Live-in dementia care or care homes – what’s the difference?

Written by Christophe Locatelli29/01/24


Dementia Care

When deciding on the type of care you or your loved ones need, it’s essential to consider all the pros and cons. In this article, we’ll the benefits of dementia care homes, potential drawbacks, and the alternative of live-in care. Find insights into the inclusion of dementia live-in care services and get practical tips on approaching the problematic conversation about care.


When should I start to think about care for someone with dementia?

As symptoms of dementia progress, it may become challenging for a person to continue having a good quality of life living without care. At a certain point, getting full-time around-the-clock care may become necessary – maybe a personal live-in carer will help or depending on the type of specialist care needed, a residential care home may meet the person’s needs better.

It may be advisable for them to get an advance statement if your loved-one has recently been diagnosed with dementia.

Advance statements were created in the early 21st century to enable individuals to outline their care and lifestyle preferences in the event of mental incapacity.

Any individual has the ability to create an advance statement, and it’s the responsibility of their loved ones and healthcare providers to honour these directives if the person becomes unable to communicate their wishes in the future.

Advance statements are significant for individuals diagnosed with dementia, as they enable them to express their preferences and dislikes, giving caregivers an understanding of their treatment preferences and desired outcomes as the condition progresses.


Who should make the decision about care?

In certain situations, a person with dementia may still have the ability to make an informed decision on whether moving into a care home is necessary or if they can receive suitable care through a live-in carer. If they can do so, they should have the autonomy to make their own choice and be offered any necessary assistance. However, it’s common for individuals with dementia to reach a point where the level of care required surpasses their mental capacity to make this decision independently.

If the person has severe memory loss and doesn’t have the capacity to decide what personal care they need, someone else will decide for them. It’s usually their power of attorney or personal welfare deputy. The decision must be in the person’s best interests. Their deputy for property and financial affairs can also make decisions in some cases. This is because they have the legal power to handle finances. However, professionals or family members can challenge this decision.


Is it better for someone with dementia to be in a care home?

Deciding to move someone into a care home is a tough decision. Feeling guilty is common. You might think you should do more or feel like you’re failing. But remember, you’re doing what’s best for the person, and there are some positives to moving into a care home.

A care home provides continuous, 24-hour support that you may be unable to do. A care home with nursing has healthcare professionals on site 24 hours a day to provide medical care – such as administering drugs or supporting someone with a STOMA. There will be a call bell system to ring for assistance, but staff will also carry out regular checks through the night.

Living in a care home also brings social benefits. Residents can meet and participate in group activities.

Moving into a care home does not necessarily mean giving up enjoyable activities. Residents can still maintain connections with loved ones and engage in activities that hold personal significance.

Dementia care homes

Going to a care home with dementia care services is still seen by many as the only viable option for later-life care. Some care homes can provide dementia care, but some may not, especially to those in the later stages of the condition. Those that offer more than straightforward elderly care may have higher staff ratios, a specially an adapted environment and staff trained in caring for people with dementia.

The design and environment of dementia care homes

A dementia care home environment promotes independence and safety through easy access, clear signage, dementia-friendly furnishings, and defined areas. For example, there will be easy navigation with simple building plans and colours to help residents know where they are. Residents also usually have secure access to all areas of the building and gardens. There are sometimes sensory gardens that can benefit people with dementia by stimulating their senses and providing opportunities for physical exercise.

Familiar environments

Dementia care homes prioritise familiarity for residents with dementia by providing homely environments and comfortable living spaces for relationships and recognition. Residents are often allowed to place their personal belongings outside their bedrooms to help them recognise their room and reduce confusion.

Sundowning  is a type of late-in the day confusion that some people with dementia may experience. To reduce confusion, agitation, anxiety, or aggression, lighting is controlled systematically in dementia care homes to help residents know what time of day it is and when it’s time to go to bed.

Staff roles in dementia care homes

Staff play a key role in dementia care by prioritising each resident’s personal experiences, preferences and family history to meet their spiritual, emotional, and physical needs. Care workers and nurses at dementia care homes have qualifications in dementia care and receive ongoing training to stay updated with best practices.

They are trained to handle dementia and its symptoms through care, emphasising personal and sensitive communication for meaningful interaction. Care workers and nurses collaborate with residents’ families and friends to comprehend their life stories, enhancing personalised care and allowing residents to maintain their identities and preferred lifestyles. Knowing a resident’s past can help with communication, as people with dementia may remember things from long ago but struggle with recent memories.

Care homes with separate dementia care units

Some care homes have on-site dementia units, also known as EMI (Elderly Mentally Infirm) units or specialist dementia care units.

An EMI unit in a care home is a separate area that provides specialised care for residents with advanced Alzheimer’s or dementia and accompanying health issues. The units will have trained staff available 24/7, including mental health nurses specialising in dementia care. The nurses can recognise and address changes in health and behaviour, and provide necessary care and medication.

Disadvantages of care homes

Older people may be worried about going into a care home and sharing their lives with many other older people. For those who have dementia, the move can be disturbing, and they may have problems making sense of the new world they find themselves in.

Placing your loved one into a care home means they have to share all the resources, including carers, with all the other residents and won’t get the one-to-one attention they would get with something like live-in care.

Although a care home’s aim to support their residents to remain as independent as possible in everyday tasks, this isn’t easy when there are so many people with individual needs to be cared for. It means that the choices about their daily life that your loved one would enjoy at home are curtailed to some extent. 

In an environment where everything is provided for them, it may encourage people not to carry out daily activities themselves and maintain cognitive strength. They may also become bored and lethargic unless encouraged to remain active. 

If you’re considering putting your loved one into a care home, look beyond the physical environment and try to judge how the staff interact with the residents and whether the people in the home appear happy and engaged in their environment. 

An asian woman helping an older lady to prepare a meal in the kitchen

Can someone with dementia have live-in care?

When given the choice, most older people wish to remain in their own homes, with familiar surroundings. Professionals largely agree that it is beneficial for those in later life, especially those with dementia, to stay in their familiar environment as it can be tough for them to accept change.

One option to find home care is to recruit a private carer yourself. If you organise your own private dementia care, you will need to screen any applicants carefully, check references and ensure that they have suitable dementia care experience and training to be able to provide appropriate care.

You will also have to comply with the legal requirements of being an employer, which can be a significant commitment in terms of time and stress. When the carer is on holiday or absent for any other reason, you will have to engage a suitable replacement, which can cause instability for those being looked after.

Another way to arrange in-home care for your loved one is to find a private live-in care provider, such as Elder, who’ll manage the whole process of identifying suitable professional carers, carrying out extensive background checks, ensuring that carers have correct qualifications and even go as far as running personality matching assessments to ensure that carers will bond with care recipients.

Should your live-in carer fall ill, go on holiday or be unable to perform their duties for any reason, a live-in care company like Elder will find an equally suitable replacement within hours.


What is included in dementia live-in care?

In this type of specialised home care, a trained professional will support your loved one to continue living as independently as possible in their own home. They will move into your loved one’s property and help in any way that is needed. In addition to assisting with the usual aspects of elderly care, such as personal hygiene, bathing or mobilising, they will also perform household duties such as cooking, cleaning and domestic work.

This type of 24/7 care is more like having a skilled family member living with your loved one, and a real friendship can develop between the carer and the care recipient. The carer will often work on a rotational basis, such as four weeks on and two weeks off. When they’re away, another carefully selected carer for respite care will take over. Providers, like Elder, will ensure that the carer chosen for your loved one has the specialist dementia experience they will need to meet your relative’s specific needs.


How to approach the difficult conversation about care

There are many reasons why talking to older family members about care can feel uncomfortable. For many people, being independent is a matter of pride, and many older people are highly resistant to the prospect of getting care. They fear the loss of their independence and the prospect of ending their lives in an institution surrounded by other elderly people.

Memory issues may lead them to believe that there’s no problem with how they manage in their own homes, and, of course, many older people dread the thought of becoming a burden to others, whether physically, emotionally or financially.

Don’t avoid the conversation

Avoiding difficult topics, unfortunately, doesn’t make them go away. By not discussing these issues with the people involved, we aren’t being honest and may feel like we are hiding something from them – and can eventually make an even more difficult time in the future when the right care requirements aren’t in place when needed.

When approaching the conversation about future care, respect the person, their wishes and unique experiences – and ensure you’re feeling calm and relaxed first so you can react and respond rationally.

Find a secure environment where all parties feel safe and comfortable with no distractions. Write down important information to cover and points made throughout the conversation so you can recall key topics, as we forget easier when we’re stressed or worried.

Long-term care is a complex subject and will probably not be one you’ll completely figure out in one conversation – therefore, allow for several conversations so everyone can think clearly and reflect on this challenging time.

Looking for care advice?

Call one of our friendly care advisors today

Learn more about dementia care

Take a look at more Elder guides on how to support those living with complex conditions below. 

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