When should someone with dementia go into a care home in the UK?

With approximately 982,000 people living with dementia in the UK, deciding when someone with dementia should go into a care home is one of the most difficult decisions a family can face. It is a highly personal choice, often made when a person's safety or care needs can no longer be met effectively at home.

Quick Summary

The decision to move a person with dementia into a care home often depends on safety concerns, the increasing complexity of their care needs, and the capacity of family caregivers. Recognising the signs of progressing dementia and understanding the available support options are crucial steps in this process.

Key Points

• Safety First: The decision often hinges on safety, especially if the person with dementia starts wandering, has frequent falls, or mishandles household tasks or medication.

• Consider the Caregiver: Caregiver burnout is a serious issue. When the physical and emotional demands of providing 24/7 care become too much, it's a sign that residential care is needed.

• Explore Alternatives: Before committing to a care home, investigate home care visits, day centres, and respite care as potential interim solutions.

• Legal and Financial Planning: Understanding the Mental Capacity Act, Lasting Power of Attorney, and how financial assessments work is crucial for navigating the UK system.

• Choosing the Right Home: Look for specialist memory care units within a care home, focusing on staff training, security, activities, and how they handle complex behaviours.

• Plan the Transition Carefully: To make the move smoother, involve the person with dementia, personalise their new space with familiar items, and maintain open communication with the care home staff.

Recognising the Signs: Is Home Care Still Safe?

For many families, the safety and wellbeing of their loved one is the primary factor driving the decision for residential care. While home modifications and increased home care can help for a time, certain signs indicate that staying at home may no longer be safe.

Escalating Safety Risks

As dementia progresses, cognitive decline can lead to dangerous situations that are difficult to manage at home. Watch for signs such as:

• Wandering: Getting lost in once-familiar neighbourhoods or leaving the house unsupervised poses a significant risk. According to the Alzheimer's Association, 60% of people with dementia will wander at least once. A secure care home environment can prevent this.
• Falls and Mobility Issues: An increase in trips, stumbles, or falls can indicate a decline in mobility and coordination. Falls are a major safety concern for the elderly, and a care home provides 24/7 supervision to minimise risks.
• Neglect of Personal Hygiene: A noticeable decline in personal care, such as forgetting to bathe, brush teeth, or change clothes, can lead to health complications. This often indicates a need for more consistent, hands-on support.
• Unsafe Household Management: Forgetting to turn off appliances like the hob, leaving taps running, or mishandling household chemicals are clear red flags. These lapses in judgment endanger not only the person with dementia but also anyone they live with.
• Medication Mistakes: Improperly managing medication, such as forgetting doses or taking the wrong amount, can have serious health consequences. Care homes have trained staff to ensure medication is managed correctly.

The Emotional and Physical Toll on Carers

Many people with dementia are initially cared for by a partner or family member. While this is often sustainable in the early stages, the demands on the caregiver can become physically and emotionally overwhelming over time. This is commonly known as caregiver burnout, and it can affect the health of both the caregiver and the person with dementia.

Recognising the signs of burnout is crucial for knowing when residential care might be the right step. These signs include:

• Exhaustion: The round-the-clock nature of dementia care can be physically and mentally draining.
• Resentment: Feeling resentful towards the person with dementia for the demands of caregiving.
• Consistent Stress and Anxiety: The constant worry about safety, medication, and overall wellbeing can lead to chronic stress.
• Neglect of Personal Health: Prioritising the person with dementia's needs over your own health is a common consequence of burnout.

Exploring Care Options Before Residential Care

Before moving to a care home, it's essential to explore all available alternatives. A care needs assessment, conducted by the local council's Adult Social Services, can help identify what level of support is required.

Alternative options can include:

1. Home Care Visits: Paid carers can visit the home to assist with personal care, meals, and other tasks. This is suitable for those with less complex needs.
2. Day Centres: These provide a safe, social environment for people with dementia during the day, offering structured activities and giving family carers a vital break.
3. Respite Care: A temporary stay in a care home allows the person with dementia to be cared for by professionals while the family carer has a planned break.

Comparing Care at Home vs. a Care Home

Feature	Care at Home	Care Home
Environment	Familiar and comforting	Structured, secure, and potentially unfamiliar
Level of Care	Can be tailored but often limited hours; relies on family	24/7 specialist care and supervision from trained staff
Cost	Varies widely based on hours and services; can become expensive for 24/7 care	All-inclusive fees, with potential for local authority funding
Social Interaction	Can lead to isolation; depends on visits and outings	Built-in community, social activities, and engagement
Safety	Requires modifications and careful monitoring; risks include wandering and falls	Secure environment specifically designed for dementia residents

Navigating the Decision-Making Process in the UK

Making this move is a significant legal and emotional process. It is best to involve the person with dementia in these discussions as early as possible after diagnosis, while they still have the mental capacity to express their wishes.

The Mental Capacity Act and LPAs

If the person with dementia no longer has the mental capacity to make their own decisions, the Mental Capacity Act 2005 applies in England and Wales. The Act's core principle is that any decision made on behalf of an individual must be in their 'best interests'. This process should involve consulting with family, friends, and health professionals.

A Lasting Power of Attorney (LPA) for Health and Welfare is a legal document that allows a trusted person to make decisions about care and medical treatment on their behalf. Establishing an LPA early can make this process smoother and ensure their wishes are honoured.

The Financial Assessment and Funding Care Homes

Once a care needs assessment confirms that residential care is the best option, a financial assessment (means test) is carried out by the local council. This determines if the council will provide funding towards the care home fees.

• Self-funding: If capital (savings, property, etc.) exceeds £23,250 in England (£24,000 in Wales), the individual will likely have to pay their own fees until their capital drops below this threshold.
• Local Authority Contribution: If capital is below the threshold, the council will contribute, with the individual contributing from their income and a 'tariff income' from capital between £14,250 and £23,250.
• NHS Continuing Healthcare (CHC): Some individuals with a 'primary health need' due to severe, complex, and unpredictable needs may be eligible for full funding from the NHS, regardless of their financial situation.
• Top-up Fees: If a person chooses a more expensive care home than the council is willing to pay for, a third party may need to cover the difference.

Choosing the Right Care Home with Memory Care

Selecting the right care home is vital for a successful transition. Not all care homes are the same, and those with specialist memory care units are best equipped to handle the complexities of dementia.

When visiting potential homes, ask key questions:

• Is the unit secure to prevent wandering?
• What specific training does the staff receive in dementia care?
• What is the staff-to-resident ratio?
• What daily activities and programs are offered for cognitive stimulation?
• How do they handle challenging behaviours?
• Can residents bring familiar items to make their room feel like home?
• How is family involvement encouraged?

Making the Move: A Guide to a Smooth Transition

Transitioning to a care home can be stressful for both the person with dementia and their family. Planning ahead can minimise disruption and anxiety.

• Prepare the Environment: Involve the person in choosing and packing familiar belongings. Decorating their new room with photos, favourite blankets, and familiar furniture can provide comfort.
• Maintain Routine: Inform the care home staff of the person's daily routines and preferences. Consistency helps a person with dementia feel safe and secure.
• Stay Involved: Regular visits and communication with the care home staff are crucial. Your involvement provides reassurance to your loved one and helps ensure their needs are being met.

Conclusion

Making the decision to move a loved one with dementia into a care home in the UK is a multifaceted journey guided by safety, the level of care required, and financial considerations. It often becomes necessary when home care can no longer safely or effectively meet their increasing needs or when the burden on family carers becomes unsustainable. By recognising the signs, exploring all options, and navigating the legal and financial aspects with care and planning, families can ensure their loved one receives the best possible support in a suitable environment. For further information on navigating care options and planning ahead, visit the Alzheimer's Society website.

Frequently Asked Questions

At what stage of dementia should someone go into a care home?

There is no specific stage for moving into a care home; it depends on the individual's needs. Typically, it becomes necessary in the moderate to later stages when a person requires round-the-clock supervision for safety and can no longer manage daily tasks like eating or hygiene.

Can a person with dementia be forced to go into a care home in the UK?

No, a person with dementia who has mental capacity cannot be forced to move. If they lack capacity, a decision must be made in their 'best interests', usually involving family and medical professionals under the Mental Capacity Act.

What is a care needs assessment?

A care needs assessment is a free evaluation by your local council's Adult Social Services to determine the level of care and support a person with dementia requires. This is the first step towards accessing council funding for care.

Will I have to sell my house to pay for care home fees?

Not necessarily. In England, the value of your property is excluded from the financial assessment if certain people (like a spouse) still live there. However, if you are a single person without protected occupants, the property value can be included once you have been in care for 12 weeks.

What is NHS Continuing Healthcare (CHC)?

NHS CHC is a package of care funded by the NHS for individuals with significant and complex health needs. Eligibility depends on a strict assessment and is not guaranteed simply by having a dementia diagnosis.

What are 'top-up' fees for care homes?

If a local council is funding your care but you choose a care home that is more expensive than their standard rate, a third party (like a family member) must pay the difference. This extra payment is known as a 'top-up' fee.

How can I make the move to a care home easier?

To ease the transition, involve the person in the decision-making process where possible. Personalise their new room with familiar items, communicate their routines to staff, and visit frequently to provide reassurance.