Dementia — what families need to know

Early signs

These go beyond normal age-related forgetfulness:

• Repeating questions or stories within the same conversation
• Getting lost in familiar places — the supermarket, the route home
• Difficulty with familiar tasks — following a recipe, managing the remote, using the phone
• Confusion about time — day of the week, season, whether it's morning or afternoon
• Problems managing money — unpaid bills, unusual purchases, difficulty with change
• Personality or mood changes — increased anxiety, suspicion, withdrawal, or aggression
• Losing things and being unable to retrace steps — or putting things in unusual places
• Withdrawal from hobbies, social activities, or conversations

Getting assessed

1. Start with the GP. They can do an initial cognitive screening (MOCA or Mini-ACE test — takes about 10 minutes).
2. Specialist referral. The GP refers to a geriatrician or psychogeriatrician for a full assessment, which may include brain imaging and blood tests to rule out other causes.
3. Diagnosis. If dementia is confirmed, the type matters — Alzheimer's, vascular, Lewy body, and frontotemporal dementia progress differently and have different management approaches.
4. Needs Assessment. Once diagnosed, request a Needs Assessment to access government-funded support services.

What needs to be in place

• EPA for Property — appoints someone to manage financial decisions (bills, bank accounts, property)
• EPA for Personal Care and Welfare — appoints someone to make health and living decisions when the person can no longer decide for themselves
• Will — should be reviewed or created while capacity exists
• Advance directive — records wishes about medical treatment
• Cost: ~$250–$500 per EPA through a solicitor

More detail on all of these at beforehand.nz/legal.

Living at home with dementia

Many people with dementia live at home for years. The key is putting support in place early and increasing it as needs change.

Government-funded support

• Home help — housework, meal preparation, shopping
• Personal care — showering, dressing, medication prompts
• Day programmes — structured activities and supervision during the day, giving carers a break
• Respite care — short-term rest home stays so carers can rest (see respite care)
• All arranged through the Needs Assessment process — no asset test for home-based support

Home safety for dementia

In addition to the standard home safety checklist:

• Stove safety — auto-cutoff device or switch the stove off at the wall when not supervised
• Door alarms or locks — to alert you if they leave the house at unusual times (wandering)
• Remove or lock away — sharp knives, cleaning chemicals, medications, car keys
• Simplify the environment — reduce clutter, label cupboards, keep routines consistent
• GPS tracker — if wandering is a risk, a wearable GPS device can help locate them

Monitoring

Home monitoring is especially valuable for dementia because the person may not recognise they need help or remember to press an alarm button. Passive sensor monitoring detects changes in daily patterns — increased bathroom visits, nighttime wandering, disrupted routines — without relying on the person to do anything.

When home is no longer safe

There may come a point when home care isn't enough. Signs that residential care should be considered:

• The person is unsafe alone for any period (wandering, fire risk, self-neglect)
• Care needs exceed what home support can provide (24/7 supervision needed)
• The primary carer is burning out or becoming unwell
• The person is distressed or agitated at home despite support

This is not a failure. See choosing a rest home for guidance on what to look for.

Support for families