Care homes and dementia

Expert reviewer Versha Sood, Dementia Lead, Bupa Richmond Villages
Next review due August 2023

Making decisions about your loved one going into a care home can be very difficult. It can seem like a huge change in your relationship with each other.

You might want your loved one to stay at home for as long as possible. At the same time, you’ll need to balance this with their needs, and the risks of them having difficulties at home. This could include things like going outside and getting lost or having an accident around the house.

About residential care

If you decide that your loved one would benefit from a care home, you may have mixed emotions. Some carers feel relieved – but then have guilt for feeling that way. You may also feel guilty if your loved one told you earlier on in their illness that they didn’t want to go into a care home. It’s natural that many people who are still living independently don’t like this idea. But when someone has dementia and their illness progresses, a care home may be the most supportive place for them.

Being in a care home doesn’t have to mean a complete loss of independence. In fact, the best care homes will try to help people do things for themselves for as long as possible. Care homes can be comfortable and homely places with a sense of community; sometimes more so than people expect.

At the same time, every care home is different, so environments and standards of care do vary. This makes it really important to spend some time choosing a care home carefully. The information in this section has tips to help you think about different options.

Choosing a care home

"It's quite a daunting experience if you've never been to a care home before. We also needed to find somewhere quite quickly because [my father] was still in hospital and couldn't be discharged until care was in place. So we had the added pressure of trying to find somewhere quickly that had availability, and a place that we liked – because I think there was quite a difference between some of the care homes.” - Susan

Choosing a care home is a huge responsibility and may feel overwhelming. The key is to find out as much as possible about potential homes. You and your loved one will feel more at ease, the more confident you are about your decision.

A good starting point is to ask your local social services to carry out a needs assessment. This is a meeting with a trained adviser who looks at a person’s needs and how social services could help. This assessment can help you decide what to look for in a care home. It may also lead to financial support from the local council.

You will notice that different care homes may be called:

• a residential home
• a nursing home

The difference between the two is that nursing homes have a qualified nurse on duty all the time. As you think about different options and compare homes, you may find it helpful to download our 'choosing a care home' checklist. You can print it off and use it to keep notes.

Some key things to consider

• Make sure you visit potential homes. Be clear on what you’re looking for. Sometimes more than one visit can help you form an opinion.
• Think about that initial impression. How are you greeted? How do you feel when you walk through the door?
• Ask to see the rooms on offer, communal areas and the gardens.
• Speak to residents about their experiences. Many homes will actively encourage you to do this.
• Find out what goes on in the home. For example, ask about the day-to-day routine and activities for people with dementia. Speak to staff about activities that your loved one may enjoy, and equally those they may not.
• Find out how family members can get involved with the home. For instance, the home may have relative-and-resident meetings in place.
• Ask how staff go about supporting new residents.

Checking the Care Quality Commission website in England

If you live in England, you can find care homes in your area and read their inspection reports on the Care Quality Commission (CQC) website. There are four overall ratings that the CQC can give a care home.

• Outstanding: this means the care home is performing exceptionally well.
• Good: the care home is performing well and meeting expectations.
• Requires improvement: the care home isn’t doing as well as it should and the CQC has told it to improve.
• Inadequate: the care home is giving a bad service and the CQC has taken action against it.

These ratings can give you a quick idea of standards but reading the full report will give you a clearer picture of why a home has its current rating. It’s worth remembering that a home’s rating can improve or decline over time.

Checking regulators in other UK countries

There are different regulators in Scotland, Wales and Northern Ireland, but they work in a similar way to the CQC. You can read their reports about care homes on their websites.

• In Scotland, care homes are regulated by the Care Inspectorate.
• In Wales, care homes are regulated by the Care and Social Services Inspectorate Wales.
• In Northern Ireland, care homes are regulated by the Regulation and Quality Improvement Authority.

Settling in

Moving into a care home can sometimes feel daunting not only for the person moving, but also for their loved ones. Like any big change, it means you will both be adapting to a new way of life. But knowing what to expect and taking your time to prepare can really help.

Suggestions for the first few days

• Your loved one might like to have some familiar items to help them feel at home. This can be as simple as a few favourite photos or pictures, or even some familiar pieces of furniture. Just check with the home first to see what they can accommodate.
• Let them go at their own pace as they move in. Some new residents may be happy to join in lots of activities from day one. Other people might prefer to spend more time alone in their room as they settle in. Give them as much time and space as they need.
• Try to set up a good relationship with care home staff from the start. Talk to them about your loved one’s life history, family, their likes and dislikes, and personal routines. The more information care workers have, the easier they will find it to engage with your loved one and help them to adapt.
• Most care homes fully encourage a resident’s family to get involved in the home. You might be able to join in a mealtime or activity, which might help your loved one to feel at ease in those early days.

Be prepared that your loved one’s preferences may change after they move in; they might take up a new hobby or start eating different foods. They may also seem lonely or stressed. This might be a temporary phase, but it’s a good idea to discuss this with the care home staff and see if there is a way you can help them to settle in.

A new way of life

"It seems to be going well. Dad seems quite content and doesn't ask to go home. Although he has outbursts of challenging behaviour and sometimes something might happen and he's clearly not happy, for the most part he seems happy and he's well-fed and safe "- Susan

Once your loved one has settled in, you can continue to be involved with their care if you want to be. Keeping up regular communications with the care home will hopefully help to reassure you and ease any worries you may have. Moving into a care home may take some adjustment but try to focus on the positive changes for both of you. Remember that you are still an important part of your loved one’s life. Many people find that taking a step back from day-to-day care means they have more opportunity to relax and enjoy quality time spent with the person who has dementia.