How do you know if someone needs to move into a care home?

Advice and things to consider when deciding whether to move a person living with dementia into full-time care.

Care homes: when's the right time and who decides?
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If you are a family member or carer, or the person’s attorney or deputy, you may have to decide whether you think the person with dementia needs to move into a care home. You may find it difficult to make this decision, seeing both advantages and disadvantages to each option. If you’re struggling, don’t worry – it’s normal to feel confused or unsure.

You should ask yourself, first and foremost, what is in the best interests of the person. If you feel you can no longer provide the care that the person needs to help them to live well, then it may be better for them to move somewhere where professional care staff can do this. Similarly, if the person cannot live independently any more – for example, cannot care for themselves or stay safe – then it might be the right time to think about alternative care.

However, moving someone into a care home doesn’t have to be the only thing you should consider. You might want to think about other care options that would enable the person to stay living at home – for example, seeing what other care and support can be provided within the person’s home, or whether different housing options might be better.

Other care options to consider

Respite care (sometimes referred to as short-break or replacement care) is one option, and could be the first step towards longer-term residential care. Respite care is temporary care for the person with dementia that aims to give the carer a break, as well as giving both the carer and the person with dementia some time away from each other.

Some respite care will be in the person’s home, but some care homes also offer short stays. This offers the person with dementia a chance to experience a care home for a temporary period. Some people use a respite stay as a ‘trial period’ and many care homes are willing to offer a short-break as they find that people who like it there may eventually move in permanently when they are ready.

If you think extra support in the home or respite care may be a good option, you should contact your local authority for a needs assessment. This is where they make a full assessment of a person’s needs and decide what support they are eligible for.

For more information see Assessment for care and support in England, Assessment for care and support in Wales, or Assessment for care and support in Northern Ireland.

You may also want to consider whether a form of sheltered housing or extra care housing would be a better option for the person. These are living arrangements where someone lives independently, but has support on hand if they should need it (though you should check what is available in each case).

This can be a good first step for someone who needs a little extra help. However, as the person’s dementia progresses, their needs will increase and in the future a care home may be the best option. For some people moving more than once may not be a good idea as it can make them disorientated or unsettled. You will need to think about the person and what they would want in this case.

The benefits of moving into a care home

Deciding that someone needs to move into a care home is often a very difficult decision. It is common to feel a sense of guilt at making this decision. You may feel that you should be able to do more to support the person, or that you are letting them down. However, it’s important to remember that you are doing this because it is right for the person, and that there can be lots of positives to moving into a care home.

A care home will have staff who can provide continuous, 24-hour support, which may be more than you are reasonably able to do. A care home with nursing will also have a registered nurse on site 24 hours a day, for example. There are also important social benefits of living in a care home. Residents can meet one another, and join in group activities.

And just because the person moves into a care home, it doesn’t mean they will have to stop doing the things they enjoy. They will still be able to see family and friends, or do things that are meaningful to them. When the person is living in a care home, some people find it allows them to visit and spend quality time with the person, without having to focus on providing day-to-day care.

For more on feelings of guilt or other emotions see ‘Dealing with your emotions’. For more on the different types of care homes see Finding a care home.

Being prepared

Quite often, a person with dementia will move into a care home because of some unexpected event. For example:

  • a hospital admission
  • a carer becoming ill and being unable to care for the person
  • safety concerns about the person the person with dementia experiencing behaviours that challenge, such as being awake all night, or becoming aggressive or agitated.

This means you may not always be expecting it, and may have to make a decision very quickly about what to do.

It can help to be prepared for this situation, and talk to the person with dementia about it as early as possible. It can help to know how they feel about a move – for example, it may be reassuring for you to know that you’re doing what they would want you to do. This can make the decision slightly easier when the time comes.

You could try talking things over with other people, such as friends or family members. You could also speak to health and social care professionals. They will be able to give their professional view of the person’s needs. You may also be able to get an assessment of a person’s needs from your local authority, or in Northern Ireland your health and social care trust. This is where they carry out a full assessment of all a person’s care and support needs, which may help you make a decision about what is in the person’s best interests. Both carers and people with dementia can get an assessment, and the local authority or trust has a duty to carry one out if you request it.

For more on getting a needs assessment see Assessment for care and support in England, Assessment for care and support in Wales, or Assessment for care and support in in Northern Ireland.

What things should you consider?

If you are finding this decision difficult, it might help to think clearly about the following things. It might also be useful to write everything down as this can help you to weigh everything up and get other people’s help.

  • Is the person able to make a decision about their care, and where to receive it, for themselves?
  • Has the person been given all possible support to make a decision themselves?
  • Have you considered other options, such as care at home, that may help the person to get the care they need?
  • Would some respite care or a short break help you to feel more able to cope, or to see how the person with dementia gets on in a new environment?
  • Would sheltered or extra care housing be a better option for the person than a care home?
  • What would be the benefits for you and the person with dementia if they moved to a care home?
  • In what ways might care staff be able to provide better care than you – for example nursing or 24-hour care?
  • If the person with dementia goes into a care home, how could you still be involved in their care?
  • What things make the person feel comfortable, safe and content? Does the care home you are considering offer these?
  • If the person goes into a care home, what would the impact be on them, you, and other people?
  • Do you think your feelings (good or bad) about placing the person with dementia in a care home could change over time?
  • Is there someone you can discuss your feelings with?
  • Has the person ever expressed any opinions about going into a care home?
  • Have you spoken to the person about the move? Even if they don’t seem to understand it or are unable to make the decision themselves it is important to involve them as much as possible.
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