Care homes: When is the right time and who decides?

Advice and practical tips for carers on when is the right time for a person to be moved to a care home.

Care homes: when's the right time and who decides?
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A person with dementia will need more care and support as their condition progresses, and there may come a time when they will need to move into full-time or residential care. This could be because a care home may be able to meet the needs of the person better. Or, it could be because something changes that then makes it difficult for the person with dementia to stay living at home.

It can be hard to know when the time is right for a person with dementia to move into a care home and who should make this decision, if the person cannot make it themselves. This factsheet is aimed at carers, friends and family of a person with dementia. It provides information and explains what might need to happen in these situations. It also talks about some of the feelings you might have when the person with dementia moves into a care home, such as relief, loss or guilt.

To help you to find the right care home, see our booklet on selecting and moving into a care home. It explains the process of finding and visiting homes, and has checklists and tips of things to consider when deciding which home is the right one.

Who makes the decision?

In some cases the person with dementia will be able to decide for themselves whether or not they need to move into a care home. If this is the case, then they should make their own decision – and be offered any help they need to do so. However, often by the time the person with dementia needs the level of care that a care home provides, they have lost the ability (known as ‘mental capacity’) to make this decision for themselves.

If the person is not able to make this decision, someone else will need to make this decision for them. This would usually be the person’s attorney under a health and welfare Lasting power of attorney, or their personal welfare deputy, if they have one. Any attorney or deputy must make decisions in the best interests of the person. An attorney or deputy for property and financial affairs (not health and welfare) is often able to make this decision for the person with dementia. This is because they have the legal power to arrange the finances to pay for this care. However, professionals or members of the person’s family can challenge this decision.

For more about mental capacity in England and Wales, and how to know if someone is able to make decisions for themselves, see our page on the Mental Capacity Act. For more information on attorneys and deputies see Lasting power of attorney and Becoming a deputy for a person with dementia.

In Northern Ireland there are Enduring powers of attorney and controllerships rather than Lasting powers of attorney and deputyships. These are only possible for property and financial affairs, not health and welfare. For more information on these see Enduring power of attorney and controllership.

The person with dementia may not have an attorney, deputy or controller. In this case, the decision should ideally be made between health and social care professionals (such as social workers or health care professionals) and those close to the person. If there is a disagreement, it would normally be the health and social care professionals who make the decision, but again this could be challenged by the person’s family or friends.

Whoever makes the decision to move someone to a care home must think about why it is in the best interests of the person with dementia. For more on making this decision see How do you know if someone needs to move into a care home? later in this factsheet. The person should be involved in the discussion too if possible, even if they don’t have capacity to make the decision themselves. This is because they are likely to have preferences and feelings about the decision.

Many carers, family members or friends will also have an idea about what the person with dementia would want. You might be the people who know the person best, or have talked to them about what they want for the future. You should be consulted where possible and should say what you think the person would want.

If the person doesn’t have someone who knows them well enough to be involved in these discussions, an Independent Mental Capacity Advocate (IMCA) may be appointed by the local authority in England and Wales. This is someone who can speak on the person’s behalf in these discussions. For more information see Mental Capacity Act.

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