When should you consider a care home?

Posted on: 11/25/2021

If you can no longer live independently at home, moving to a care home might be the answer. We look at the the pros and cons of moving into a care home, and what to consider before making the decision.

When should you consider a care home? 

A move into a care home is a big step. Many people only consider it when other care options have been exhausted or are no longer suitable. But if residential care provides greater benefits for the individual than any other available option, then it’s often the right choice. 

Some typical situations when it might be time to consider residential care: 

• When an older person is struggling to live alone, even with the help of carers, friends or family.  
• If they have recently suffered a significant deterioration in their health or mobility, caused by an illness or a fall. 
• If they need extensive support and supervision to live safely and comfortably, and this can no longer be provided at home by family and/or carers. 
• When someone’s home is no longer a suitable environment in which to have their care needs met. 
• When a social care needs assessment indicates that a care home is the best place for you to live, following a fall or a stay in hospital, for example. 

Residential care homes provide living accommodation with 24-hour support and supervision, including help with personal care needs, meals and social activities. Nursing homes provide all of the above services, plus on-site medical care from a registered nurse.  

Signs that you might need residential care 

If one or more of these situations is a cause for concern, it might be time to consider residential care. 

• Daily living - If someone is struggling with personal care or daily tasks, such as washing, going to the toilet, getting out of bed, cooking or eating meals, or keeping the home clean and comfortable. But before opting for a care home, consider whether these tasks could be managed by domiciliary care visits and/or help from family or friends. 
• Safety - If someone can no longer live safely at home because of illness, frailty or dementia – for example, if they’re at increased risk of falls, or at risk of malnourishment because they’re not eating properly. Is their home a safe and suitable environment? If not, consider whether home adaptations could address these issues before considering residential care. 
• Memory problems - If someone is becoming confused or disorientated. This could include leaving the house at unexpected times, allowing strangers into the home, or leaving the water running. 
• Health needs - If someone requires intensive support for health or mobility needs, including managing essential medication. If specialist nursing care is required, then a registered nursing home might be the best option.   
• Quality of life - If someone is feeling intensely lonely and isolated at home, perhaps missing the company of a partner or friend who has passed away, moving to a care home might provide much-needed social contact and a sense of community. 
• Care support - If you’re the main carer for a vulnerable older person, but you feel overwhelmed and no longer able to provide adequate support, then residential care might be the next step. 
• Needs assessment - A social care needs assessment might indicate that moving into a care home is the best way to meet an individual’s needs. 

How will I know when it’s the right time for a care home? 

The decision to move into a care home is rarely straightforward. There are no fixed rules that tell you when is the right time to take this step. The decision should be based on an individual’s needs and circumstances. 

For some people the need for residential care might happen quickly, because of a sudden illness, fall or a bereavement. Others will experience a gradual increase in their care needs before residential care has to be considered. 

Despite what other people might tell you, don’t assume that a care home is the only option when an older person needs extra care. Solutions such as home adaptations, care at home or sheltered housing can be suitable support options, which can help someone to maintain their independence for longer. 

When should someone with dementia go into a care home? 

Getting a dementia diagnosis does not automatically mean that someone will need to move into a care home. With the right support and planning, they should be able to continue living at home for as long as possible. However, a care home may eventually prove to be the best option, especially in the later stages of dementia, if they need 24-hour supervision and support to stay safe and comfortable.  

Three key things to consider if you’re thinking about a care home for someone with dementia:

1. Try to start the conversation with your loved one as early as possible about their future care needs. Try to do this while they have the mental capacity to be involved in the decision. Encourage them to set up a power of attorney as this will enable you to make important decisions on their behalf if they lose the capacity. 
2. Get a needs assessment for your loved one from their local authority. This should recognise their dementia-based needs and recommend suitable care options. 
3. Before choosing a care home, ensure the home is registered to provide specialist dementia care. Ask some key questions to find out how well equipped they are to support your loved ones needs.  

Questions to ask before choosing a care home for someone with dementia:

• What training have staff received for dementia care? Is there a dedicated dementia care unit? 
• What specialist facilities or activities does the home offer for people with dementia, such as reminiscence therapy, a memory cafe or a sensory room?   
• Can you arrange a meeting with an experienced dementia carer to talk about their approach?  

The Alzheimer’s Society provides more guid ance on arranging care for someone with dementia. 

Making the decision for someone else 

Whenever possible, an individual should be involved in decisions about their own care. But inevitably, the decision to move into a care home often needs to be made by a family member or relative.  

It can be a difficult decision to make, and often involves feelings of doubt and guilt. There’s still a stigma associated with ‘putting Mum/Dad into a home’. But when it is appropriate for someone’s needs, the decision to move into a care home can be the best possible solution. 

Here are some pointers to help you approach a decision about a loved one’s care: 

• Even if you feel responsible for the decision, always try to discuss the options with your loved one first. If they are able to be involved in the decision, this can make the process less distressing for everyone.  
• Be positive about the move. Explain why it’s important and highlight the benefits for your loved one.  
• Try not to rush the decision, if possible. Reassure your loved one that they will only have to move to somewhere that’s right for them. 
• Get a needs assessment for your loved one – this will support you in making the best decision. Ask for a reassessment if circumstances have changed since the last time they were assessed.  
• Be realistic. Remember that there is no ‘ideal’ answer. Focus on taking the best available decision based on your relative’s needs and circumstances. 
• Does your loved one have the mental capacity to make decisions about their own care? If not, have they previously given lasting power of attorney (LPA) to you or someone else? A Health and Welfare LPA enables you to make decisions about someone’s health and care, including whether they need to move into a care home. A Property and Financial Affairs LPA empowers you to make financial decisions such as selling their property if required. 
• Focus on your loved one’s best interests, but also think about the impact of the situation on yourself and other family carers. For example, is being a full-time carer putting a heavy strain on you or someone else? Is it creating pressures for your own family or career? Does your loved one have a partner who is struggling to cope themselves? The interests of everyone involved should be considered in the decision. 

It’s quite common that an older person will be opposed to the idea of moving into a care home. Naturally, they might worry about losing their independence or feeling abandoned. Despite this, once they get used to their new surroundings, many people find that life in a care home is better than they had imagined, and brings noticeable improvements for their health and quality of life. 

Pros and cons of care homes 

If your loved one’s needs can no longer be met at home, there are benefits to moving to a care home, although there can be downsides, too. Knowing what to expect can help you to make realistic decisions. 

The benefits of living in a care home 

• Safety - There’s always someone around. Staff on duty 24/7 - In a residential care home, someone is on call at night. In a nursing home, medical care from a qualified nurse is available 24 hours a day. 
• A room of your own - Residents can usually personalise their room with their own furniture, pictures and ornaments. 
• Meals - Regular meals are provided and nutritional needs met. 
• Companionship - There are opportunities to socialise with others of a similar age and take part in organised activities. 
• Peace of mind - Family members will know that their loved one is being taken care of and not living alone. 
• Supervision of medication - It’s reassuring to know that medication routines will be monitored and managed. 
• Stress-free - No worries about household bills, cleaning or upkeep. 
• Better living conditions - The physical environment might be better – safe, warm and clean. 

The potential drawbacks of a care home 

• Cost - Care home fees can be very expensive, particularly when someone has to fund their own care. To access local authority funding, you must be assessed as needing residential care and undergo a means test. 
• Choice - There might be a limited choice of suitable homes with rooms available when you need one. 
• Unfamiliar surroundings - Moving somewhere completely new can be unsettling. 
• Loneliness - People might miss contact with neighbours and old friends. 
• Emotional effect - Families can feel guilty that they’re not looking after their loved one themselves, even though this might no longer be practical. And the person moving into a care home might feel rejected. It can help if you talk things through beforehand, so that everyone understands the need for the move. Regular contact once they’ve moved in will also help. 
• Loss of independence - A good care home will encourage residents to be as independent as they can be, but it might still feel like losing your independence.   
• Lack of privacy - It can be difficult to adjust to a communal environment. 
• Small living space - You might not be able to take all your furniture and personal possessions with you. 
• Variations in care - All homes have to achieve a minimum standard to ensure they can be registered, but quality of care might vary from home to home. Doing your research and asking around for recommendations should help you avoid the less suitable homes. 

How to choose a care home 

If you decide to start looking for residential care, read our article on choosing a care home for tips on how to identify suitable homes. You’ll also find a handy checklist of key questions to ask when viewing a home for the first time. 

Alternatives to a care home 

Other people might tell you that a care home is the only option for you or your loved one, but don’t just assume they’re right. Make sure you research all the options before making a decision. 

• If you want to stay in your own home and maintain a degree of independence, home care services and other help at home could provide the assistance you need. 
• If staying at home is no longer viable, moving into sheltered housing might be more suitable. For those who need regular support with personal care, think about assisted living or extra care housing schemes. These are purpose-built retirement communities that also provide access to care and support. 
• If a family member or friend is willing to provide support, another possible solution might be to share your home or move in with them.

Original article: https://www.which.co.uk/reviews/later-life-care/article/care-home-guides/when-should-you-consider-a-care-home-a7Zp63E9V5Ct