Choosing a Dementia Care Home in Wales: EMI Nursing, CIW Ratings, and What to Ask

Why Dementia Needs a Specific Type of Care Home

Not every care home in Wales is registered for the same type of service. A home must be registered with the Care Inspectorate Wales under the Regulation and Inspection of Social Care (Wales) Act 2016 (RISCA), and you should check that its registration and assessed capacity cover your parent's dementia and any nursing needs. The old terminology — "EMI nursing" (Elderly Mentally Infirm) — still circulates among families and even some care providers, but the regulatory framework now sits under RISCA and the Care Inspectorate Wales (CIW).

The practical difference matters. A residential home without dementia registration may accept your parent initially, then issue notice when behavioural symptoms escalate beyond their staff training or building layout. That forced move — at a point when your parent is already vulnerable — is one of the most distressing experiences families report.

How to Search CIW Inspection Reports

Care Inspectorate Wales publishes inspection reports for every registered care provider. Start at the CIW online registry, where you can filter by location, service type (residential or nursing), and specialism (dementia care).

Each CIW inspection evaluates providers against four statutory themes:

1. Well-being — is the home meeting residents' emotional, social, and physical needs?
2. Care and support — are care plans individualised and regularly reviewed?
3. Environment — is the building designed for people with cognitive impairment (clear signage, safe outdoor space, dementia-friendly colour schemes)?
4. Leadership and management — are staff trained, supervised, and retained?

Read the full report, not just the summary rating. Pay particular attention to staffing ratios during night shifts (dementia residents often have disrupted sleep patterns and need support overnight) and whether the home has received any compliance notices or improvement conditions since the last inspection.

Questions to Ask When Visiting

Arrange visits to at least three homes. Go at different times of day — a lunch visit reveals how mealtimes are managed; an evening visit shows you the handover between day and night staff. Bring these questions:

Staffing and training

• What is the staff-to-resident ratio during the day and overnight?
• Are care staff trained in dementia-specific approaches (Dementia Care Mapping, person-centred care, de-escalation techniques)?
• What is the staff turnover rate? (High turnover means your parent constantly adjusts to unfamiliar faces — deeply unsettling for someone with dementia.)

Clinical capability

• Can the home manage escalating needs without issuing a discharge notice? At what point would they say they can no longer cope?
• Does the home have on-site registered nursing, or do they rely on district nurses for clinical tasks?
• How do they handle medication management, including PRN (as-needed) medications for agitation?

Daily life

• What does a typical day look like for a resident who can no longer participate in group activities?
• Is there secure outdoor space where residents can walk freely?
• Can family members visit without appointment, including evenings?

Complaints

• How are complaints handled internally? Ask for a copy of their complaints procedure.
• If you are unhappy with the home's response, use its complaints procedure first; you can also share concerns about a registered care provider with CIW, or contact Llais (the successor to Community Health Councils) for NHS-related care concerns.

Residential vs Nursing: Which Registration Level

A residential care home provides personal care — help with washing, dressing, eating, and mobility — but is not registered to provide nursing care as part of its service.

A nursing care home is registered to provide nursing care and has registered nursing input for clinical interventions such as administering injections, managing complex medications, wound care, PEG feeding, and oxygen monitoring.

For moderate-to-advanced dementia, ask whether nursing care registration is necessary for your parent's current and foreseeable needs. Dementia can involve sudden swallowing difficulties, falls with complex injuries, and behavioural crises requiring clinical assessment, so needs can shift from personal care to nursing care within days. Starting in a nursing-registered home may avoid a forced transfer later.

If your parent does not qualify for full CHC but is assessed as requiring registered nursing care in a registered nursing home, they can receive NHS-Funded Nursing Care (FNC) of £201.74 per week (2026/27), paid directly by the NHS to the home. FNC is non-means-tested.

The Wales Dementia Care Guide includes a care home comparison matrix for scoring facilities against these criteria, plus a template letter for requesting CIW inspection history if the online report is outdated.

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