When is the right time for someone living with dementia to go into a care home?

When should a person living with dementia go into a care home?

Making a judgment about when a person living with dementia is in need of residential care can be a difficult and emotional step for their loved ones, but understanding the factors which necessitate this move can enable more confident decision-making.

Many families are keen to care for their loved one at home in a familiar environment for as long as possible. However, as dementia progresses, it is likely that the person is going to need some kind of more specialist care.

It may become clear that someone living with dementia can no longer be safe and comfortable while living independently. For example, if they are struggling with everyday tasks such as cooking, cleaning or bathing and dressing themselves.

Since dementia most often affects older people, it may also be accompanied by other physical deteriorations, and incidents such as hospital admission may create a compounded need for a higher level of care.

While it can be possible for loved ones to care for a person living with dementia and help to calm them down when they are feeling anxious or becoming agitated, there are usually limits to how much family and friends are able to do, especially as the individual’s symptoms worsen and their needs become more complex. When caring for someone at home starts to become unsustainable and too much for their loved ones to cope with, it is wise to begin considering professional care options such as a residential care home.

Who decides when it’s the right time for someone with dementia to go into a care home?

The ability of patients to make their own decisions about going into a dementia care home can vary depending on their cognitive and decision-making capacity. Here are the varying levels:

1. Full decision-making capacity: Some individuals with early-stage dementia may still have the ability to make informed decisions about moving into a care home. They can express their preferences and provide informed consent. In such cases, their decisions should be respected.
2. Partial decision-making capacity: In the middle stages of dementia, individuals may have reduced decision-making capacity. While they can contribute to the decision-making process, they may not fully grasp all aspects, and family or legal guardians may be involved.
3. Limited decision-making capacity: As dementia progresses, individuals may have limited capacity to make decisions, especially complex ones like choosing a care home. They may rely on family or legal representatives to make the final decision in their best interest.
4. Incapacity: In advanced stages of dementia, individuals may lack the capacity to make any decisions, including where to receive care. In such cases, decisions are made on their behalf by family members, legal guardians, or healthcare professionals, prioritising their wellbeing and safety.

It’s essential to involve individuals with dementia in the decision-making process to the greatest extent possible while also considering their safety and best interests. That said, legal processes and established protocols may be necessary when individuals cannot make this critical decision.

At what point do dementia patients need 24-hour care?

The round-the-clock care that residential homes can provide for people living with dementia may become more and more valuable and necessary as it becomes harder to guarantee their well-being at all times.

Dementia can cause someone’s behaviour to become unpredictable and difficult for their loved ones to manage. Sometimes dementia patients actions can make it extremely hard to guarantee their safety at all times, for example, if they tend to wander out of the house and get lost during the night, so 24-hour care may become necessary.

As their symptoms progress, it may become impossible for a person with dementia to take care of their own physical well-being all the time while they are living at home. For example, if someone needs to take regular medications to maintain their physical health. but because of their dementia, they may forget to take it.  Whilst their loved ones cannot be around at all times to ensure they take it this can present a serious challenge. 

The impact caring for someone with dementia can have on their loved ones can also make it necessary to seek 24-hour care. Dementia may make it very difficult for someone to move around, get dressed, go to the bathroom, or wash and it may not be possible for caregivers to help them do these things at home. These needs can occur at all times of day and night, and often it isn’t possible for someone to be present at all times. It may also be too physically challenging for a spouse or family member to be continuously helping their loved one move around.

Benefits of a care home for dementia patients

When a dementia patient’s situation becomes too difficult to manage at home, full-time specialist dementia care can allow them to receive the support they need from professionals who understand how to help them and are available at all hours of the day and night. Some of the vital services a care home can provide for dementia patients include:

• Round-the-clock supervision to guarantee their safety, so that any risky behaviours, such as wandering off or failing to take medication, can be managed, giving families greater peace of mind.
• Clean and comfortable surroundings with adaptations for wheelchair users and people with mobility issues, plus regular meals planned to fulfil their nutritional needs.
• Staff who understand dementia - are knowledgeable about caring for people living with the condition, and are able to deal with associated behavioural challenges.
• The ability to socialise with other residents, rather than risking becoming socially isolated at home.
• Quality time with loved ones, who are able to relax while visiting, plus the ability to join activities together rather than providing care.
• In some care homes - specialised dementia care, including music and art therapy, memory aids and exercises together with emotional support for both residents and their families.

What should you consider before making a decision about moving someone into a care home?

• It is always best to involve the person who is living with dementia as much as possible in decisions about their care. It is important to consider how capable they are to make good judgments about their own needs and to participate in making choices.
• It can be helpful to contact your local authority social services to arrange a care needs assessment and get an outside opinion on what kind of care your loved one needs. Getting a neutral, professional opinion can help you make an informed decision and leaves less room for disagreements.
• Since care - both in care homes and home care packages -  can be expensive, it is useful to get a financial assessment, which can be done alongside a care needs assessment. This allows you to find out whether you qualify for any financial assistance and may help guide you in your decisions.
• If you decide to move a loved one into a residential home, you’ll want to choose the right one for them, where their needs will be met and they can have the best possible quality of life. This will mean considering whether they need a care home or a nursing home, and whether you need to find a home able to cater for someone living with dementia.
• When moving someone into a care home, it is also worth considering how their loved ones will manage them being there. For example, is it close enough to allow frequent visits, and do the staff help residents stay in touch with their family and friends online or on the phone.

Signs that someone with dementia needs full-time care

Recognising when someone with dementia requires full-time care is essential for their safety and wellbeing. Here are the signs to look out for:

• Wandering: Frequent, uncontrolled wandering, especially in unsafe areas or at odd hours, can be a danger to the individual.
• Loss of mobility: When dementia leads to a significant decline in mobility and the person struggles with daily tasks or is at risk of falls.
• Caregiver burnout: If family caregivers are physically or emotionally exhausted and unable to provide adequate care, it may be time for full-time care.
• Safety concerns: When the person’s forgetfulness or confusion results in neglecting personal hygiene and nutrition or engaging in risky behaviours.
• Behavioural changes: Severe agitation, aggression, or hallucinations that are challenging to manage at home.

These signs often indicate the need for a care facility or full-time in-home care to ensure the person’s safety and wellbeing.

Can a person living with dementia refuse care?

Individuals living with dementia can sometimes be reluctant to accept offers of help, or may not understand why they need a higher level of care. This might be because their condition is affecting their ability to see their situation clearly or is causing them to forget the problems they have had while living independently, or it might be because they feel ashamed or anxious about needing more intensive care. 

It is important to try and keep people as involved as possible in their own care, and to respect them and their right to make decisions about what’s best for them as far as they are able. The first step when care is refused should always be to try to listen and understand the person’s reasoning and to provide the clearest possible explanation as to why you think the care is needed. Getting an external professional opinion can often be helpful, as it can validate your suggestions and help persuade your loved one to accept help.

Sometimes you may be able to identify the feelings your loved one is experiencing which are causing their refusal. For example, they might be scared about not having privacy in a care home or worried that they might be given medication with unpleasant side effects against their will. Knowing this can put you in a better position to address their concerns and perhaps put measures in place or reach a compromise that makes everyone feel more comfortable and ensures they get the care they need.

Sometimes, dementia can cause patients to lose the capacity to make rational and informed decisions about their care. Someone can only be judged to have lost capacity when they have been given all the means to be able to make good choices, but are unable to use them in a reasonable way. Under these circumstances, a refusal of care might be overridden.

Sometimes, a dementia patient may have assigned a lasting power of attorney (LPA) to someone they trusted while they still had the capacity to do so, in which case, that individual can make a decision on the patient’s behalf. If there is no LPA, then medical and care professionals can step in and make decisions in the person’s best interests. These will be based on the preferences they expressed when they did still have capacity, and on information provided by family members and carers.

To better understand how a care home can support the needs of those requiring care and to enquire about a dementia care home within The Fremantle Trust contact us today.

We have dementia care homes located across the Buckinghamshire county. Learn more about care homes nearest to you:
Dementia care Aylesbury
Dementia care home Princes Risborough
Dementia care home Chalfont St Peter
Dementia Care home in Amersham
Dementia Care homes in Slough
Dementia care home Chesham
Dementia care home Stoke
Dementia care Burnham 
Dementia care High Wycombe
Dementia care Marlow