Dementia care guide: Supporting transitions between residential age care and hospital

Print
Last updated 12 March 2026
Dementia care guide: Supporting transitions between residential age care and hospital

Dementia Support Australia have created a dementia care guide to help support the transition from one care setting to another, helping older people with dementia make transitions between hospital and residential aged care or home when needed.

About the dementia care guide to support transition between hospital and residential aged care

Navigating care transitions can be challenging for healthcare professionals, people living with dementia, their families. Changes in routine, environments and caregivers may cause distress and behaviour changes in people with dementia, meaning thoughtful planning is key to creating an easier and smoother transition.

Whether transitioning between home, hospital or residential care, this resource can provide key considerations and risk reduction strategies to help maintain clear communication, person-centred care, dignity and comfort to people with dementia.

The guide includes, but is not limited to:

  • referral considerations

  • handover advice

  • services and support for families.

Dementia Outreach Service: Support for people with dementia who live at home

Metro South Health’s Dementia Outreach Service provides short-term clinical interventions for people living at home or in the community with dementia if they are medically and socially at risk due to complexities related to their disease process.

The service is run by a small team of specialist dementia nurses and a social worker, led by a Nurse Practitioner. It aims to ensure the complex needs of people with dementia are being met optimally at home and supports people with dementia to avoid unnecessary hospital presentations, admissions, and readmissions due to issues related to their dementia including behavioural and psychological symptoms of dementia and caregiver burden.  

More information for health professionals