Skip to main content Accessibility help

Is there an “optimal time” to move to a care home for a person with dementia? A systematic review of the literature

  • Laura Cole (a1), Kritika Samsi (a1) and Jill Manthorpe (a1)



There is limited evidence regarding how the decision evolves about whether and when it is best for a person with dementia to move to a care home. The factors leading to the timing of the decision remain particularly unclear. This systematic review of existing literature aims to gain an understanding of the decision-making timing and process to distinguish the drivers of these decisions, and to identify if there is an “optimal” or best time (if any) for a person with dementia to move to a care home.


Six English language electronic databases were searched up to the end of 2016, along with included papers’ reference lists. Papers were screened against the inclusion criteria and rated for quality. Extracted data were thematically analyzed.


The review identified 16 relevant papers. Seven themes were identified: (1) what happened before the move; (2) planning for the move, (3) weighing up the decision, (4) lack of support, (5) drivers of the decision, (6) emotional significance of the move, and (7) continued reflection on the decision. “Time” of the move was largely absent from much of the literature, although inferences were made. Overall, the decision-making process appeared to be cyclic, with family carers constantly re-evaluating when might be the time to make the move with some continuing to reflect on this even subsequently.


Further research is required to understand the “optimal” or best time (if any) for when a person with dementia moves to a care home, and how to determine when someone is ready to move.


Corresponding author

Correspondence should be addressed to: Dr Kritika Samsi, Social Care Workforce Research Unit, King's College London, Strand, WC2R 2LS, UK. Phone: +44-20-7848-1665. Email:


Hide All
Alzheimer's Society (2013a). Outcomes of the James Lind Alliance Dementia Priority Setting Partnership. London: Alzheimer's Society.
Alzheimer's Society (2013b). Low Expectations: Attitudes on Choice, Care and Community for People with Dementia in Care Homes. London: Alzheimer's Society.
Aminzadeh, F., Dalziel, W. B., Molnar, F. J. and Garcia, L. J. (2009). Symbolic meaning of relocation to a residential care facility for persons with dementia. Aging and Mental Health, 13, 487496. doi: 10.1080/13607860802607314.
Armstrong, M. (1999). Factors affecting the decision to place a relative with dementia into residential care. Nursing Standard, 14, 3337.
Ashton, S., Roe, B. and Jack, B. (2016). Choosing a care home: families need more support. Journal of Dementia Care, 24, 2224.
Butcher, H. K., Holkup, P. A., Park, M. and Maas, M. (2001). Thematic analysis of the experience of making a decision to place a family member with Alzheimer's disease in a special care unit. Research in Nursing and Health, 24, 470480.
Cahill, S. M. (1997). ‘I often think I wish he were here’. Why do primary carers institutionalise family members with dementia? Australian Social Work, 50, 1319.
Caldwell, L., Low, L. F. and Brodaty, H. (2014). Caregivers' experience of the decision-making process for placing a person with dementia into a nursing home: comparing caregivers from Chinese ethnic minority with those from English-speaking backgrounds. International Psychogeriatrics, 26, 413424. doi: 10.1017/S1041610213002020.
Caron, C. D., Ducharme, F. and Griffith, J. (2006). Deciding on institutionalization for a relative with dementia: the most difficult decision for caregivers. Canadian Journal on Aging, 25, 193205.
Chang, Y. P. and Schneider, J. K. (2010). Decision-making process of nursing home placement among Chinese family caregivers. Perspectives in Psychiatric Care, 46, 108118 111p. doi: 10.1111/j.1744-6163.2010.00246.x.
Chang, Y. P., Schneider, J. K. and Sessanna, L. (2011). Decisional conflict among Chinese family caregivers regarding nursing home placement of older adults with dementia. Journal of Aging Studies, 25, 436444. doi:10.1016/j.jaging.2011.05.001.
Chene, B. (2006). Dementia and residential placement: a view from the carers’ perspective. Qualitative Social Work, 5, 187215. doi: 10.1177/1473325006064257.
Crawford, K., Digby, R., Bloomer, M., Tan, H. and Williams, A. (2015). Transitioning from caregiver to visitor in a long-term care facility: the experience of caregivers of people with dementia. Aging and Mental Health, 19, 739746. doi: 10.1080/13607863.2014.962008.
Duncan, M. T. (1992). Alzheimer's Disease Caregivers: The Transition From Home Care to Formal Care. Dissertations and Theses. Paper 3228. Portland State University Dissertations and theses. Available at:
Elliott, B. A., Gessert, C. E. and Peden-McAlpine, C. (2007). Decision-making on behalf of elders with advanced cognitive impairment: Family transitions. Alzheimer's Disease and Associated Disorders, 21, 4954.
Elliott, B. A., Gessert, C. E. and Peden-McAlpine, C. (2009). Family decision-making in advanced dementia: narrative and ethics. Scandinavian Journal of Caring Sciences, 23, 251258. doi: 10.1111/j.1471-6712.2008.00613.x.
Hagen, B. (2001). Nursing home placement. Factors affecting caregivers’ decisions to place family members with dementia. Journal of Gerontological Nursing, 27, 4453.
Joanna Briggs Institute (2011). Joanna Briggs Institute Reviewers’ Manual: 2011 Edition. Adelaide: The Joanna Briggs Institute.
Kmet, L. M., Lee, R. C. and Cook, L. S. (2004). Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. Alberta: Alberta Heritage Foundation for Medical Research.
Lord, K., Livingston, G., Robertson, S. and Cooper, C. (2016). How people with dementia and their families decide about moving to a care home and support their needs: development of a decision aid, a qualitative study. BMC Geriatrics, 16, 68. doi: 10.1186/s12877-016-0242-1.
Mamier, I. and Winslow, B. W. (2014). Divergent views of placement decision-making: a qualitative case study. Issues in Mental Health Nursing, 35, 1320. doi: 10.3109/01612840.2013.834014.
Mistric, M. L. (2008). “Coming to Terms”: A Grounded Theory of Dementia Caregivers' Journeys and Expectations of Care. PhD, The University of Texas Medical Branch Graduate School of Biomedical Sciences. Retrieved from
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G. and Group, The PRISMA (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. PLoS Med, 6, e1000097.
Orellana, K., Manthorpe, J. and Moriarty, J. (2017). What do we know about care home managers? Findings of a scoping review. Health & Social Care in the Community, 25, 366377. doi:10.1111/hsc.12313.
Park, M., Butcher, H. K. and Maas, M. L. (2004). A thematic analysis of Korean family caregivers' experiences in making the decision to place a family member with dementia in a long-term care facility. Research in Nursing and Health, 27, 345356. doi: 10.1002/nur.20031.
Pierre-Louis, M. (2012). Decision-Making Process of African Americans Caring for Parents with Alzheimer's. Dissertations and theses. John F. Kennedy University, California.
Sandberg, J., Lundh, U. and Nolan, M. R. (2001). Placing a spouse in a care home: the importance of keeping. Journal of Clinical Nursing, 10, 406416.
Sanford, A. M. et al. (2015). An international definition for “nursing home”. JAMDA: Journal of the American Medical Directors Association, 16, 181184. doi: 10.1016/j.jamda.2014.12.013.
Strang, V. R., Koop, P. M., Dupuis-Blanchard, S., Nordstrom, M. and Thompson, B. (2006). Family caregivers and transition to long-term care. Clinical Nursing Research, 15, 2745. doi: 10.1177/1054773805282356.
The Commission on Residential Care (2014). A Vision for Care Fit for the Twenty-First Century. London: DEMOS.
Thein, N. W., D'Souza, G. and Sheehan, B. (2011). Expectations and experience of moving to a care home: perceptions of older people with dementia. Dementia, 10, 718. doi: 10.1177/1471301210392971.
Tilse, C. (1998). Continuing or refusing to care: the meaning of placing a spouse in long term care. American Journal of Alzheimer's Disease, Jan/Feb, 2933.


Is there an “optimal time” to move to a care home for a person with dementia? A systematic review of the literature

  • Laura Cole (a1), Kritika Samsi (a1) and Jill Manthorpe (a1)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed