From time of admission to a care home From time of admission to a care home, to the time unable to communicate effectively by speech. This is a difficult one, for several reasons: often people enter care homes at a very advanced stage because family have been caring for them effectively to that point, and speech may already have been compromised. It is important not to apportion the cause of the loss of communication to anything other than the developing condition of dementia. communication by speech is a moving target because families and carers remodel their communication as the patient's speech becomes less effective. They may use a combination of speech and physical contact, for instance. It is often difficult to identify when communication becomes impossible by means of speech.