Families searching “Do dementia patients do better at home or in a nursing home?” are really asking where their loved one will stay safest, healthiest and most settled. The best answer is the one grounded in facts. Below we summarise UK and international evidence on outcomes that matter – falls, delirium and infections, continuity of care, quality of life, and the impact of relocation – then explain how live-in care (one-to-one support delivered at home) aligns with those evidence-based factors.
Guidelines and studies consistently highlight the benefits of familiar environments, person-centred support, and continuity of care. Falls are substantially more frequent in care homes than among older adults living in the community, relocation can carry health risks, and delirium is common in institutional settings. These factors together help explain why many people with dementia can do well at home when the right level of support – such as live-in care – is in place.
Person-centred dementia care: what national guidance says
The National Institute for Health and Care Excellence (NICE) recommends person-centred care for people living with dementia – care built around the individual’s history, preferences and relationships. While NICE does not prescribe a single setting, its guidance places strong emphasis on tailoring support and maintaining identity and routine, principles that are naturally easier to uphold in someone’s own home. (https://www.nice.org.uk/guidance/ng97/chapter/recommendations)
Alzheimer’s Society also states that remaining at home with extra support can be a good option for some people with dementia because the environment feels familiar and safe – provided the person can remain well and supported there. (https://www.alzheimers.org.uk/get-support/help-dementia-care/care-homes-who-decides-when)
What this means for families: If the goal is to protect identity, routine and choice, home is often the best starting point – so long as adequate support is in place. Your loved one will be surrounded by comfortable and familiar surroundings, memories, and with a helping hand enjoy their favourite hobbies and activities for as long as possible.
Falls: rates are markedly higher in care homes
Falls are a leading cause of injury, loss of independence and emergency admission in later life. Public health data for England show around one in three people aged 65+ and one in two aged 80+ fall at least once each year. (https://www.gov.uk/government/publications/falls-applying-all-our-health/falls-applying-all-our-health)
Critically, multiple studies indicate fall rates are roughly three times higher in care homes than among older adults living in the community. A BMJ trial and NIHR evidence briefing both report this three-fold difference, and a falls-research feasibility study echoes the finding. (https://www.bmj.com/content/375/bmj-2021-066991)
How live-in care can help with falls:
- Carers can reduce hazards (lighting, flooring, clutter) and adjust routines in real time.
- One-to-one observation supports early action when gait, balance or confidence changes.
- Minor home adaptations have evidence for helping older people remain at home longer and more safely.
(https://pmc.ncbi.nlm.nih.gov/articles/PMC6473599/)
Delirium and infections: institutional settings carry recognised risks (H2)
Delirium – sudden confusion caused by acute illness (often infections such as UTIs) – is common in hospital inpatients (around 23% of older adults) and is associated with longer stays, cognitive decline and higher mortality. (https://pmc.ncbi.nlm.nih.gov/articles/PMC7614999/)
For people living with dementia, UTIs frequently present as sudden confusion or behavioural change, and prompt assessment and treatment can reverse the delirium. Carers who know the person’s baseline are often first to notice subtle changes and are able to raise the alarm before infections get worse. (https://www.alzheimers.org.uk/get-support/living-with-dementia/UTIs-and-delirium)
Evidence from “hospital at home” models – care delivered at home for acute illness—shows slightly fewer cases of delirium at home than in hospital, reinforcing how familiar surroundings and tailored routines may protect against confusion. (https://evidence.nihr.ac.uk/alert/hospital-at-home-good-option-older-people)
A live-in carer provides continuous observation, encourages hydration and nutrition, and can escalate to the GP quickly when early signs appear – often preventing avoidable crises at home.
Continuity of care
For people with dementia, continuity of care prevents confusion and promotes a sense of security. Live-in care delivers continuity by design: a small team of live-in carers learn the person’s rhythms, “good-day” markers and early warning signs – enabling faster, more appropriate responses and calmer days.
Relocation effects: moving into long-term care can carry health impacts
Research on relocation stress in long-term care residents indicates links with depression and poorer adjustment during the first year in care, regardless of cognitive status. Reviews also find negative health effects associated with relocation of older adults with dementia. (https://pmc.ncbi.nlm.nih.gov/articles/PMC7048638/)
While some moves are necessary for safety or clinical reasons, these findings underline why minimising disruptive transitions and keeping support within familiar surroundings can be beneficial for those living with dementia.
Quality of life and the home environment
Peer-reviewed literature on dementia-friendly environments notes that simplicity, structure, safety and familiarity are core to supporting orientation and wellbeing. Home familiarity allows people with dementia to move more freely not only at home but also in their community, maintain roles and remain connected to friends and family. (https://pmc.ncbi.nlm.nih.gov/articles/PMC5795848/)
Live-in care aligns with these principles by keeping daily life anchored to known places, people and routines with the help of a trusted companion: a live-in carer.
Costs and funding: a factual note
Funding depends on need, not diagnosis. Some people with dementia qualify for NHS Continuing Healthcare (CHC) – full-funding for a package of care where needs are primarily health-related – assessed case by case.
Comparing costs across settings is complex (and varies regionally), but families should consider hidden costs of institutional care (e.g., relocation impacts, frequency of hospital transfers) as well as fees. The decision should be needs-led, then matched to the most supportive setting – often home with live-in care.
Read more about costs of live-in care for dementia: https://mumbys.com/what-is-the-cost-of-live-in-dementia-care
If you are considering live-in care for dementia, our team is here to guide you through the process – contact us today for a friendly, no obligation conversation.