How to choose a care home for someone with dementia

Choosing a care home can be an exciting, daunting and lengthy task. It is a highly personal journey to find a care home that suits your desired location, care needs and finances as well as giving you the quality of life you desire in a permanent home.

For families choosing a care home for a loved one with dementia, this comes with different challenges. Many people living with dementia do not understand that they have the condition and moving away from a home they’ve lived in for a long time can be confusing for them. However, care homes are often the perfect place for people with dementia, providing a safe, sociable environment with round-the-clock care.

You can read David’s story of what it is like having a partner with dementia living in a care home.

What care does your loved one need?

If you’re considering a care home for your loved one, it’s likely because they are struggling with day to day life in their own home. Different types of dementia affect people differently, but it is a progressive illness. You could speak to their doctor about the types of care (such as personal or nursing care) that the right care home will need to offer, for now and in the future.

Your local authority can conduct a care needs assessment, which is free, to give you an idea of what to look for.

Also think about their needs according to their personality. Are they a very sociable person who would be happy in a larger home or more introverted and prefer a close-knit, family environment? Are they independent and would like to be able to pop out to local amenities or would they prefer a quiet place in the countryside?

Some care homes specialise in dementia care and are registered for that as a special category. You can use the Advanced Care Search on this website to search for homes that accommodate Registered Care Categories.

What is your budget?

Most people move into a care home on a permanent basis so finding one that is financially sustainable is essential.

If your loved one has already had a means test, you will likely be aware of their budget. If not, you can contact your local council, who will arrange a means test free of charge. This is an assessment of your loved one’s capital to decide whether they qualify for local authority funding, partial funding or if they will have to pay privately. You can also see if they are eligible for NHS Continuing Healthcare Funding, as people living with dementia sometimes are.

If they have to pay privately, you will need to work out their budget. This can include their savings, their income and any money that can be generated from their assets. Much of this will have been calculated in the means test, but you’ll need to decide how to use the money, such as whether to sell their home and use that money towards their care. It is important to talk about Power of Attorney early in life because if your loved one’s dementia means that they don’t have the cognitive capacity to make these decisions for themselves, it will be too late to arrange that.

Find out more about care fees.

Searching for care homes to view

You can search for care homes via the care search on this website. You search using a map view, or using advanced requirements such as registered care categories or care home size.

On each care home’s profile, you can find information about the home, look at its reviews and email the home directly or get their phone number to arrange a viewing. Due to the COVID-19 pandemic, many care homes are now offering virtual tours of their homes.

You can also access each care home’s latest Care Quality Commission (for England), Care Inspectorate (for Scotland) or Care Inspectorate Wales report (unless they are a new home and have not been inspected yet) for further information about the standard of their care. 

Viewing care homes – what to look for

June Andrews is a Fellow of the Royal College of Nursing, a Professor Emeritus in Dementia Studies and an international dementia specialist adviser. She has used her expertise and experience to write a complete guide to choosing the best care home for your loved one, Care Homes: The One-Stop Guide.

Her essential checklist when viewing a care home includes:

Access road and neighbourhood

Professor Andrews says that the very first aspect of a home is a welcoming and well-kept front or access drive. 

She notes the advantage of your loved one moving to a care home that is in their usual neighbourhood, is they know their way around, know the locals and friends can visit easily and regularly. This applies if they are in poor health, as Professor Andrews explains: “If at the time of going into care the person is confined to a room or bed for health reasons, the most important thing to consider is how close the home is to the people who are most likely to be making frequent visits … Also make sure the room has a windowsill low enough to see outside.”

If it is not possible to live in their usual neighbourhood, finding a pleasant and accessible new neighbourhood is very important. Professor Andrews says: “Being able to post a letter or go to the local doctor’s surgery keeps life normal.”

Car parking

Sufficient car parking is important for visitors and for safety reasons. Too many cars in too small a space could block ambulances or other emergency services from accessing the home. Professor Andrews notes that building guidance, “suggest one space for a doctor, one for every three members of staff, and space for lorries and ambulances.” She advises checking whether there is parking in the surrounding area too.

Gardens

Professor Andrews stresses that the most important reason a care home should have a good garden is health. “The exercise from walking or working in a garden helps with every physiological function  (including constipation, the bane of older people) and exposes them to daylight. Daylight allows your body to manufacture Vitamin D.” This, in turn, helps people to sleep and to, “cheer people up and improve their appetite.”

Many care homes describe having a ‘sensory garden’, designed to stimulate residents’ senses, which can be very beneficial for people living with dementia. Professor Andrews says that while this is a positive idea, it’s important to make sure that the gardens really do provide stimulation and activity for residents to get involved with.

When exploring a home’s garden, she suggests you look for:

• An area for residents’ gardening. If this includes a vegetable patch, produce of which can be used in the kitchen, all the better.
• A washing line for residents to hang their laundry.
• “Something to play about with, such as an old car or a boat. A play area for children, a place to let the dog off the leash and proper seasonal planting, might give a sense of movement and activity.”
• Accessibility. A well-designed roof garden that residents can come and go from at their leisure is better than a large but bleak garden that nobody uses.
• A toilet close to the garden.
• How the home supports people to get out in the fresh air. Do they have regular activities outside, such as a gardening club, exercise classes or barbecues in the summer?
• If your loved one smokes, where can they go to do this? Is there a shelter and heater there for the winter?
• Are there any pets that the residents can get involved in looking after? Do any residents have their own pets?

Entrance

The entrance “sets the tone”. Is the door locked unnecessarily? Is there a friendly and welcoming person at the front desk to open the door immediately when visitors arrive? Can they answer questions about the home or are you left to rely on a wall covered in signs to find out about activities and mealtimes?

Common areas open to the public

Areas of the home that are open to the public are good for the business but also a great way for the care home to integrate with the local community. If the care home you are viewing has a public space, check that it is:

• Visible and accessible from the street
• Authentic. Many homes have nostalgic-looking communal areas to help people with dementia, but the best are authentic. Is there a real sweetshop behind the sweetshop front? Can you really get a drink at the bar in the pub?

Dining area

Professor Andrews clarifies: “The aim with older people is usually to overcome their small appetite, and it’s desirable for them to eat as much as possible.”

For this reason, an ideal dining area in a care home should:

• Be divided into smaller, more intimate areas so that no more than 12 people are eating together.
• Long mealtimes.
• Properly laid tables: “tablecloth, napkins, condiments, place settings, water jugs, glasses and perhaps menu cards.”
• Light from the windows and artificial light over the tables so residents can read the menus and see their food.
• Clear and contrasting colours between the floor, tablecloth and plates, to help older people see what they are doing more clearly.
• Dining-themed decoration.
• Most of all, it should be quiet, as, “Noise is said to be as disabling for people with dementia as a stairway is for someone in a wheelchair.”
• A place where someone can eat alone if they wish. Residents should also have the option of eating in their rooms.

Communal spaces

A range of communal spaces is ideal in a care home. Many homes feature cinemas, hair salons and even bars.

Even if the home is small and only has a lounge area, it shouldn’t have the television on all the time. There should be a separate room designated for a large TV, where residents can watch televised events and films as a social activity.

There should also be a room for crafts and activities so that residents can take their time on what they’re doing without having to clear it away the same day.

Access corridors

Are the corridors brightly lit? Is there something for frail people to hold when they are walking from room to room? Are there chairs they can rest on? Is each door easily distinguishable from the other doors around the home?

Shared bathroom

Is the bathroom clean and welcoming at all times? Bathrooms should not be used as storage areas for hoists and wheelchairs. What does it feature that will benefit residents? How is their privacy and dignity protected when using the bathroom?

Personal space and bedroom

Each bedroom needs to be somewhere that your loved one could feel safe, relaxed and at home. Some questions to ask are:

• How big is it? There should be at least 20 square feet of useable floor.
• Is it easy for them to turn on the light in the night if they need the toilet?
• How do residents call for assistance? Professor Andrews says: “In homes where the nurse call system is very loud, it is worth checking that residents will not be disturbed by it, when trying to relax. A silent call system is easy to provide and keeps stress levels down. Some homes have movement sensors in the rooms and on the bed.”
• Can they personalise their bedrooms? How much decoration are they allowed? Some other residents may like to show you how they’ve personalised their rooms.

En-suite facility

Homes are now required to provide an en-suite sink and toilet for each resident. Is the toilet easily visible in the night? If there is a shower, are the controls simple and easy to use?

Professor Andrews suggests: “The best care homes offer an en-suite wet room,  because there may be times when the resident gets into a situation such as an episode of incontinence, or reaches a stage of frailty where they need help with personal hygiene. It is better to have that in the support and privacy of your own room.”

Security

Safety and security for people with dementia is of paramount importance, but not in the way you might think. Professor Andrews explains: “There is a widely shared belief that going to a care home always means being ‘locked up’. That’s not true. Confining people is illegal, unless they have committed a crime or been detained under mental-health legislation.”

Because some people in the home may need to be locked in due to mental-health legislation, homes should have technology such as coded doors or key fobs so that only those who must be restrained are. Other residents should be able to come and go, and restraint measures should be minimal and last only as long as they are needed.

Noise and light

Because noise and light can be distressing and disorientating for someone living with dementia, there should be no unnecessary noise or light, particularly at night.

Smells

Care homes should rely on good ventilation rather than aerosols to clear out bad smells.

June Andrews’ book, Care Homes: The One Stop Guide, goes into much more detail about finding a care home, exploring how they work and what life is like in them. The book is published by Profile Books Limited and available to purchase here.