Making decisions and managing difficult situations

9. Going into residential or nursing care

As a person’s dementia progresses, they will need more support and care, and there may come a time where full-time residential or nursing care is needed. If the person cannot make this decision for themselves, it is often left to the carer or family to make the decision about moving them into a care home. Being prepared for this eventuality early on, and having discussions as early as possible, can help to make the decision slightly easier when the time comes.

A carer’s decision to move someone they care about into residential or nursing care is often very difficult. Sometimes carers feel as though they have let the person down, which can prompt feelings of guilt.

Families can consider other care options and alternatives – for example, seeing what other care and support can be provided within the home. A family may wish to have a community care assessment through the local social services. Others may consider whether sheltered accommodation or assisted living is more appropriate.
Respite care (sometimes referred to as replacement care) is another option, and could be the first step towards longer-term residential care. This offers the person with dementia a chance to experience residential care on a short-term basis and offers the carer a break from their caring duties.

Carers or relatives of a lesbian, gay, bisexual or transgender (LGBT) person will have to consider additional factors when selecting the right care home. This could be choosing a gay-friendly home or one that has an anti-discrimination policy or anti-gay bullying policy. Look for organisations that feature lesbian and gay couples in their brochures. 

It may help to discuss the decision with a social or health care professional, such as a social worker or the person’s GP or consultant. Often they can give families their professional opinion on the type of care that someone needs. A social worker can carry out a needs assessment, which can help with deciding the level of care someone needs and the right care setting.

Although a move to residential or nursing care can be an emotionally difficult time, some carers do find that there are benefits. Some feel that the quality of care provided is better than they can provide themselves. Others feel that it is in the person’s best interests to be in residential or nursing care. There are also social benefits of living in a residential or nursing home. Residents can interact with one another and build new friendships, as well as take part in the activities that care homes can provide.

This change does not mean you will have a less important role in the person’s wellbeing. Talk about your continuing involvement in the care of your relative with the staff of the home. It may help you decide whether residential or nursing care is the right decision for you and your relative.

Things for carers to think about

  • Is the person able to make a decision about their care, and where to receive it, for themselves?
  • Have you considered other options, such as care in the home or respite care?
  • Is there a point at which you would feel unable to cope, when residential or nursing care would be the only option?
  • What would be the benefits for you and your relative if they moved to a residential or nursing home?
    Have you taken into account the person’s needs when selecting a care home if they are lesbian, gay, bisexual or transgender?
  • Have you considered any cultural, religious or spiritual beliefs the person with dementia may have when choosing a suitable care home?
  • Have you discussed the person’s care needs with a health or social care professional?
  • In what ways might residential or nursing care staff be able to provide better care than you?
  • If your relative goes into a residential or nursing home, in what ways might you still be able to be involved in their care?
  • What factors help make your relative feel comfortable, safe and content? Do the local residential or nursing homes offer this?
  • If your relative goes into a residential or nursing home, what would the impact be on them, you, and other people?
  • Do you think your feelings (good or bad) about placing your relative in a care home could change over time?
  • With whom can you discuss your feelings?
  • Has your relative ever expressed any opinions about going into a residential or nursing home?

Alzheimer’s Society also has a downloadable guide to selecting a care home. You can find it at alzheimers.org.uk/carehomeguide.