The first step is that the person with dementia will have to be formally assessed, this is called a needs assessment. The next phase is called the service coordination and this is discussed in more detail later.
Assessments are done by your local Needs Assessment Service Coordination service (NASC). Your local NASC organisation might operate under a different name such as Support Works or Community Supports.
You may already have had contact with this service in organising support in your home or respite care. You can contact this service directly, or your GP or someone from your local organisation can refer you.
If the person with dementia is in hospital, staff there will arrange the assessment. If a person has specific care needs relating to their dementia, a specialist (such as a Psychiatrist of Old Age or Geriatrician) may be involved in the assessment process.
A needs assessment ensures a person with dementia:
- is informed of support services that would help them to stay in their own home (such as home care, district nurses)
- has access to specialist medical advice or rehabilitation that may improve their health so they can remain at home
- has help with making decisions around care and residential care
- is informed of the needs assessment and the financial means assessment criteria for access to public funding for residential care.
The assessor visits a person and their family at home or hospital and works out how much support the person with dementia needs.
Service coordination is the next step in the process, where the support services that are identified are coordinated and put in place for the person with dementia.
With the permission of the person being assessed, where possible, the service coordinator uses the information from the assessment to explore all options that might be helpful. They then help coordinate these services.
As part of this, the person with dementia and the people who care for them will be asked what solutions they think will help them. In many instances, and certainly in the earlier days of living with dementia, these solutions will include increasing or changing services or support received at home.
This can include a mix of publicly funded services and user-pays services, as well as increasing or organising help from family/whānau and friends. If residential care is recommended, the service coordinator will let you know what level of care the assessment shows is appropriate for the person concerned (there are four different levels of residential care available).
They will also help you prioritise what’s important, discuss available options, and provide a list of residential facilities for your consideration. Just because the person has been assessed as eligible for a particular level of care does not mean they must go into care. It may be that with extra support that can be provided the person’s entry to residential care is delayed.
Types of residential care facilities
If the needs of the person with dementia mean they can’t be supported to live at home, you will be advised which type of residential care facility will give them the care they need.
There are four types:
- Rest homes
- Dementia units
- Long-term care hospitals
- Specialist long-term care (psychogeriatric) hospitals.
A person with dementia might move into any one of these types of residential care facility, depending on their individual needs and how much care they need.
When the person’s condition and their needs change, they will be reassessed. The assessment may show that they now need a different level of care. If this is the case the person with dementia may need to be moved to a different facility as not all facilities offer all four levels of care.
Younger people with dementia
Because there are fewer people aged under 65 with dementia, it can be very hard to find a suitable residential care facility for someone who developed dementia at a younger age.
While some people will be happy in a rest home or hospital where most residents are a lot older, others may feel out of place and the activities on offer may be unsuitable.
Arranging care for younger people living with dementia often means you will need to compromise in some ways because you are likely to have fewer choices. Perhaps the rest home or hospital isn’t quite right, but is near enough for friends and family to visit often. Or perhaps there’s a suitable place but it’s further away.
There is no easy solution to this but it may be helpful, if possible, to organise trial stays before a permanent move to see what works best.
If there’s an activities coordinator at the rest home, they may be able to arrange activities suited to the younger person living with dementia, so try to find out how the facility plans an individual’s care.