Choosing an aged care home for someone with dementia

At some point many carers of people living with dementia find they can no longer manage caring for a loved one at home. Changed behaviours, incontinence and wandering are some of the reasons carers often seek residential aged care. 

Deciding when is the right time for the move into an aged care home is highly individual. Having an understanding of the needs of people living with dementia can help you select the aged care home that offers the best quality of life for your loved one.

Some aged care homes provide care known as "Dementia Specific" although this will not be suitable for everyone. Dementia care should focus on providing individualised care that promotes independence, choice and respect. 

What is important for people living with dementia? 

• Environment
  
• Daily care 
  
• Safety and independence
  
• Toilets
  
• Nursing staff
  
• Palliative care
  
• Restraints
  
• Care plans
• Activities 

Environment

An aged care home should feel familiar, safe and comfortable. A home like atmosphere with furniture that is era and culturally appropriate will make a person with dementia feel secure. 

•  Is the environment calm? Too much glare, loud noises (continuous TV)) confusing patterns on carpets or walls can be disorientating.
•  Too many residents in a small confined space can create a stressful and noisy home.
•  Is the aged care home well lit? Are there signs or indicators on walls that help people with dementia find their way to rooms? 
• Can residents easily identify their rooms? Is there enough room for personal belongings and mementoes? Are there easily identifiable alert buttons for people with dementia?
• Is the nurse's station within view? In case of an emergency will my family member be heard from their room?
•  Is there a toilet in the room or close by?  

Daily care 

People with dementia need assistance with activities of daily living. Care should encourage independence where possible, choice and dignity. 

• Can my loved one choose when they take a bath or shower?
• How does the aged care home monitor nutrition and ensure my loved one is eating enough? 
• Can a person choose their meals?
• Is the dining room pleasant and social?
• Is food available outside of meal times?
• Can a resident go to sleep when it suits them? What time do residents usually get up? 
• Does the aged care home support residents in their usual routine?  

Safety and independence

People with dementia benefit from a secure environment where they feel safe and supported whilst maintaining independence where possible.

• Does the aged care home foster independence? Are there common kitchen or dining areas that have familiar appliances that are safe to use? 
• Can residents wander freely without obstruction? Are hallways wide enough and free of hazards such as trolleys and equipment?
• Are there adequate handrails for balance?
• Is the unit secure? A small closed ward with a noticeable security system can make a person feel trapped
• Can a person wander outside safely? Are there circular walkways or exercise areas? Is the facility ground level? 

Toilets

People with dementia can have bladder and bowel problems if they can no longer locate the bathroom, remove their clothes or use a toilet correctly.   

•  Are there easily accessed toilets?
•  Are there visual cues such as signs indicating where the toilets are?
•  Are the toilets fitted with grab rails and have enough room for lifting equipment and wheelchairs?
•  What is the aged care homes policy on incontinence pads? (most nursing homes only allocate a certain number of pads a day) 
•  Is the lighting adequate? 

Nursing staff

Staff that understand a resident's life history, habits and abilities are more likely to fulfil and anticipate your loved one's daily needs. An environment that fosters communication and relationships between staff, residents and family will optimise a person's care and quality of life. 

•  Do staff have specialised training in dementia care?
•  What is the ratio of staff to residents? (how may residents are staff expected to care for on a shift)
•  How many registered nurses are on duty? 
•  How does the aged care home support people with changed dementia behaviours and care staff?   

Palliative care

People with end stage dementia become very frail and require specialised dementia care. A palliative care approach can enhance the quality of life for people in end stage dementia. A good aged care home will encourage communication, choice of care and participation of family in decision making and care of a loved one at the end stage of life. Pain often goes unrecognised in people with dementia. Good dementia care involves techniques to assess and manage pain. 

• Does the aged care home have a spare room for palliative residents?
• Does the aged care home have access to a palliative care team?
• Have staff received education in palliative care?
• How does the aged care home include family in the care of a loved one with end stage dementia?
• How does the aged care home ensure a resident's wishes and preferences for end stage of life are fulfilled?  

Restraints

Alzheimer's America describes  restraints as any method use to restrain a person that prevents freedom of movement or mobility that cannot be removed easily. Restraints can be chemical (drugs), lap restraints (soft belt), table top restraint or bed rails. 


• What is the aged care homes policy on the use of restraints?

• Do you use restraints? When is a restraint used? What type of restraint is used?
• Will you be informed of the use of a restraint?

• What techniques do staff use to reduce the need of restraints?
 

Care plans

People with dementia benefit most from individualised care. Understanding why a person with dementia behaves as they do has much to do with a person's history, hobbies and significant people in their life.

•  What efforts do staff make to get to know a person?
•  How much are family involved in the care of a loved one? Do family have a say in a care plan?
•  How do staff promote independence and choice in the care of the person with dementia?