Dementia care homes: cost, and what makes one good

What the premium actually is

For nursing with dementia the gap widens: Hertfordshire pays £1,100.02 before the NHS contribution, against £880.86 for standard nursing.

What the premium buys

Staffing, mostly. Norfolk requires homes on its enhanced band to provide at least two waking night care staff whatever the size of the home, an escort whenever a resident leaves the building, and a specialist training programme for all staff based on the Skills for Care dementia knowledge set.

Bolton is stricter about who qualifies: its £84 supplement applies only where a resident is assessed as needing specialist dementia care in a dedicated unit. A home that simply accepts people with dementia does not get it.

Nottinghamshire’s approach, and why it is ending

Nottinghamshire ran a Dementia Quality Mark — homes meeting a defined standard received an extra £66 to £78 a week for residents whose primary need was complex dementia care.

It is being withdrawn. The council’s position is that quality has reached the required level, so the temporary funding is phased out: no new applications after 1 April 2026, existing payments folded into standard fees from April 2027.

What the rating does not tell you

A home can be rated Good overall and be poor at dementia specifically. Most homes accepting people with dementia are not registered as specialist units.

Read Responsive and Well-led rather than the headline word. Responsive covers whether care is organised around the person; Well-led is where staffing decisions and manager turnover show up. And check the date — nationally the middle home was last judged more than four years ago. See what CQC ratings mean.

The six questions that separate homes

1. What proportion of your residents have a dementia diagnosis? A home where it is 15% is a different place from one where it is 80%.
2. How many staff have completed dementia-specific training, and what training was it? Ask for the name of the programme.
3. How many waking night staff are on duty? Not “someone is available” — how many are awake.
4. What do you do when someone wants to leave? The answer tells you whether the home manages distress or contains it.
5. What is your staff turnover in the dementia unit? People with dementia rely on familiarity more than on facilities.
6. Can I visit at 7pm on a weekday? Late afternoon and evening are when dementia care is hardest. A home confident in its evening staffing will say yes.

Funding

Dementia is treated as a social care need in most assessments. That is why families with savings pay in full for years.

It is not automatic. Where needs are unpredictable, complex and require skilled judgement in the moment — not simply severe — NHS Continuing Healthcare may apply and pays the entire bill regardless of savings. Eligibility has fallen sharply and varies enormously by region, but asking costs nothing.