Choosing a Dementia Care Home in England: Checklist and What to Ask

Residential vs. Nursing: The First Decision

Before you start visiting homes, you need to know which type your parent needs:

Residential care homes provide personal care — help with washing, dressing, eating, and medication. Staff are trained care workers, not nurses. These suit people with mild to moderate dementia who don't have complex medical needs.

Nursing homes provide everything a residential home does, plus 24-hour registered nursing care. A qualified nurse is always on site. These are appropriate when your parent has medical needs alongside dementia — catheter care, wound management, PEG feeding, or advanced-stage symptoms that require clinical oversight.

Dementia-specific units exist within both types. A home rated well for general elderly care may not have the environment, training, or staffing ratios needed for dementia. Look specifically for units designed around the needs of people with cognitive decline — not just a wing of a general care home.

The cost difference is significant. Residential dementia care in England typically runs £800 to £1,200 per week. Nursing dementia care runs £1,000 to £1,600 or more. If your parent is in a nursing home but doesn't qualify for full NHS Continuing Healthcare, the NHS pays a flat Funded Nursing Care contribution of £267.68 per week (2026/27) directly to the home.

How to Read CQC Ratings

The Care Quality Commission inspects every care home in England and rates it across five domains:

Each domain gets a rating: Outstanding, Good, Requires Improvement, or Inadequate. The overall rating is a composite.

What to watch for with dementia specifically:

• Check the inspection report, not just the rating. Search the full report for "dementia" — inspectors often note specific findings about dementia care quality, staffing ratios on dementia units, and whether staff have received dementia-specific training
• A home rated "Good" overall may have "Requires Improvement" in a specific domain. Read the detail
• Look at the date of the last inspection — a rating from two years ago may not reflect current reality

Questions to Ask When Visiting

Staffing:

• What is the staff-to-resident ratio on the dementia unit during the day? At night?
• What dementia-specific training do staff receive? How often is it refreshed?
• How long have the current manager and senior carers been in post? (High turnover is a red flag)
• Are the same staff assigned to the same residents, or do they rotate? Consistency matters enormously for people with dementia

Care approach:

• How are care plans developed and reviewed? How often?
• What happens when a resident's dementia progresses — can they stay in the same unit, or would they need to move?
• How does the home handle challenging behaviour — aggression, agitation, resistance to personal care?
• What activities are available specifically for people with dementia? Are they meaningful or just passive entertainment?

Environment:

• Is the dementia unit on the ground floor with direct access to a secure garden?
• Is there dementia-friendly signage — large text, picture labels on doors, contrasting colours for toilet seats and handrails?
• Can residents wander safely within the unit, or are they confined to their rooms?
• What does the home do about nighttime restlessness?

Practical:

• What is the weekly fee, and what does it include? What costs extra? (Hairdressing, chiropody, personal laundry, and incontinence pads are common extras)
• Is there a trial period before committing to a permanent placement?
• What happens if funding circumstances change (e.g., savings drop below the self-funder threshold)?
• What notice period is required if things don't work out?

Top-Up Fees: What They Are and When to Push Back

If the local authority is funding your parent's placement, they set a "usual cost" they're willing to pay. If the home you want charges more than this, someone must pay the difference — a "top-up."

First-party top-ups (paid from your parent's own money) are possible but tightly regulated. Third-party top-ups (paid by a family member) are more common, but be aware:

• The council must offer at least one suitable placement at no top-up cost
• A top-up agreement is a legal contract — if you stop paying, the council can move your parent to a cheaper home
• Top-up amounts can increase annually, and you have limited ability to challenge the increase

Before agreeing to a top-up, ask the council to show you the alternatives within their usual cost rate. Sometimes the "suitable" alternatives are genuinely poor, and the top-up is justified. Sometimes there are decent options that cost less.

Timing the Move

Visit at least three homes, at different times of day. An afternoon visit shows activities and engagement; an evening visit shows how settled residents are during sundowning hours. If possible, visit unannounced rather than by appointment — you see the home as it normally operates, not prepared for a visitor.

Don't rush the decision. Unless a hospital discharge is forcing the timeline, spend time getting this right. A poorly chosen placement that fails within months means a second move — disorienting and distressing for someone with dementia.

Our Dementia Care in England guide includes a fifty-point care home evaluation scorecard, a fee negotiation checklist, and guidance on the 12-week property disregard and Deferred Payment Agreements that protect the family home during residential placement.

See more England guides →