Dementia - residential care

As dementia progresses, it can become harder for someone with the condition to live at home. You might need more support or medical care, or living at home may no longer be safe for you.

If someone is caring for you, they may need to make the decision to move you into residential care. This can be a very difficult decision, and it’s normal for both of you to feel a mix of emotions: loss, guilt and even relief. That’s normal. Be kind to yourselves and make sure you both get the support you need.

It can also be a stressful and challenging process, particularly if you need to move into residential care quickly: after a hospital admission, for example. It’s worth making a plan and researching your options ahead of time, as this can reduce stress and help you to make the best decision.

Below are the key steps for moving into residential care, as well as things to look for when choosing a home.

Types of residential care

There are different types of residential care, which provide varying levels of support:

• Low-level care: This supports people who are mobile but need some assistance, such as help with personal care, laundry or shopping.
• High-level care: This provides 24-hour nursing care. It is often a good option for people in the later stages of dementia.
• Dementia-specific units: These units are designed specifically for people with dementia and may offer low-level or high-level care. Not all people with dementia need to live in a dementia-specific unit — they’re usually best for people with special care needs.

Types of residential care

Learn about the different types of residential care and some practical tips to help you make the move.

Being assessed for residential care

If you’re considering residential care, the first step will be an assessment of your eligibility.

If you’re over 65, contact My Aged Care. These are the steps:

• Check your eligibility and apply for an assessment on the My Aged Care website. You can also call My Aged Care on 1800 200 422.
• If the application is successful, My Aged Care will arrange for you be assessed at home by an Aged Care Assessment Team (ACAT). The ACAT will assess your needs and determine the level of care you need.
• If you’re eligible for residential care, the ACAT will provide a support plan that lists suitable types of care, including any specialist care (like dementia care). The ACAT can also refer you to a residential care home, or you can directly contact care homes yourself.

If you’re under 65, the process takes place through the National Disability Insurance Scheme (NDIS). For more information, see Dementia Australia’s NDIS support webpage.

When is the right time for residential care?

In this video, family members share their personal stories of moving a loved one into residential care.

Choosing a residential care home

Trying to find the right residential care home can be overwhelming, so it’s helpful to break it down into steps.

Make a shortlist

First, review the homes that provide the level of care that the ACAT has recommended, then make a shortlist. These are some things to consider:

• Location: This is usually the first thing to think about. Is there a location that you’d prefer? For example, if you’ve lived in a regional town all your life, you may want to stay nearby. Is that location convenient for family, friends and visitors? This will help them to keep in contact with you.
• A dementia-friendly focus: more on this below.
• Language and cultural practices: Do you prefer to speak in a language other than English? Do you have cultural or religious practices or traditions that you practice? Can the home support this?
• Individual needs: Does the home provide appropriate, sensitive care for:
  • your sexual and gender identity
  • your cultural background?

My Aged Care has a Find a Provider tool that allows you to filter by location, care needs, cultural needs and other preferences.

It’s also worth thinking about cost, as you may need to pay a number of different fees for your care. Some of these fees are means-tested, which means you might be eligible for government funding. My Aged Care has more information about the different fees, as well as a Fee Estimator tool.

Finding a dementia-friendly home

When you’re researching different care homes, think about how they support people with dementia. You’ll probably have your own priorities and needs, but these are some things to look for:

• Do staff have training and skills in dementia care? Not everywhere does, yet.
• Does the home have a focus on resident-centred care? For example, do staff tailor their care for each resident’s individual needs?
• Does the home actively create and promote a dementia-friendly environment? Below, we’ve listed some things to look out for when you visit your shortlisted homes.
• Does the home involve family and friends? For example, do they consult and actively involve them in care planning?
• Do they have strategies in place to support pain management for people with dementia?
• Do they avoid using physical restraints or chemical restraints (like using tranquillisers or sedatives outside of normal medical treatment), apart from in extreme circumstances?
• Do they provide access to dementia specialists and relevant allied health professionals, such as physiotherapists, speech pathologists and dietitians?

Visiting the shortlisted care homes

Once you have a shortlist of residential care homes, arrange to take a tour. Dementia Australia suggests visiting at least three homes. A good care home will be happy to show prospective residents, friends and family around.

To get the most from your visit:

• consider taking a friend or family member, as there can be a lot to think about
• pre-prepare a list of questions and things you want to find out
• take notes as you go
• trust your intuition and common sense when you’re assessing the home.

Questions to ask yourself

As well as the considerations listed above, these are some things to look out for when you tour a home.

General atmosphere

• Does the residence feel home-like, welcoming and friendly?
• Do management and staff greet you? Do they listen to you and ask for information?
• What are residents doing? Do they look comfortable, happy and well-cared for?
• Do staff seem to respect the residents?

Facilities and environment

• Is the home clean and well-organised?
• Are residents’ rooms well-maintained? Are they treated as residents’ own private spaces?
• Is there an accessible, sun-protected outdoor space? Is it used?
• What activities and outings are on offer? Do these reflect your hobbies and interests?
• Are there any other services, like hairdressing or massage?
• What belongings can you bring into the home?

Dementia-friendly design

• Is it obvious how to get to the toilet?
• Is there clear signage to help people who might be lost or disoriented?
• Is it easy to move around the home? Are potential obstacles moved out of the way?
• Do fixtures and furnishings use contrasting colours, where relevant?
• Are private rooms decorated with home-like furnishings that aren’t too distracting? Would your friend or family member feel comfortable with the decoration?
• Does the home have quiet, private spaces?
• Is it clear to residents where they should go for help?

Medical treatment and care

• How does the home manage medical or clinical care needs?
• Can residents have their own doctor?
• What is the home’s policy on prescribing medication?

Engagement with family and friends

• How are staff assigned to families and residents? Ideally, residents and families should be assigned a specific staff member who can answer their questions.
• Is there a family/carer group or committee? This allows families to connect and share their experience.
• What are visiting times and access like? Can you easily organise outings, overnight stays and holidays with your loved one?
• Can you be involved in your loved one’s care? For example, can you help them to shower or eat?

Other considerations

• If your loved one’s care needs increase, can the home support this?
• Has management clearly explained the fee structure?
• Does the home provide any help in preparing for your move?

Moving into residential care

Watch this video to learn tips and hear personal stories about ways to continue to care for a family member in residential care.

Once you’ve decided on a care home, it’s time to start organising the move. You might need to make a decision very quickly, once a place becomes available. To avoid stress, it’s worth thinking about what you’ll need to do.

This might be a frightening or disturbing process for you and your carer/s, but there are some things to help:

• If you’re a carer - explain simply and gently, where and why the move is necessary. Focus on the positive aspects, like new friends and fun activities.
• If possible, introduce the new home gradually. This helps it to become more familiar and less confusing.
• Decorate the new room with items from home, like family photos, prints and bed covers. You might also want to bring favourite books, music or movies.
• Mark all personal items with large, easy-to-read labels, so belongings aren’t lost.

It’ll probably take time for you and your carer to adjust to the new situation - this is normal. In fact, many people with dementia actually feel better in a structured environment, as they’re more secure and get more stimulation.

There’s no right or wrong way to approach this adjustment period. Carers may want to visit often, or need some time to rest and recover. Whatever approach is right for carers, our Visiting someone with dementia page has advice on how to make each visit as rewarding and enjoyable as possible.

In this video, family members share strategies for coping with moving a family member into residential care.

Working with the care home

Once you have moved into residential care, your carer’s role will change - but they can still play an important part in your care.

You will get the best possible care if your carer and the care home staff can form a partnership together. Your carer is the expert on who you are and what you like. Their involvement should be welcomed and encouraged. Signs this will be possible include, staff:

• asking carers for information about your background, past employment, culture, religion, hobbies and activities, likes, dislikes and daily routines
• working with carers to develop a care plan, and reviewing it with them regularly
• consulting carers about managing your response to stress
• inviting carers to help out with practical tasks and activities, including outings
• encouraging carers’ feedback on things like meal times, menus, activities and communication.

It’s entirely up to carers how involved they become. It’s important they look after themselves, as well as feel comfortable about your care.

Making a complaint

If you or your carer are unhappy with the care you’re receiving, talk directly to the residential care home. Every care home will have a complaints process, which should be outlined in its handbook or another document.

If you’re not comfortable contacting the care home, or they don’t solve the problem, you can make a complaint.

If you receive an Australian government funded aged care service, visit the Aged Care Quality and Safety Commission website or call 1800 951 822.

Or, if you’re supported through the NDIS, visit the NDIS Quality and Safeguards Commission website or call 1800 035 544.

A Better Visit app

Dementia Australia’s A Better Visit app, is a free app that helps people visiting you in residential care. Read about the app on the Dementia Australia website.

Dementia Australia Library Guides

Find a curated list of helpful resources from Dementia Australia’s Library Team on their website.

Where to get help

• The National Dementia Helpline: free telephone support for people living with dementia, and their families and carers – available every day, anytime, 1800 100 500.
• Carer Gateway: emotional and practical services for carers.
• Aged care home costs and fees: information from My Aged Care.
• Fee estimator: online calculator from My Aged Care.
• Find a Provider: My Aged Care.
• NDIS Support, Dementia Australia: information for people diagnosed with dementia, under age 65.
• A Better Visit app: free app by Dementia Australia to support visitors of people living with dementia.
• Visiting someone with dementia: Dementia Australia
• Aged Care Quality and Safety Commission websiteor call 1800 951 822: For information and how to make a complaint about a residential home.
• NDIS Quality and Safeguards Commission website: For information and how to make a complaint about a residential home.
• Dementia Australia Library Guides: a curated list of resources about residential care.