When Should Someone with Dementia Move into an Aged Care Home?

Individuals with dementia may need to transition to a care home due to increased care needs, safety risks, behavioural issues, or caregiver burnout.

‘When should someone with dementia move into an aged care home’ is one of the toughest questions I help families navigate. There is not one simple answer, as it depends on the individual circumstances of the person and their current care situation.

As a professional in the aged care sector, I’ve seen the immense toll dementia can take on everyone involved.

I created this guide to help reclaim control in a situation that often leaves individuals and their families feeling powerless.

If you are the carer or family member of an individual with dementia, this guide will cover:

• How dementia progresses
• When should someone with dementia move into an aged care home
• Key signs to watch for that indicate an individual needs additional care
• The importance of early planning for dementia-specific care

Quick Summary

• Increased safety risks are a key sign that an individual with dementia may require residential aged care
• Some stages of dementia can require 24-hour supervision
• Individuals providing dementia care may experience carer burnout, necessitating the need for professional dementia care
• Escalating behaviours, such as aggression, may mean it is time to consider dementia-specific care
• Limited dementia-specific care availability in Perth and long waitlists require early planning
• Declining quality of life is a primary sign to watch for if your loved one has dementia
• Shift your focus regarding your loved one from “Can they stay home?” to “Are they living well at home?”

Understanding How Dementia Progresses

Dementia is a progressive condition marked by cognitive decline. It can include a wide range of symptoms and typically involves several stages. The stages can span several years, but the rate can vary between individuals.

In my 15 years as a Registered Nurse, I’ve seen how drastically dementia symptoms can vary from person to person.

One person in the early stages of dementia may notice mild lapses in memory or difficulty remembering a certain task. Other individuals may notice issues with navigation or subtle personality changes.

These varying symptoms are a result of how the brain is affected. In the early stages of dementia, only a small, localised part of the brain is affected.

One individual may have changes to a different part of their brain than another person in dementia’s early stages. This means symptoms can vary widely from person to person.

With time, the abnormal changes start to affect other areas of the brain. As the condition advances, major changes in language, memory, emotions, and behaviour can occur.

Progression varies for each person, but the stages of dementia progression typically include:

• Early Stage Dementia (Mild): Memory lapses, confusion, difficulty with complex tasks, changes in personality, decreased independence, navigation issues
• Middle Stage Dementia (Moderate): Increased confusion, difficulty with daily tasks, disorientation, difficulty recognising familiar faces, dramatic mood swings or irritability, aggression, wandering, increasing care needs
• Late Stage Dementia (Severe): Loss of ability to communicate, severe cognitive decline, physical deterioration, need for 24/7 care and supervision

Safety Signs That It May Be Time for Dementia-Specific Care

Key safety signs that it may be time for dementia-specific residential care include: 

• Wandering and getting lost: Increased wandering, disorientation, or getting lost may require 24/7 supervision to ensure safety.  
• Frequent falls or injuries: As dementia worsens, individuals may struggle with balance, using stairs, or getting around their house. This can lead to accidents, falls, and injuries.
• Night-time wakefulness: Night-time waking and restlessness can lead to wandering, confusion, poor-quality sleep, and safety risks.
• Nutrition, health, and hygiene concerns: Individuals with dementia may struggle with daily tasks, such as eating, drinking, or maintaining hygiene. This can lead to poor hygiene, malnutrition, and infections.
• Unsafe cooking or medication errors: Memory issues or confusion can lead to leaving appliances on or medication mishandling. This can increase the risk of accidents, requiring additional care and supervision.

Learn more about when aged care may be needed in my guide here: When to Consider Aged Care.

When Care Needs Exceed What Can Be Managed at Home

Sometimes, home care remains appropriate, but looking into residential care should be considered if care or safety needs arise.

Excess care needs that can no longer be managed at home may include:

• Assistance with personal care
• Incontinence concerns
• Two-person transfers
• Complex medication management
• Safety concerns
• Behaviour concerns

When Behavioural Symptoms Become Difficult to Manage

Behavioural symptoms of dementia can include:

• Aggression
• Paranoia
• Sundowning (Increased confusion and anxiety typically occurring in the late afternoon or evening)
• Severe agitation
• Severe mood swings

Although these are symptoms, not choices, these behaviours can become unmanageable at home.

Serious aggression, mood swings, or agitation may require the structured, secure support of professional dementia care.

Dementia-specific care offers safety and specialised training, with a focus on maintaining an individual’s sense of dignity, self-worth, and independence.

The Role of Carer Burnout

Being a caregiver for an individual with dementia can be emotionally and physically taxing. 

The immense stress and physical and emotional requirements of being a caregiver can lead to:

• Exhaustion
• Health decline
• Feeling constantly on edge
• Guilt
• Excessive worry
• Feelings of resentment or tension
• Increased stress
• Feeling worn out physically and emotionally

These feelings take a toll on the carer, making it harder to provide the support needed.

Carer burnout can indicate the need to consider professional dementia care.

Remember, protecting the carer is also protecting the person with dementia.

If you are dealing with carer burnout, you don’t have to face it alone. As an aged care consultant, I’ve helped many individuals recognise and address carer burnout.

Transitioning the individual to residential care can give the carer the necessary chance to recharge and protect their own health. This can create a better situation for the carer and the individual requiring care. It means the time spent together can be more meaningful when the relationship can return to its original state and you can spend quality time together without the stress of being in the carer role.

Is Their Quality of Life Declining at Home?

Even if your loved one can technically manage at home, it may not be the best or safest place for them.

It is important to watch for signs of a decline in quality of life at home, including:

• Isolation
• Restlessness
• Poor nutrition
• Lack of stimulation
• Reduced hygiene

If your loved one appears restless, malnourished, or lacking hygiene, their quality of life may be in jeopardy.

I remind clients to consider the key distinction in these questions:

• “Can my loved one live at home?”

vs.

• “Is my loved one living safely and happily at home?”

What Dementia-Specific Care Actually Provides

Professional dementia care can provide emotional support, socialising, and mental stimulation, all in a safe, structured environment.

Dementia-specific care often include:

• Secure environments, such as safe spaces for your loved one to enjoy the outdoors
• Memory-friendly design
• Trained dementia staff
• Engaging activities and cognitive therapies
• Structured daily routine
• Palliative support if required
• 24/7 medical support and medication management
• Social and group activities to foster a sense of belonging and companionship
• Personalised care plans

Wondering how to find an aged care facility that will meet your loved one’s needs? See my guide here for tips: Choosing the right aged care facility

Who Decides When Someone Moves into Care?

Deciding when someone should move to dementia-specific care usually involves input from the individual, family members, and medical professionals:

• Person’s wishes: When possible, the individual’s wishes need to be considered and respected. Having conversations early with the individual assists in knowing what their preferences are as when the time for residential care comes they may not have the capacity to decide this for themselves.
• Capacity considerations: Capacity considerations in dementia care involve an individual’s functional and legal ability to make healthcare decisions.
• Family involvement: Family members are often the primary decision-makers when their loved one should move into care to ensure safety and well-being. Having Enduring Power of Attorney and Enduring Power of Guardianship in place plays an essential part in having the authority to make these decisions.
• Medical recommendations: A GP or specialist can assess an individual with dementia and make appropriate care recommendations.
• Formal assessment process: Australia has a formal assessment process for residential aged care approvals. This process involves contacting My Aged Care needs assessment to determine eligibility and organising an assessment. 
• Aged Care Consultant: An aged care consultant can provide personalised guidance and independently assess facilities to find the best fit for your loved one’s needs.

Hospital Admissions and Crisis Placements

The immense need to open up hospital bed capacity can lead to hurried discharges.  Hospital discharge pressures can influence care decisions, leading to rushed decisions and crisis placement.

Crisis placements limit choice, often leading to less-than-ideal care situations.

Planning early for dementia care gives families more options. It’s a small but tangible way to regain control in a situation that often makes families feel helpless.

You May Also Like: How WA’s ‘Time to Think’ Program Eases Aged Care Stress

Planning Ahead vs Waiting for a Crisis

Planning ahead is a practical way to reduce some of the stress, worry, and emotional turmoil of navigating dementia care.

Here are 4 reasons early planning for dementia care in Perth is critical.

1. Longer waitlists for dementia specific rooms

Specialised dementia residential care typically includes longer waitlist times. Dementia specific wings in aged care homes are usually kept small to support high quality, individualised care which in turn limits the number of places available.

2. Limited availability in Perth

Dementia-specific aged care is limited in Perth as there is currently a high demand

3. Complex Financial Planning

I recommend financial planning in order to avoid rushing and extra stress.

Financial planning for aged care includes:

• Seeking professional financial advice where necessary
• Assessing assets and income for aged care, this is a formal assessment which determines eligibility for government support
• Assessing Superannuation availability
• Setting up an Enduring Power of Attorney

4. Emotional Preparation

Pre-planning for dementia care helps prevent the emotional turmoil of last-minute decisions.

Have conversations ahead of time, with a special focus on the safety and specialised support dementia care can provide.

Focus on the benefits, such as increased socialisation and specialised activities. Listen to your loved one’s concerns and acknowledge their worries and emotions.

These early conversations can provide the emotional readiness needed for a smooth transition to aged care.

You May Also Like: Tips for Moving into Residential Aged Care

Questions to Help You Decide

Questions that can guide your decision on when should someone with dementia go into a care home include:

• Am I (or the caregiver) unable to provide the necessary care and support?
• Am I constantly worried about safety?
• Is someone supervising 24/7?
• Has caregiving affected my health?
• Are behaviours escalating?
• Would dementia-specific care provide better support?
• Is my loved one’s well-being suffering?

Remember to shift your focus from “Can they stay?” to “Are they living well?” to help guide your decision.

You Don’t Have to Make this Decision Alone

Deciding when should someone with dementia go into care will be different for each individual’s situation.

While there is no easy answer, safety, behaviour, or caregiver burnout concerns all indicate that specialised care may be needed.

Ultimately, it comes down to, “Is my loved one living happily and safely at home?”. If the answer is ‘no’, it may be time to consider dementia-specific care.

If you are struggling with these care-related decisions and worries, you don’t have to go it alone.

I provide compassionate, individualised support every step of the way, from consultation to placement.

Contact Care Match Solutions to speak with one of our knowledgeable, friendly aged care placement consultants. Together, we can ensure your loved one gets the dementia-specific care they need.