Care Homes: When Is The Right Time And Who Decides?

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This information is for carers, friends and family who are considering care options, including going into a home, for a person with dementia. It explains how to identify when someone needs to move into a care home, and when at home support is more appropriate.

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Care homes: when's the right time and who decides?

1. You are here: Care options: When is the right time to move someone into care?
2. Care options for a person with dementia
3. The costs and benefits of moving to a care home
4. Who makes the decision to move a person with dementia into a care home?
5. Support if you're struggling with decisions relating to care

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When should a person with dementia move into a care home?

Each person’s situation is different, and there isn’t a time that's right for everyone. Often, a person will move into a care home because it's no longer possible for them to receive the right level of care where they currently live. This could be for many reasons, such as:

• The person with dementia is no longer managing at home as well as they used to. For example, they are no longer able to do daily tasks, like eating, without the support of another person.
• The person is no longer safe at home. For example, they keep having falls. This is likely to affect how well they can continue living at home, for instance if they have to use stairs to get to parts of the house. If the person doesn’t feel safe at home, this can also affect their confidence and cause anxiety.
• Something unexpected happens that means the person with dementia can no longer be cared for at home. For example, the person’s carer becomes ill and is no longer able to care for them as they did before.
• The person’s needs change after a stay in hospital and they now need continuous care, day and night. The person with dementia may also have health issues that can’t be managed at home.
• The person’s needs become too challenging for others to manage at home. Family or friends may not be able to provide the level of care that the person needs at home, or they may feel unable to cope.

In situations like these, the person will need more support. It is likely that they will have to move into a care home in order to access the level of care they need.

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. The following pages provide 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.

Finding the right care home

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.

Read the booklet

Can a person with dementia stay at home?

Staying at home is the preference for some carers and people with dementia. Remaining at home but with extra support can be a good option for some people with dementia. It allows them to stay in a place that feels familiar and safe to them.

It is important to make sure that the person can remain safe and well and get the support they need at home.

If they’ve not already had a care needs assessment, this is a good place to start. This will show what care they need and what support is available to them. If you are the person’s carer, you can also get a carer’s assessment.

These are provided by the local authority in England and Wales. In Northern Ireland, they are provided by the health and social care trust. They must be provided free of charge, no matter what the person’s financial situation.

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Making your home dementia friendly

Read a booklet about practical ways to make your home more dementia friendly.

Read more

Supporting the person at home

In some cases, the person’s needs can be managed at home with additional help. If you are considering this, it can be useful to follow these steps:

1. Talk to the person and make a list together of what more support they need. You should also include anything that you are finding difficult to manage as their carer.
2. Think about possible solutions you can try to help them with. If you’re not sure where to start, consider the following options:
   • Check if the local authority or trust offers any services that you can use.
   • There may also be other organisations that can offer support. For example, some private providers offer respite sitting services and day care options.
   • Some charities may offer support groups for carers or people with dementia.
   • Speak to local carers to find out what’s available near you, or use our online directory.
3. You may have to try a few different solutions before you find an option that works for you and for the person with dementia.
4. If you’ve still got concerns, you will have to consider carefully whether the benefit the person gets from staying at home outweighs the risk.

Possible issues when a person stays at home

Incontinence – It's common for people to have more difficulties using the toilet as they get older, particularly if they have dementia.

Aggression – A person with dementia may sometimes behave in an aggressive way. This may be caused by pain, discomfort or infection.

Walking – Some people with dementia may start repeatedly walking around the home or leave the house.

Forgetting to take medicines – If the person with dementia has memory loss, they may forget to take their medicines.

Issues with eating and drinking – Common symptoms of dementia can make eating and drinking difficult too.

Safety concerns – People with dementia may forget to turn electrical equipment or the oven off. They may be at risk of falling over at home, especially on the stairs.

You should ask yourself, first and foremost, what is in the best interests of the person in your care? If you feel you can no longer provide all that the person needs to help them live well, then it may be better for them to move somewhere where professional care staff can do this.

You may find it difficult to make this decision, seeing both advantages and disadvantages to each option. If you’re struggling, don’t worry – it’s normal to feel confused or unsure.

Getting homecare for a person with dementia

One way of getting extra support at home is by arranging for other people to help the person with specific tasks. This could be a cleaner, gardener or a professional carer.

This can work well if the person needs help around the home with particular aspects, or if they can get support from family members and friends at other times.

Another option for homecare is hiring a personal assistant (PA). This may be especially suitable if the person has young-onset dementia.

A PA can give more flexible support than traditional care arranged through social services. For example, they can help people keep up with hobbies and access community services, such as social groups and courses.

Skills for Care has a range of guides to help you recruit and manage a PA.

You may be able to get funding for a PA through direct payments from the local authority. Speak to the person’s social worker about this.

The person with dementia could also get ‘live-in’ care. This is where a paid carer moves into the person’s home to provide care during the day and at night.

Employing professional carers can be expensive. The local authority or trust may contribute to the cost, but it won’t usually cover care at all times of day and night. You may be able to arrange carers through a private agency, but this won’t be affordable for many people.

Having full-time professional carers at home can be confusing for some people with dementia. It can also affect what ‘home’ feels like for the person and anyone who lives with them. It may not be the right option for some people.

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