Dementia and care homes
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A person with dementia will need more care and support as their symptoms get worse over time. This may mean that a move into a care home can better meet their needs.
If you have been helping someone live independently with dementia or are a carer, this can be a hard decision to make.
But it's important to remember that there can be many positive aspects to moving into a care home.
- 24-hour support from care staff
- knowing that the person with dementia is in a safe place
- social activities with other residents
Sometimes the person themselves can make the decision. But the person with dementia often lacks the ability to decide (mental capacity).
If you or someone else has a lasting power of attorney, you can make the decision for the person with dementia, as long as it's in their best interests.
Read more about managing legal affairs for someone with dementia.
Try to talk to the person with dementia about their preferences regarding care in a home, even if they lack the capacity to make a decision over what care home is best for them.
First steps: getting an assessment
The first step towards choosing a care home is to get a new needs assessment from social services.
If the assessment suggests a care home would be the best option, the next step is a financial assessment (means test).
The financial assessment will show if the council will pay towards the cost of a care home.
In most cases, the person with dementia will be expected to pay towards the cost.
Social services can also provide a list of care homes that should meet the needs identified during the assessment.
There are 2 main types of care home:
- residential care homes
- nursing homes
Some care homes offer both residential and nursing care places.
Care homes can be run by private companies, voluntary or charitable organisations, or sometimes by local councils.
Both types of care home should have staffed trained in dementia care.
These provide personal care, such as help with:
- taking medicines
- going to the toilet
These are sometimes called care homes without nursing.
These provide personal care, as well as 24-hour care from qualified nurses. These are sometimes called care homes with nursing.
One of the most important things to check when choosing a care home is the most recent Care Quality Commission (CQC) report. You can find these on the CQC find a care home directory.
The CQC regulates all care homes in England. Its inspection reports can show you how well a care home is doing and any areas of concern.
When visiting a care home, spend time looking around and talk to the manager and other staff and residents.
It's useful to take a friend or relative with you as you can compare notes after your visit.
It's a good idea to make your own checklist before visiting care homes. These tips may help.
You may already know of a care home through personal recommendation or from social services.
Check the following:
- Is the care home near family and friends?
- Are there good transport links?
- Are there shops, leisure facilities and cafes nearby?
It's a good idea to ask to see a couple of bedrooms, as long as current residents are happy with this.
Other things to think about:
- Can residents have their own room, with space for their own furniture and possessions?
- Are there enough toilets within easy reach of bedrooms and living space?
- Is there a garden where residents can walk safely?
- Are chairs arranged in groups in living areas to encourage socialising, rather than round the edge of the room?
- Will the home meet specific religious, ethnic or cultural needs?
- Are residents' food likes and dislikes catered for?
Check if the manager of the home arranges a care assessment of potential residents to make sure it can meet their needs.
Other things to think about:
- Are all the staff trained in dementia care?
- Do staff seem interested and caring?
- Is there a full-time activity co-ordinator specialising in dementia-friendly activities?
- Do the staff hold regular relatives' meetings?
- Is the home accredited under the Gold Standards Framework for end of life care?
You can look for accredited care homes on the Gold Standards Framework website.
A good sign of a well-run care home is residents who appear happy and responsive.
Other things to think about include:
- Are residents treated with dignity and respect by staff?
- Can they have visitors whenever they want?
- Are there regular residents' meetings?
- Have they got access to community health services, such as chiropodists and opticians?
- Can you continue to help care for your relative in some way, perhaps helping them with an activity?
Read more about care homes and when is the right time from the Alzheimer's Society.
Who pays for care will depend on individual circumstances.
If you're entitled to local council funding, the council will set a personal budget. This will set out the overall cost of a care home, what the council's contribution will be, and what you'll have to pay.
The council must show there's at least 1 suitable care home available at your personal budget level.
If you choose a care home that's more expensive than the council considers necessary, top-up fees may have to be paid.
If the person with dementia isn't eligible for council funding, they'll have to pay the full cost of the care home (known as self-funding).
NHS continuing healthcare and NHS-funded nursing care
If the person with dementia has complex health and care needs, they may be eligible for NHS continuing healthcare. This is free and is funded by their local clinical commissioning group (CCG).
A diagnosis of dementia doesn't necessarily mean the person will qualify for NHS continuing healthcare.
People who don't qualify for continuing healthcare, but have been assessed as needing care in a nursing home, may be eligible for NHS-funded nursing care.
This means the NHS will pay a contribution towards the cost of their nursing care.
Choosing a care home and finding out about the different funding options isn't easy.
Charities and voluntary organisations can provide valuable help and advice:
- Alzheimer's Society's dementia connect support line on 0300 150 3456
- Age UK's advice line on 0800 678 1602 (free)
- Independent Age's helpline on 0800 319 6789 (free)
Page last reviewed: 08/06/2021
Next review due: 08/06/2024