Caring for people with dementia: at home or in a specialist centre?

In 2026, over 200,000 families in Romania face a painful question every day: how to provide the best possible care for a parent or grandparent diagnosed with dementia? It is a decision laden with profound emotions, uncertainty about the future, and often feelings of guilt, regardless of the choice made. The reality is that there is no universal answer that works for everyone – each situation is unique and deserves to be considered carefully, with empathy and sound information.

Dementia is not simply a disease of memory. It is a complete transformation of personality, daily needs, and family relationships. As the condition progresses, what begins as occasional forgetfulness becomes an ongoing challenge that demands considerable physical, emotional, and financial resources. Families often find themselves unprepared for the intensity of care required, and the decision between home care and placement in a specialist centre becomes unavoidable.

This article aims to guide you through this difficult decision, offering clear perspectives, practical evaluation criteria, and information to help you choose the option that best protects both your loved one and the wellbeing of the whole family. Because loving someone sometimes means making hard decisions when they are needed most.

Contents

1. What dementia truly means and the challenges it brings
2. Home care: real advantages and real limitations
3. Specialist centres: what they offer and who they are right for
4. Essential criteria for making the decision
5. Financial considerations: costs and available resources
6. Managing emotions and feelings of guilt
7. Signs that it is time for a change
8. The transition and adjustment process
9. Frequently asked questions

What dementia truly means and the challenges it brings

Dementia is an umbrella term covering several neurodegenerative conditions, of which Alzheimer's disease is the most common, accounting for approximately 60–70% of cases. It is not a normal part of ageing, but a progressive illness that affects memory, thinking, orientation, comprehension, calculation, the capacity to learn, language, and judgement.

In the early stages, the person may forget recent conversations, have difficulty planning activities, or experience confusion about time and place. As the disease progresses, significant challenges emerge: the person may no longer recognise family members, may need assistance with basic activities such as dressing or eating, or may display behavioural changes such as agitation, anxiety, or even aggression.

Stages of dementia and care needs

Each stage brings different care requirements, which means the decision between home care and a specialist centre is not a fixed one – it requires periodic reassessment:

• Mild stage: The person can function relatively independently with minimal supervision and occasional guidance
• Moderate stage: Assistance is needed for most daily activities, along with constant supervision for safety
• Advanced stage: Complete dependence for all basic needs, with an increased risk of medical complications

Impact on the family

The challenges of dementia do not affect only the person diagnosed. Studies from 2026 show that informal carers of people with dementia experience significantly higher rates of depression, anxiety, and physical exhaustion. The carer's relationships, professional life, and their own health are frequently compromised. Recognising this impact is the first step towards making an informed decision.

Home care: real advantages and real limitations

For many families, home care is the first option, driven by the desire to keep their loved one in a familiar environment, by deep emotional bonds, and sometimes by promises made in the past. This choice can work very well under certain conditions, but it requires a realistic assessment of the resources available.

A familiar environment offers significant psychological comfort in the early stages of the illness. The person with dementia feels safe among familiar objects, stable routines, and known faces. One-to-one personalised care allows complete adaptation to individual preferences, from the daily schedule to favourite meals. The family retains full control over the quality of care and can respond immediately to any change.

What home care actually involves

Beyond the idealised picture, caring at home for a person with moderate or advanced dementia means ongoing responsibilities that can become overwhelming:

• Round-the-clock availability: The risk of wandering, falls, or accidents means the person cannot be left unsupervised
• Complex medical care: Administering medication, managing co-existing conditions, recognising signs of deterioration
• Intensive physical assistance: Help with mobility, personal hygiene, and feeding – activities that require physical strength
• Managing difficult behaviours: Nocturnal agitation, verbal or physical aggression, resistance to care
• Social isolation: The primary carer often gives up their social life, hobbies, and personal time

When home care works

Home care can be a viable long-term solution when certain conditions are met: the illness is at an early or stably moderate stage, the family has the financial resources to engage professional carers, several family members can share responsibilities, the home can be adapted for safety, and the primary carer has sufficient emotional resilience and adequate psychological support.

Specialist centres: what they offer and who they are right for

Specialist residential centres for people with dementia have evolved considerably in recent years. In 2026, modern facilities no longer resemble the impersonal institutions of the past; instead, they offer therapeutic environments designed specifically for the needs of people with cognitive conditions.

A quality specialist centre offers far more than accommodation and basic care. Staff trained in specific communication techniques and behavioural management can turn daily challenges into moments of genuine connection. Cognitive stimulation programmes, occupational therapy, and structured social activities maintain engagement and slow functional decline.

The advantages of a specialist environment

Căminul de bătrâni Cici in Argeș County provides a warm and safe environment for older adults, with qualified staff dedicated to daily care – illustrating how modern centres approach holistic care. The advantages of such an environment include:

• Continuous professional supervision: Qualified staff present at all times, able to respond immediately to medical emergencies
• Socialisation and stimulation: Interaction with other residents and participation in structured daily activities
• Maximum safety: An environment adapted to prevent falls, wandering, and other accidents
• Multidisciplinary team: Access to doctors, nurses, physiotherapists, psychologists, and nutritionists
• Respite for the family: Relatives can return to the role of loving visitors, free from the burden of physical care

Different types of centres and services

Not all centres are equal. Some facilities have dedicated dementia units, separate from other residents, where the environment is tailored to reduce confusion and agitation. Others offer graduated care, allowing a progressive transition as the disease advances. Day centres represent an excellent intermediate option, providing professional stimulation and supervision during the day whilst the person returns home in the evening.

Essential criteria for making the decision

The decision between home care and a specialist centre should not be made purely on an emotional basis or under the pressure of a crisis. An objective assessment of several factors will help you identify the option that best serves the interests of everyone involved.

Assessing the medical condition and care needs

The first step is gaining a clear understanding of the diagnosis, the stage of the illness, and the prognosis. Speak openly with the neurologist about the challenges you can expect in the months and years ahead. A person in the early stage, requiring only occasional supervision, has entirely different needs from someone in the advanced stage, with reduced mobility and complex medical requirements.

• How frequently does the person need assistance with basic activities (eating, hygiene, mobility)?
• Are there any dangerous behaviours (a tendency to wander, aggression, refusal of treatment)?
• What co-existing medical conditions are present and what level of expertise is required to manage them?
• How rapidly is the disease progressing and what changes are anticipated in the short term?

Assessing the family's capacity

Love and devotion, whilst essential, are not sufficient for the long-term care of a person with dementia. It is crucial to honestly assess the family's resources:

• Available time: Who can provide daily care and for how many hours? Is there backup cover when the primary carer is unwell or has an emergency?
• Physical capacity: Physical care becomes increasingly demanding – can the primary carer safely lift, support, and move the person?
• Emotional resilience: How does the family manage the stress, frustration, and grief of witnessing their loved one's cognitive decline?
• Financial resources: What are the realistic costs of each option and for how long can they be sustained?
• The home environment: Is the home adapted, or can it be adapted, for safety (handrails, removal of thresholds, video monitoring)?

Involving the person with dementia in the decision

Where possible, in the early stages of the illness, the person diagnosed should be included in conversations about the future. Many people express clear preferences regarding their desired care, giving the family peace of mind in making subsequent decisions. Even if it is too late for dialogue, respecting the values and preferences the person expressed throughout their life remains an important guide.

Financial considerations: costs and available resources

The financial dimension is a reality that cannot be ignored, however uncomfortable it may be to discuss money when it concerns our parents or grandparents. In 2026, the costs of long-term care represent a significant challenge for the majority of Romanian families.

The costs of home care

Home care may initially appear to be the more affordable option, but the real costs accumulate quickly. A full-time home carer costs approximately 2,500–4,000 RON per month, and round-the-clock supervision requires at least two people working in shifts. Added to this are: home adaptations for safety, specialist hygiene products, medication and supplements, transport to medical appointments, and medical monitoring or assistance equipment.

There is also an invisible but very real cost: the loss of income for the primary carer who gives up their career or significantly reduces their working hours. Studies show that this opportunity cost can substantially exceed the direct costs of care.

The costs of a specialist centre

Residential centres have fees that vary considerably depending on location, the standard of the facility, and the level of care required. In rural areas or smaller towns – such as at Căminul de bătrâni Cici in Băloteasca – costs are generally more affordable than in large cities, ranging from 1,800–3,500 RON per month for standard care and up to 4,000–6,000 RON for intensive specialist care.

Most centres include accommodation, meals (three main meals plus snacks), basic medical care, assistance with daily activities, and recreational activities in their fees. Additional services such as physiotherapy, specialist consultations, or hospital transport may incur extra costs.

Available resources and financial support

Families can access several forms of support, although the Romanian system remains limited compared to other European countries:

1. Disability allowance: People with dementia may be assessed as having a degree of disability, providing access to a monthly allowance and medical benefits
2. Tax deductions: Documented medical expenses may be deducted from income tax
3. Private insurance: Some health or life insurance policies include cover for long-term care
4. Local authority support programmes: Some local authorities offer subsidised home care services for older adults

Managing emotions and feelings of guilt

Perhaps the greatest challenge in making this decision is not logistical or financial, but emotional. Feelings of guilt are almost universal among families who choose a specialist centre, regardless of how sound the reasons behind the decision are.

It is important to recognise that guilt often stems from unrealistic expectations about what it means to be a good child or partner. Our culture places enormous pressure on families to sacrifice everything for their elderly parents, without acknowledging the very real human limits of intensive long-term care. The reality is that carer burnout serves no one – not the person with dementia, who receives lower-quality care from someone who is physically and emotionally exhausted, nor the family, whose relationships and health are compromised.

Redefining family responsibility

Being responsible for your loved one does not necessarily mean personally providing every aspect of physical care. It means ensuring that the person receives the best possible care, in a safe environment, with dignity and compassion. Sometimes, the greatest act of love is recognising the moment when your loved one's needs exceed your capacity to meet them at home.

• Moving to a specialist centre is not abandonment – it is a continuation of care through different means
• Regular visits, involvement in the centre's activities, and advocating for quality care are all active expressions of love
• Maintaining your own physical and mental health enables you to be emotionally present for your loved one
• The quality of time spent together matters more than the quantity when you are exhausted

Support for carers

Regardless of the decision made, carers need ongoing support. Support groups for families of people with dementia provide a safe space to share frustrations, learn practical strategies, and receive emotional validation. Individual psychological counselling can help with managing anticipatory grief – the process of gradually losing your loved one whilst their body is still present. Respite services, whether temporary carers at home or day centres, provide essential breaks that prevent burnout.

Signs that it is time for a change

For families who initially chose home care, recognising the moment when this situation is no longer sustainable or safe is crucial. Ignoring warning signs out of loyalty or guilt can lead to dangerous situations or the complete collapse of the carer.

Signs from the person with dementia

Certain changes indicate that the person's needs have exceeded what the home environment can safely provide:

• Rapid functional decline: A sudden loss of self-care abilities or mobility
• Wandering episodes: A tendency to leave the house and become disorientated, with an increased risk of accident
• Aggressive behaviours: Physical or verbal violence that puts the carer or others at risk
• Complex medical problems: The emergence of complications requiring frequent medical monitoring
• Severe sleep disturbances: Reversal of the day-night cycle, making adequate supervision impossible

Signs from the carer

The health and wellbeing of the carer are equally important in this equation. The following signs indicate that the burden has become unsustainable:

• Chronic exhaustion, sleep disturbances, persistent physical pain
• Symptoms of depression or anxiety: frequent crying, irritability, feelings of hopelessness
• Complete social isolation and giving up all personal activities
• Deteriorating relationships with other family members due to stress
• Neglecting one's own health due to a lack of time for medical care
• Thoughts of harming the person with dementia or oneself

Signs from the care environment

Sometimes the physical or social environment becomes inadequate for the changing needs of the person with dementia. The home may present too many hazards that cannot be eliminated, the neighbourhood may be isolated without quick access to emergency medical services, or the person may lack any cognitive and social stimulation, accelerating their decline.

The transition and adjustment process

If you have decided that moving to a specialist centre is the best option, the way in which you manage the transition can significantly influence how well your loved one settles into their new environment.

Preparing for the transition

Begin the process well in advance of the actual move date. Visit several centres together, if the person is still able to participate, or visit on your own to assess the atmosphere, cleanliness, the staff's conduct, and the level of engagement among residents. Speak openly with the director and medical staff about your loved one's specific needs and how these will be met.

At Căminul de bătrâni Cici in Băloteasca, as at other quality centres, qualified staff dedicated to daily care work with families to create personalised transition plans that minimise stress and confusion. Ask about the possibility of preliminary visits or a period of gradual adjustment.

Supporting the adjustment

The first few weeks are critical for establishing routine and a sense of safety in the new environment. Helpful strategies include:

1. Personalising the space: Bring familiar objects from home – photographs, favourite blankets, small pieces of furniture that create a sense of continuity
2. Maintaining routines: Inform staff about preferred daily routines, favourite foods, hobbies, and interests
3. Regular visits: Frequent family presence in the first few weeks provides emotional grounding
4. Avoiding false promises: Do not say it is temporary if it is not – honesty, within the bounds of the person's understanding, is important
5. Collaborating with staff: Share observations about what works and what causes distress

Adjusting your own relationship

After the move, your relationship with your loved one changes. You are no longer the primary physical carer; instead, you become a son, daughter, husband, or wife once again. This can be liberating, allowing visits to focus on emotional connection, conversation, walks, or activities together, without the burden of physical care tasks. Many family members find that their relationship becomes warmer and less strained once the day-to-day responsibility of care is transferred to professionals.

Frequently asked questions

How long does the adjustment period take at a specialist centre?

The adjustment period varies considerably depending on the stage of dementia and the person's temperament. Generally, between two weeks and three months are needed to establish a comfortable routine. People in more advanced stages may adjust more quickly, as they have a reduced awareness of the change, whilst those in earlier stages may experience more initial anxiety but benefit more from socialisation programmes.

Can I take my loved one home for weekends or holidays?

Most centres allow and encourage home visits for short periods, provided the person's condition permits. It is important to speak with the medical staff about how to manage the transition in order to minimise confusion. Some people with advanced dementia may experience increased agitation after home visits, so the decision should be made together with the care team.

What if I chose a centre and now regret the decision?

Feelings of regret and guilt are normal and do not necessarily mean the decision was wrong. Give yourself time to process your emotions and assess the situation objectively. If there are genuine concerns about the quality of care, discuss these with the management or consider a different centre. However, if your loved one is well cared for and safe, and the guilt is emotional in nature, psychological support can help you come to terms with the decision.

Is home care with professional carers a viable alternative?

For families with adequate financial resources, engaging professional carers at home can provide quality care in a familiar environment. It is essential to work with licensed agencies, to verify references and qualifications, and to have back-up staff for days off and emergencies. Costs are generally higher than at a centre, but the arrangement offers maximum personalisation and the comfort of familiar surroundings.

How do I choose between several centres that seem similar?

Beyond the obvious aspects such as cleanliness and price, pay attention to these details: observe how staff interact with residents – is the communication respectful and patient? Check the staff-to-resident ratio, ask about the staff's specific dementia training, visit at different times of day to see what the daily routine actually looks like, and ask to speak with the families of other residents about their real experience.

What rights do I have as a family member once my loved one is in a centre?

You retain important rights: unrestricted access to your loved one at any reasonable time, participation in the care plan and in significant medical decisions, access to medical records and care reports, the ability to raise concerns without fear of reprisal, and the right to move your loved one to another facility if you are not satisfied. Most quality centres actively encourage family involvement and open communication.

The decision about caring for a person with dementia is one of the most difficult a family can face. There are no perfect choices – only options that best meet the concrete needs of your loved one and the real capacity of your family. What matters most is not the physical location of the care, but the safety, dignity, comfort, and quality of life of the person with dementia, and the long-term sustainability of the chosen care arrangement.

If you are facing this decision, allow yourself to assess all options objectively, to speak openly with medical professionals and wider family, and to accept that making the best possible decision in the given circumstances is all that can be asked of you. Caring is a marathon, not a sprint, and protecting your capacity to offer emotional presence over the long term is just as important as the immediate physical care provided.

This article is for informational purposes only and does not replace medical advice. For specific situations, please consult a specialist in geriatrics, neurology, or long-term care social services.