How the Decision to Move Into Dementia Care Is Made
Families often ask who actually decides when a move into dementia residential care should happen.
Is it the family? A doctor? A social worker? Or does it come down to one final moment where a decision has to be made?
When is the right time for a dementia care home?
If you’re looking for some clarity on this matter, this guide explains how those decisions are usually made, who is involved at different stages and what happens when a loved one can no longer make that choice themselves.
Who Decides When Someone With Dementia Needs a Care Home?
The decision is usually shared between the family, the person with dementia (if they still have mental capacity) and health or social care professionals. It is based on care needs, safety and whether those needs can be met at home. This means that it isn’t one person making a single decision.
If a loved one no longer has capacity, professionals carry out a mental capacity assessment and decisions are made in their best interests, with input from family and reference to past wishes wherever possible.
How Decisions About Dementia Care are Typically Made
Deciding to move your loved one into a dementia care home usually involves multiple people:
The role of the family
Families are often the first to recognise when care at home is no longer workable. Day to day, they see the risks, the changes in behaviour and the growing level of supervision needed to keep a loved one safe.
This insight matters because families can raise concerns, notice patterns that don’t show up in short appointments and often prompt the conversations that lead to assessments. In many cases, they also act as advocates, pushing for the right level of support when current arrangements are no longer enough.
The role of the person with dementia
When a loved one is in the early or moderate stages of dementia, it’s important for them to be involved in decisions about their care wherever possible. Many residents can still share their views, preferences and worries, even if they need time or support to do so.
Wishes expressed earlier, along with any advance statements or known preferences, often help guide decisions later on if mental capacity changes.
The role of health and care professionals
Health and care professionals help guide decisions through assessment and advice. This may include GPs, memory clinic teams and social workers, depending on the situation.
Their position is to assess care needs, risks and levels of support and to explain when residential care may be appropriate. While they may recommend a move into a care home, they do not usually make the final decision on their own. Instead, they provide the professional input families need to make informed choices.
What Happens if Your Loved One lacks Capacity
There may come a point where your loved one is no longer able to make decisions about their care in a meaningful way.
However, that doesn’t usually happen overnight.
A mental capacity assessment is carried out to look at whether a resident can understand the decision being made, retain that information long enough to consider it and communicate a choice. Capacity is assessed for specific decisions, and it can change over time.
If a loved one is found to lack capacity to decide about moving into a care home, then the decision is not left to just one individual. Families are involved and professionals provide guidance. And any known wishes, values or preferences are taken into account.
Comments and conversations from earlier in life often hold more significance than you might expect. Conversations about independence or what felt important in later life can help form decisions when your loved one is no longer able to express them clearly. Written care preferences or advance statements may also be considered.
In practice, it means doing what keeps a loved one safe while staying as true as possible to who they are and how they have lived.
Knowing What to do Next
If you’re unsure who should be making decisions about dementia care, the next step is usually to bring the right people into the conversation.
You can start by raising concerns with your GP, memory clinic or a social worker. Ask for a care or needs assessment, and, if appropriate, a mental capacity assessment because these help clarify what level of care is required and who can be involved in decisions.
If your loved one can still take part, involve them early on and talk through preferences while they are able to express them.
Understanding this process can help you move forward with clearer expectations and avoid having to make any decisions under pressure.
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