When do people with Alzheimer’s need to go to a nursing home?

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Alzheimer’s is a life-limiting illness that eventually affects every aspect of health and functioning.

It affects memory and cognition, which can make it unsafe for a person to live independently. For example, they may no longer be able to safely cook food or avoid hazards.

The condition also affects virtually every system of the body. It may:

• affect urination and cause incontinence
• increase the risk of choking
• lead to frequent infections

When symptoms become unmanageable at home and require ongoing, specialized care, it may be best for a person to move into a nursing home, if possible.

No single sign or set of signs always indicates a person needs to move to a nursing home.

The decision will depend on whether the individual has a safe living situation and can receive the care they need at home. If not, a nursing home may be an option.

A person with Alzheimer’s may need to move to a nursing home in the following situations:

• the home environment is difficult to move around due to narrow hallways, steps, or stairs
• the person lives far away from their loved ones and can no longer care for themselves
• caregivers do not have the time or physical ability to provide the level of support the person requires

Caring for a person with Alzheimer’s can be physically demanding and can also affect a person’s mental health. Caregivers can become burned out, overwhelmed, or depressed. When this happens, it may be best to consider a move to a nursing home, if possible.

Nursing homes are just one of many care options for those with Alzheimer’s. Others include:

• Independent living: This is for independent adults who do not need daily help. People in the very early stages of Alzheimer’s may choose to move into an independent living community that also offers more advanced care to get accustomed to the lifestyle.
• Assisted living: Assisted living offers help with the activities of daily living and may suit someone in the early to middle stages of dementia before they need ongoing support.
• Memory care: Memory care offers comprehensive, 24/7 care for people with Alzheimer’s and other forms of dementia.

In contrast, a nursing home offers specialized medical care from trained nursing staff and is best for people with complex medical needs. Some people use this term interchangeably with other types of senior living or to refer to memory care.

The benefits of transitioning to a nursing home or other form of residential care can include:

• increased safety
• opportunities to socialize
• reduced caregiver stress
• potentially lower expenses, especially if people have been paying for live-in care

However, there can also be some downsides. For example, the move to a nursing home may:

• involve higher costs than other options, such as at-home care from loved ones
• cause distress, which can exacerbate a person’s symptoms
• lead to the person spending less time with their loved ones, especially if the home is not nearby

The potential benefits and downsides will vary depending on each person and their situation.

Some questions people can consider when weighing care options for Alzheimer’s include:

• What about the current living arrangement works? What does not?
• What is the available budget?
• Are there quality nursing homes in the local area?

Some people may opt to consult a social worker or aging life specialist for guidance on options and a deeper understanding of how best to manage dementia symptoms as they progress.

Preparing to move into a care facility for Alzheimer’s can look different from person to person. Depending on the stage of Alzheimer’s, the individual with the condition may have decided on the move themselves, in which case, they may be fully aware of what is happening.

Those in a more advanced stage may feel afraid or act out by wandering, resisting care, or sometimes, being aggressive. This happens because Alzheimer’s undermines a person’s ability to understand what is happening around them, and can make periods of transition more stressful than for people without the condition.

To prepare for the process of moving to a nursing home, it may help to:

• Explain what is happening: If necessary, people can tell their loved one about the move right before it happens and offer lots of reassurance. If possible, it may help to visit the new place ahead of the move, so that a loved one can get familiar with it.
• Consult a doctor: Talk with a doctor or Alzheimer’s specialist about what may help. They may suggest medication to ease the transition.
• Prepare their room: Ensure the new space is comfortable and accessible, and bring comforting items from home that will help the person adjust.
• Step into the loved one’s world: People with dementia can mix people up or have perceptions that do not match reality. It is okay to go along with these, as it can be easier than trying to correct them. For example, if they think their child is actually their brother, accepting this role may reduce stress.
• Practice self-care: The process of moving a loved one into a nursing home are often hard on caregivers. They may undergo major changes in their own lives and routines. It can help to try to make time for activities that are relaxing or enjoyable and be self-compassionate.

If a person is still capable of making informed decisions, they have the right to decide whether or not to move into a nursing home. Others should not try to force them to move.

In cases where the person is no longer capable of making informed decisions, a caregiver may need to hire a lawyer to pursue legal options, such as appointing a legal guardian to make the choice on their behalf.

If a person with Alzheimer’s is reluctant to move to a nursing home but cannot receive the care they need at home, their loved ones may wish to try:

• listening to their opinion on their long-term care
• looking into the feasibility of alternative options together
• focusing on love and concern for their well-being
• asking a doctor, another trusted authority, or another loved one to talk with them
• visiting a few communities together
• taking a break from the topic if it is causing distress

Learn more about setting up power of attorney for dementia.

Moving to a nursing home can feel overwhelming, but a nursing home may provide a person with more support, more socialization, and a safer environment than they have at home.

There is no single sign that always means a person with Alzheimer’s needs to move to a nursing home. In some cases, people receive at-home care for the full duration of the illness. In others, alternative forms of care are preferred or required.

Each type of Alzheimer’s care has potential benefits and downsides, and each person’s situation will be different. Support organizations and medical and legal professionals can offer advice and guidance.