How to choose the right residential aged care for your loved one with dementia

Choosing the right residential aged care facility for a person living with dementia is a big decision, whether they’re able to make the choice themselves or if it is the decision of a relative.

The emotional aspects of a move to residential care weigh heavily on most people, making it hard to think clearly. Here are a few ways to make the process a little easier to navigate.

Have the conversation early

Don’t leave the conversation too late so the person living with dementia can no longer be part of the decision-making process.

The truth is, ageing happens and frailty sets in – it’s not a question of if, it’s a question of when. And I think the conversation about future care options needs to happen early – by which I mean years and years before the need arises.

Talk through what might happen if it got to the point where the person with dementia could no longer live at home. What would their wishes be? Most people will say their preference is to stay at home until the end.  In this instance, try taking that conversation one step further by saying, ‘let’s just say you couldn’t stay at home, what would your preferences be then?’

For many people, this conversation never happens – and the need for residential aged care arises when the person with dementia has difficulty contributing actively to the decision. That’s why it’s important to find out as much as possible about their preferences. What are the things that are really important to them? Do they want to be in a big facility or a small one?

Visit and observe

If you did need to find a residential aged care facility for yourself or someone that you love, there’s a few things you should look out for.

To start, spend some time in the facility, both during visiting hours and after hours. I’d suggest late at night or early in the morning,  because I think that’s where a residential facility shows its true colours.

When you’re arranging the visit, make sure you’re clear about how close the facility is to the person’s familiar neighbourhood. Give preference to those that are close by. If the geographic location is unfamiliar, this will be just one more thing to adjust to and could mean they are less likely to want to get out and about locally.

Scope out the environment

When viewing a potential home, rely on your senses for cues: what does the environment look like, what does the environment feel like? Listen to the level of noise: what do you hear when you walk into the space? What do you smell?

If it’s the smell of faeces and urine, then I’d suggest walking out immediately. If it’s a sound of alarms and trolleys and residents calling out – walk out. But if you walk in and the smell of freshly cooked food is in the air, or you hear beautiful sounds of people chatting and soft music playing, then you know that it’s a place that will feel like home.

Interact with residents

It’s obviously important to establish that the care team are well trained in dementia care – but again I’d be looking for signs of this in action, rather than asking for too many specifics about the training. When an admissions officer is showing you around a facility, ask to see how the staff are relating to the residents – rather than just being shown the pretty places within the home.

You want to be able to observe how the staff interact with a resident, for example, when they are agitated or when they say the same thing over and over. How do the staff relate to a resident who feels distressed and wants to go home? With dementia, it’s inevitable that there will be times where it will be more difficult – how the staff work through them shows if they are putting good dementia training into practice or not.

Get to know the care team

Make sure you meet the care team on your visit too. Find out which staff are having direct contact with the residents throughout the day. A registered nurse may be the one who speaks with the family, even though they are likely to have much less contact time with the residents.

You want to be able to communicate directly with the care staff yourself. If it’s an English-speaking environment that you’re looking for, it’s obviously important to be able to have a good conversation. If it’s a culturally specific environment, you want to make sure the care staff speak the language of that specific group.

Observe

Make sure that the residents are up and active, perhaps out and about in the garden or at the local shops. People get very fixated on looking at activity schedules, but I would suggest being observant and curious. Look around and see signs of the sort of purposeful and meaningful engagement the facility has for individual residents. One person might be pottering about in the kitchen, while another is watering plants out in the garden.

Similarly, are you seeing signs that the support is personalised and flexible? Do people have individual daily routines or, for example, is there a fixed time for showers for everyone? Allowing people to have their own routines, not having to conform to an institutional routine, is so important. It’s another sign that the dementia care is tailored to the individuals who are living there at that point in time.

All in all, I would say value your observations across critical things like the engagement of the residents, the training of the staff, and the environment. I think when choosing a residential aged care facility, actions do speak louder than words.