Considering a care home for a person with dementia

Moving a person with dementia into a care home is a big and emotionally challenging decision. However, as dementia progresses, it may become necessary. For example, if the person’s care needs are increasing or there are concerns about their safety.

When the time comes to consider a care home, there are important factors to weigh up. These include the type of home and quality of care on offer, the costs involved and the funding options available. This page, written by our dementia specialist Admiral Nurses, explores the reasons why a care home move might be beneficial, how to choose the right home, and how to help the person with dementia settle in.

When to consider a care home for someone living with dementia

Deciding to move a person with dementia into a care home is not easy, and the ‘right time’ will be different for each person. Some of the signs that it may be time to start considering a care home include:

• the person’s care needs increasing
• concerns about their safety at home
• increasing strain on family carers
• a breakdown or change in a home care arrangement

Signs that care needs are increasing

Dementia is progressive, so a person’s care needs will increase over time. Signs that their needs are increasing and may be better supported in residential care include:

• sleep problems, including broken sleep throughout the night
• the person leaving the home alone and/or getting lost outside the home
• difficulties managing personal care such as washing, dressing and continence
• frailty in the person with dementia and/or the person caring for them
• difficulty managing multiple health conditions in the person with dementia and/or the person caring for them
• the person finding it increasingly difficult to cope with daily living, eg looking after their home and/or themselves
• the person feeling anxious and unsettled in their own home and/or not recognising that they are at home

The impact on the carer’s health and wellbeing

Supporting a person with dementia can be emotionally and physically exhausting. If you are struggling to meet the needs of the person with dementia or keep them safe, or if caring for them is affecting your physical or mental health, moving them into a care home may be the best decision for them and you.

Safety concerns at home

Dementia can make a person more vulnerable to accidents or getting lost. Moving into a care home, where staff are available to support and supervise residents 24/7, may be the best option if:

• there are worries about the person’s safety, or the safety of yourself and others
• the person is becoming reluctant to accept help at home – whether from carers or family members – or refusing help altogether
• the person leaving the home alone and/or getting lost outside the home

Types of care home suitable for people living with dementia

There are two main types of care home:

• Residential care homes provide accommodation and personal care such as help with washing, dressing, giving medication, using the toilet and taking part in activities. Some specialise in caring for people with dementia
• Nursing homes also provide personal care, but with qualified nursing staff on site. This means they can support people with more complex physical or mental health needs or learning disabilities

Some homes offer both residential and nursing care.

The needs of the person with dementia will influence the type of care home you choose. Some people move from a residential care home to a nursing home as their needs become more complex.

It can be particularly difficult to find a suitable care home for a person with young onset dementia (where symptoms develop before the age of 65). Many are tailored to older people and cannot support the different physical and mental health and social needs of a younger person. Care Choices and Carehome.co.uk let you search for care homes and include filters for homes suitable for adults under 65. Some organisations like

Lottie and Care Finder will also offer free assistance in finding a suitable care home.

How to choose a care home for someone with dementia

Every care home is different, so it is important to research and visit several options. It is helpful to prepare some questions and a checklist of your requirements and wishes. You can also ask friends, family, and other people in your area – such as members of carers’ support groups – if they have any recommendations or insights.

Evaluating the quality of care services

As well as visiting homes, do some research into the quality of care. All care homes are inspected by independent regulators who rate them based on residents’ quality of life and the care delivered. Care homes are inspected by:

• the Care Quality Commission (CQC) in England
• the Care Inspectorate in Wales
• the Regulation and Quality Improvement Authority (RQIA) in Northern Ireland
• the Care Inspectorate in Scotland

You can find care homes’ inspection reports online or ask for a copy when you visit. The Care Choices website also shows each care home’s CQC rating as you browse.

Questions to ask staff

A compassionate, skilled team with supportive leadership is vital to a good care home. Talk to the staff and manager about how they provide care, what training the staff get and how they make a difference to the residents. If the manager is new, you could ask about their vision for the future of the home.

Here are some specific questions you could ask care home staff:

• Do staff have specific dementia knowledge and training?
• What is the staff turnover rate?
• What are the visiting times? Are they flexible?
• Can you have a meal with the person with dementia by prior arrangement?
• How are residents and their families involved in care decisions?
• How easily can you communicate with staff if you have questions, concerns or recommendations?
• How are residents with communication difficulties supported?
• What are the laundry arrangements?
• Does the home arrange special events such as day trips, visits from local schools, parties, film nights, themed activities etc?
• Are there links to the local community – for instance, can residents get their newspapers delivered? Go to a place of worship? Go to the Post Office?
• How accessible is the home for the people who are most likely to visit?
• Does the care home offer transport for visitors who cannot drive or use public transport?
• How will staff support you and the person with dementia as they approach the end of life?

What to look for when visiting a care home

Every family has its own needs and preferences when choosing a care home, but a warm welcome, homely atmosphere, and residents and staff who seem content are good indications of a positive environment. You can find out a lot by talking to residents, relatives and staff. It is also important to use your senses: how does it smell? Is it warm enough? Is it noisy?

Other questions to consider include:

• Does the care home tailor activities to residents’ individual interests?
• Are there opportunities for the person to continue with their current hobbies and interests?
• Are residents involved in the care home’s daily activities and routines, eg helping to prepare food, lay tables, do gardening?
• Is there access to books, board games, radio, TV, puzzles, a piano etc?
• What is the food like? Can they cater for special diets?
• Is there secure access to outside space and fresh air?
• Is there a choice of social and communal areas – eg a quiet space to sit and rest, and a livelier area for activities and conversations?
• Is there regular access to healthcare and wellbeing support, including doctors, dentists, podiatrists and hairdressers?
• What residents’ and relatives’ groups are there?

What are the benefits of a person with dementia moving into a care home?

Moving into a care home is often a positive step for a person with dementia. It allows them to receive expert care tailored to their needs, and when you are relieved of some of your caring responsibilities, you and the person with dementia can focus on enjoying the time you spend together.

The benefits of moving into a care home include:

• peace of mind about the person’s safety
• specialist care around the clock
• less pressure on family and friends to provide care, often meaning they can spend more quality time with the person
• professional support with personal care, including intimate care
• opportunities for the person to take part in activities and hobbies in a safe environment
• specialist medical care from nurses, if the person is in a nursing home
• improved wellbeing for family carers

Do people with dementia have a better quality of life in a care home?

While it depends on the individual situation, moving into a care home often leads to improvements in health and quality of life for the person with dementia. They will receive a higher level of support, from people with professional training and experience in caring. They often have more opportunities for socialising, meaningful activities and spending quality time with family and friends without the friction that can be caused by them providing daily care.

Dementia care home costs and funding

Paying for residential care can have a significant impact on a family’s finances. While some financial assistance may be available through the local council or the NHS, navigating the care funding system can be complex and the person with dementia or their family often need to shoulder a lot of the costs themselves.

Evaluating care costs

If the person has income, savings, property and other assets below a certain threshold, they may be eligible for financial support for the cost of care. You can find the latest thresholds at online:

• England guidance at gov.uk
• Wales guidance at gov.wales
• Northern Ireland guidance at nidirect.gov.uk
• Scottish guidance at carinfoscotland.scot

The local council will first carry out a financial assessment to identify what care the person needs, followed by a financial assessment to see what funding, if any, they may be entitled to.

Financial support for residential care

To establish whether the person with dementia qualifies for financial support with the cost of care, they will first need a needs assessment by their local Social Services. If the needs assessment recommends moving into a care home, Social Services will then carry out a financial assessment to see if they are eligible for support.

Financial assessments are routine but can be complicated, so do not hesitate to ask the assessor to clarify the process and explain the outcome. Our dementia specialist Admiral Nurses can also offer guidance.

Financial support for care fees is means-tested, so people who have ‘capital’ (the amount they own, such as pension, savings and property) above a certain threshold will not qualify for assistance.

If the person with dementia is paying for a care home themselves, known as ‘self-funding’, and their capital falls below a certain amount, they may become eligible for financial support from their council. If possible, request an assessment for the person a few months before their capital is likely to fall below that amount.

Deferred payment agreements (DPA)

A deferred payment agreement (DPA) is an arrangement with the local council that helps people avoid having to sell their home to cover care home costs. It’s a long-term loan against the value of the property, which is repaid to the council when the person dies or when they choose to sell their home.

If the person with dementia has had a financial assessment to establish how much they need to pay towards their care, information about their eligibility for a DPA and how to apply will be included in the outcome letter from the assessment.

NHS continuing healthcare funding (CHC)

CHC is a package of care that is available in England and Wales. It is for adults with long-term, complex health needs, which may include dementia. Normal NHS healthcare – for example, from a GP, district nurse or in hospital – is free, but CHC covers other costs, such as home carers or care home fees. It is partly or fully funded by the NHS, or you can be awarded a contribution towards funded nursing care (FNC).
Learn more in our Guide to continuing healthcare (CHC) funding.

Making the decision to move a person with dementia into a care home

When making the decision to move a person with dementia into a care home, you should involve them as much as possible. You should also consider how to communicate the change to them, be prepared in case they are resistant, and look after your own mental health as a carer.

Involving the person with dementia in the decision

The person with dementia should be given the opportunity to be involved in decisions about their care wherever possible, with support if they need it. Even if they lack the mental capacity to make decisions about their own care, it is important to include them in the discussion, taking into account their past and present wishes and preferences.

If possible, try to establish the person’s wishes for long-term care in advance. This will help you respect their views as much as possible, and allow them to choose who they would like to make decisions if they lose capacity. To ensure this happens, they should make:

• An advance care plan (ACP): a document that sets out the person’s wishes for their future medical and personal care, including residential care. An ACP will help you plan ahead and avoid having to make significant care decisions in a crisis.
• Lasting power of attorney (LPA): a legal process where a person appoints someone they trust (known as their ‘attorney’) to make decisions on their behalf if they lack the mental capacity to make decisions themselves.

There are two types of LPA:

• health and welfare
• property and financial affairs

LPA applies to England and Wales. In Scotland, the equivalent is called power of attorney. In Northern Ireland, it is called enduring power of attorney and only applies to property and financial decisions.

Read more about lasting power of attorney

How to communicate with someone with dementia about the move

Raising the subject of moving to a care home can be difficult, so it is best to approach the conversation gently, giving the person the opportunity to share any concerns. For example, if they are worried about losing their privacy, you might reassure them that they will have their own room. Or if they are concerned about seeing loved ones, let them know that family and friends will be able to visit regularly.

Sometimes a person with dementia may not recognise that they need additional support, either through denial or a lack of insight into their condition. In these situations, it can be more helpful to focus on the positive aspects of care home living — such as not having to worry about housework or cooking — rather than trying to convince them that they are struggling.

Bear in mind any communication difficulties the person may have and try to use techniques that work for them. For example, showing them pictures to choose from might be easier for them to understand than explaining their options with words.

If Social Services are carrying out a needs assessment, it may be helpful for the assessor to introduce the idea of moving to a care home to the person with dementia. Sometimes, people find it easier to accept advice from a professional rather than a relative.

The support of family, friends, professionals and the care home itself is essential during this transition. Involving the person with dementia and the wider family throughout will allow everyone to share their views and minimise disagreements.

What to do if the person refuses to go into a care home

If a person with dementia has the capacity to make their own decisions, the choice of whether or not to move into a care home is theirs alone, and nobody can make that decision on their behalf. Read more about mental capacity and decision-making for people with dementia.

If the person decides not to move into a care home and you are unable to provide the care they need yourself, it may be possible to arrange home care, either privately or through the local council, depending on their financial circumstances. A small number of people may qualify for CHC funding for home care, which is not means-tested, though this is rare.

Be aware that a family member cannot be forced to provide care, even if it feels difficult to say no. If Social Services have carried out a needs assessment to identify what care the person needs, they may take into account any care and support their family or other people close to them can offer, but only if they are willing and able to provide it — so it is important to let them know if this is not the case.

These situations can be particularly challenging, especially if you feel the person’s needs would be best met in a care home, or if you live together. In such cases, it is a good idea to speak to Social Services for advice. Our Admiral Nurses can also talk you through your options and provide emotional support. If the person is neglecting themselves, the local Safeguarding Team should be informed — you can call the council and ask to be transferred.

Dealing with feelings of guilt

Moving a person with dementia into a care home can be very emotional. You may feel that you are letting them down, especially if – like many people – you made a promise to keep caring for them at home. You may feel a sense of loss and grief if your caring role changes or if you are now living alone.

You may feel guilty for considering your own needs when deciding to move the person into a care home, and worry that other people will judge you for not being able to continue in your caring role. However, supporting a person with dementia can be emotionally and physically exhausting, so it is important to look after yourself. You cannot care for someone else if your own health is suffering.

Moving someone into a care home does not mean you have failed. Many people need more specialist care from trained professionals as their dementia progresses.

Learn more about coping with feelings of guilt as a carer

Helping a person with dementia adjust to a care home

Moving into a care home is a major transition for the person with dementia. They may feel the loss of independence, and of their attachment to their main carer, home and normal routines. But with time and care, you can help them settle into their new environment.

Preparing for the move

Start talking to the person about the move well in advance. Have regular conversations about it and give them the opportunity to ask questions and discuss any concerns.

Try to arrange visits to the care home before the move, so the person starts to become familiar with it. Some care homes have open days, lunch clubs or other community events that they could attend, and some might be able to accommodate an overnight or short respite stay before moving in.

Personalising their room

Personalising the person’s room in the care home will help make it feel familiar and homely. As far as possible, involve them in choosing what to take. Bring comforting items from home, such as their own bedding, photos and ornaments. They may even be able to take in their favourite chair or other small pieces of furniture.

Building relationships with staff

Building good relationships with the care home staff will help them understand the person’s needs and wishes and provide the best care possible. It will also reassure you that the person is being well looked after, and ensure you can have open conversations if you have any updates or concerns.

Here are some tips for building strong relationships with care home staff:

• Get to know the staff by name and help them get to know you too. This includes the wider team, eg cleaners, gardeners and kitchen staff – everyone can contribute to making a positive difference
• Try to think of the care home as an ‘extended family’ around you and the person with dementia – this can frame the transition in a positive way
• Share your knowledge of the person so staff can understand and support them better. You could do this by creating and sharing the person’s life story – a record of their past and present life, likes, dislikes, values etc. Small details are important, such as how they take their tea, their favourite radio station, and what sports team they support
• Be clear with staff about the person’s needs and how their dementia affects them – everyone’s experience is unique
• Ensure staff know how the person usually responds to being distressed and how carers can support and comfort them
• If you are struggling to connect with the person, particularly if their ability to communicate changes, talk to staff about other ways to maintain your relationship, eg looking at photos or giving them a gentle hand massage
• Thank staff and tell them when you see good examples of care – you can also tell the manager, as this feedback can be useful in staff appraisals
• Ask for regular review meetings and look for solutions together if issues arise – keep conversations open and share your ideas
• Get to know the home’s routines – for example, find out about the best time to visit, whether you could offer support at mealtimes, if you can be involved in group activities etc
• Ask to be involved with the person’s care planning (establishing and meeting the person’s care needs in the present) and advance care planning (planning for the future)
• Consider if you could offer support with activities – for example, if you play an instrument, could you lead a music session? If you enjoy gardening, could you start a residents’ gardening group?
• Think about joining the home’s relatives’ and residents’ group to support the care home more generally

Alternatives to a care home for someone with dementia

Moving into a care home is not inevitable for people with dementia. You might feel able to keep caring for the person at home, with paid home carers if necessary. They may be very distressed about moving, or you may not be able to find a home that you think will meet their needs. In these cases, there are alternatives that can make it possible for the person to remain at home.

In-home care for dementia

There are various options for care at home for a person with dementia, depending on their level of needs. This could be hiring a cleaner or gardener to help with household tasks or arranging home care from a paid carer, who could visit anywhere from a couple of times a week to several times a day. Some people hire live-in carers, although this is very expensive. Depending on the outcome of the needs assessment and financial assessment, the person may be eligible for some funding towards home care.
Read our information on finding help and support at home.

Respite care options

Another option is respite care, where a person with dementia goes to a care home for a few hours, overnight or for several days. This gives carers a break, knowing that the person is well cared for, but without making the permanent move to a care home.

Sources of support

To speak to a dementia specialist Admiral Nurse about moving into a care home or any other aspect of dementia, please call our free Helpline on 0800 888 6678 (Monday-Friday 9am-9pm, Saturday and Sunday 9am-5pm, every day except 25th December) or email  helpline@dementiauk.org.

Alternatively you can book a phone or video appointment in our virtual clinic.

How we can support you

Dementia UK resources

• Advance care planning
• Choosing a care home for a person with young onset dementia
• Creating a life story
• Coping with feelings of guilt
• Grief, bereavement and loss
• Guide to NHS continuing healthcare funding
• Lasting power of attorney
• Looking after yourself as a carer
• Mental capacity and decision-making

Other resources

• carehome.co.uk – care home reviews
• Financial assessments for social care
• Make, register or amend a lasting power of attorney
• My Home Life – supporting quality of life in care homes
• The needs assessment
• Paying for your own care (self-funding)
• Relatives and Residents Association