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National review of care homes for people living with dementia

Our review looked at the care received by people living with dementia in care homes in Wales, and how they are supported in this important stage of their lives.

This is a companion report to our national review of prevention and promotion of independence for older adults.


We carried out inspection visits to 164 care homes and spoke to people living with dementia and their families about the care they received. We also talked to commissioners and providers of care home services.

Our findings

  • We found people living with dementia are cared for by staff who are warm, respectful and provide care in line with personal plans.
  • We established in a small number of homes, care is rushed.
  • Staff received dementia training but this did not always mean that people were cared for in the best way.
  • We found people’s well-being and care could be better with improvements to where they live.
  • In general, families were very positive about the care, staffing and management in the care homes. They described staff as caring and welcoming and praised the food. Families told us improvements were needed in the range of activities available for people, staffing levels and the environment.
  • We found people living with dementia had access to healthcare but frequently did not receive a diagnosis of their dementia soon enough.
  • We found the way that different groups of people work together could be improved, particularly when patients leave hospital.
  • We found people’s medication had been checked by a doctor or pharmacist in about 90% of care homes and staff checked to see what effect the medication had on people.
  • We established providers said one in four people living with dementia are given medication known as antipsychotic medication. In about three quarters of cases, there had been a meeting to look at the use of this medication. More work is needed to look at how often these reviews take place.
  • People living with dementia were supported to access specialist mental health support.
  • More effective admission and discharge from hospital would help care homes.
  • We saw care homes using technology, developing links with their communities and doing a range of creative activities that improved the well-being of people living with dementia.
  • Providers told us that the main challenges in care homes for people living with dementia are keeping staff, the complexity of dementia and the impact on the home of people needing one-to-one care. Finance was a common challenge.


  1. Choice –people need clearer information about the location and types of service available. People who arrange care in local authorities need to look at gaps in care home provision.
  2. Training – people who provide care services, and those who arrange it in local authorities, need to make sure that training involves people living with dementia who receive care.
  3. Environment – we identified that new care homes should be designed and built to give good care, based on information about what good care looks like.
  4. Welsh language – there should be better information about how many staff speak Welsh in care homes; more staff should be able to speak Welsh.
  5. Antipsychotic medication – we recommend groups who are involved with care for people should work together to improve the way that antipsychotic medication is given out and checked.
  6. Rights – staff need better training around people’s rights when they receive care and support.
  7. Working together to provide support – support from mental health services, and the way that people enter and leave hospital, should both be improved.

Next steps

We are committed to following up the recommendations contained in this report and will work with others to improve outcomes in relation to the care received by people living with dementia in care homes in Wales