The conversation nobody wants to start
Most families we meet have been thinking about this for months before anyone says it out loud. That delay is understandable, and it is also the thing most likely to turn a considered decision into a crisis one, because when the fall or the hospital admission comes there is no time left to choose properly.
- Start earlier than feels necessary. A conversation held calmly is a completely different conversation from one held in a hospital corridor.
- Lead with the specific rather than the general. Talking about the stairs, the nights or the cooking is easier than talking about a care home.
- Ask rather than tell. What would make the days easier? What are you most worried about? What would you want if things got harder?
- Expect several conversations, not one. Very few people agree the first time, and many come round when the idea has stopped being a shock.
- Involve the person in every step you reasonably can, including the visits. Being part of the choice changes how a move feels.
- If capacity is limited, act in the person's best interests, involve everyone with a legitimate interest, and check whether a power of attorney or guardianship is in place.
What happens before the move
- 01Care needs assessment. Free, requested from the council, and the gateway to Free Personal and Nursing Care. See our Free Personal and Nursing Care guide.
- 02Financial assessment, if you are asking the council to contribute. Our costs guide explains the capital limits.
- 03Visits and shortlisting. Two or three homes, ideally visited at different times of day. Our guide to choosing a home has the questions to ask.
- 04Pre-admission assessment. The home manager or a senior nurse meets the person, usually at home or in hospital, to understand their needs, routines and preferences, and to confirm the home can genuinely meet them.
- 05Contract and fees. Read it properly: fee reviews, notice periods, extras, what happens if needs change. Ask for anything unclear in writing.
- 06Practical admin. GP registration, medication list, pharmacy arrangements, benefits notifications, mail redirection, and telling utilities and insurers if a property is being left empty.
What to bring, and what to leave
- Enough everyday clothing for a fortnight, all clearly labelled, plus something for occasions and comfortable indoor shoes with good grip.
- Toiletries in familiar brands. The smell of the right soap is a surprisingly large comfort.
- Photographs, a favourite blanket or cushion, and two or three ornaments that make the room recognisably theirs.
- A favourite chair if it will fit, or a small piece of familiar furniture. Check with the home first.
- Radio, television, tablet or music player, with a list of favourite music and programmes.
- Medication in its current packaging, the repeat prescription list, glasses, hearing aids, dentures and any mobility aids.
- Important documents: power of attorney, DNACPR if there is one, GP details, next of kin contacts and NHS number.
- Leave behind large sums of cash and irreplaceable jewellery. Ask the home how valuables are stored and insured.
One thing worth doing before the day: send a short note to the home about the person's life. Where they grew up, what work they did, their family, their music, what they cannot stand. It helps the team meet a person rather than a set of needs, and it is particularly valuable where memory loss makes it hard for someone to tell their own story.
The first day
Arrive in the morning if you can. The home is at its liveliest, there is time to meet people before the evening, and the day does not end on a goodbye in the dark.
- Set the room up together before anything else. Photographs on the wall and the blanket on the chair turn a room into a place.
- Meet the named key worker and the nurse or senior on shift, and write down who to call and when.
- Stay for a meal if you are invited. It makes the first sitting in the dining room much less daunting.
- Keep the goodbye short and warm. Long, drawn-out goodbyes are harder for everyone, and staff are practised at what comes next.
- Agree before you leave when you will next visit and when you will phone. A definite time is far more reassuring than soon.
The first month, week by week
| Period | What usually happens |
|---|---|
| Week 1 | Getting to know routines and faces. Care plan started. Expect some disruption to sleep and appetite; it is normal. |
| Weeks 2 to 4 | Routines settle. Activities that suit the person emerge. The care plan is reviewed with the family. |
| Around 4 to 6 weeks | Most people are settled. The home should have a fuller picture of what works and what does not. |
| Ongoing | Regular care plan reviews, and a named contact you can call. Ask what a normal review looks like and when the first one is. |
Settling takes longer for people with dementia, and progress is rarely a straight line. Difficult days after good ones do not mean things are going backwards.
Visiting is not restricted to fixed hours in most homes, and it should not be. Vary the time of day so you see different parts of life in the home, and do ordinary things together rather than sitting formally in a lounge: a walk in the garden, a hand of cards, folding washing, a hairdresser appointment.
About the guilt
Almost every family feels it, including families whose relative is visibly happier within a month. Guilt is not evidence that you made the wrong decision. Very often it is evidence of how long you managed on your own before asking for help.
What we notice is that relationships change for the better. When you are no longer the person managing medication, worrying about the cooker and getting up in the night, you can go back to being a daughter, a son or a husband. That is worth something to both of you.