research Council (MRC) guidance. These emphasise iterative testing and refinement based on empirical evidence [35]. For instance, the expanded FRAME framework emphasises the importance of documenting modifications to understand their impact on fidelity and outcomes [36]. Without detailed documentation of changes to scheduled practice and implementation challenges, it is difficult to ascertain the effectiveness of individual components and the necessary ‘dose’ for achieving the intended benefits. It is critical going forwards that the structures, processes and outcomes of Namaste Care are fully documented to feed effectively into evidence-based adaptations to the implementation of Namaste Care so that a programme of care is both realistic, and able to deliver the desired outcomes.

Although there is extensive evidence indicating positive outcomes of Namaste Care for residents [18], staff members [24], and families [13] in nursing care homes, the current lack of reproducible dose-specific data makes it difficult to compare results due to variability in the frequency and duration of the Namaste Care sessions. Furthermore, even when the studies were focusing on other aspects of the implementation of Namaste Care within nursing care homes, such as staff training and education, a lack of a standardised training approach resulting in diverse training formats, duration and sometimes even presence of training [19], highlights the need for a more consistent and unified protocol for the delivery of Namaste Care across different settings and contexts.

The dominance of certain components in descriptions of Namaste Care was highlighted in the review, with less attention given to broader issues such as family involvement and training. Family and volunteer engagement in the delivery of Namaste Care offers opportunities for involvement in care moments which have shown to have positive outcomes for family members in feeling empowered and positively engaged in the provision of care of their family member [4, 13]. Nevertheless, little focus is directed towards the provision of standardised training or knowledge exchange, and more on the assessment of attitudes towards the intervention [13, 23] or the outcomes from the attendance of the Namaste Care sessions [2]. Other tools and instruments designed with the aim to facilitate family members understanding and participation in the life and care of people with advanced dementia approaching the end of life, can represent potentially insightful resources into enhancing family engagement and potentially improving the overall effectiveness of the Namaste Care intervention. One example is the Family Carer Decision Support tool [37], designed to inform family carers about end-of-life care options for people with advanced dementia and enable them to contribute to advance care planning. This provides a structured approach that includes an information booklet on end-of-life care and a family care conference facilitated by trained staff. This tool has shown high levels of acceptability and effectiveness in reducing family carer decision uncertainty and improving satisfaction with care quality. Integrating such tools into Namaste Care could standardise the family involvement component of the intervention, enhance communication between staff and family members, and potentially improve the intervention’s outcomes.

Finally, the need for pragmatic trials that test interventions in real-world settings is paramount. There is significant variability in the implementation of Namaste Care due to practical constraints such as staff shortages, rigid schedules, and limited resources. Future research should deploy pragmatic designs that reflect the typical conditions of nursing care homes. These trials will assess the feasibility and effectiveness of Namaste Care within the actual operational and resource limitations of these settings. Additionally, incorporating Equity, Diversity, and Inclusion (EDI) principles into future research is crucial to addressing the needs of underrepresented groups and diverse populations [38]. This includes prioritising culturally sensitive methodologies and engaging with stakeholders from varied socioeconomic and cultural backgrounds. Pragmatic trials [39], offer a more adaptable research design for nursing home settings, addressing the limitations of traditional randomised controlled trials (RCTs). This approach ensures that interventions are not only effective in controlled environments but also adaptable and sustainable in everyday practice. By prioritising pragmatic trials, we can develop more realistic and implementable models of Namaste Care that can be seamlessly integrated into the daily routines of nursing care homes, ultimately enhancing the quality of life for residents with advanced dementia.

Strengths and limitations

This review has several strengths, including a comprehensive search strategy and a framework synthesis approach to integrate findings across diverse studies. However, there are also limitations to consider. The variability in study designs and outcomes assessed posed challenges for data synthesis. Additionally, relying on English-language studies may have excluded relevant research published in other languages, and most included studies were conducted in high-income Western countries. This might limit the generalisability of the findings to underrepresented groups or settings with different cultural, social or economic contexts. The lack of diversity in study populations highlights an important gap in the literature, particularly regarding the potential applicability and adaptations of Namaste Care in low and middle-income countries or among culturally diverse groups. Despite these limitations, the review provides valuable insights into the feasibility and impact of Namaste Care in nursing homes. The quality of the included papers was generally high, as assessed using the JBI Critical Appraisal Checklist and the Mixed Methods Appraisal Tool (MMAT). All studies demonstrated congruity between their research methodology and objectives, adequately represented participants’ voices, and received ethical approval. The high quality of these studies adds robustness to the review’s findings.

Conclusions

We systematically synthesised the current literature on the implementation of Namaste Care in nursing care homes, providing valuable insights into the practicalities and challenges associated with this intervention. Despite the likely benefits of Namaste Care in enhancing the quality of life for residents with advanced dementia, nursing care homes often deviate from the original design due to various organisational constraints. The review highlighted key themes such as the frequency and duration of sessions, personalised care environments, staff engagement, training needs, and family involvement as critical factors influencing successful implementation.

To enhance the implementation of Namaste Care, several practical recommendations emerge from this review. Establishing standardised training programmes is essential to ensure that all staff members are adequately prepared and confident in delivering Namaste Care. These programmes should be comprehensive and consistent, addressing the diverse needs of staff across different care homes. Involving family members and volunteers more systematically can alleviate some of the burden on staff and enhance the residents’ engagement and well-being. Tools like the Family Carer Decision Support tool may facilitate better communication and participation from families in the daily and future care of residents with advanced dementia.

Furthermore, adopting flexible scheduling can accommodate the specific constraints of each care home, allowing for the adaptation of session frequency and duration while maintaining the core components of Namaste Care. Future research should focus on pragmatic trials that reflect the real-world conditions of nursing care homes, ensuring that Namaste Care can be adapted and sustained effectively in practice. By addressing these challenges and focusing on evidence-based implementation strategies, Namaste Care can continue to be a valuable intervention for improving the lives of individuals with advanced dementia in nursing care homes.