Moving a loved one into an assisted living, frail care or specialised dementia care facility is a major decision for any family. Alongside the emotional considerations, there is often a significant financial commitment involved.
It can be difficult to understand why residential care costs as much as it does, particularly when the monthly fee is initially viewed as the cost of accommodation. In reality, assisted living and specialised care are very different from simply renting a room.
A quality residential care facility is providing accommodation, meals, personal assistance, professional care, security, activities, cleaning, laundry, maintenance and, depending on the level of care required, supervision and support around the clock.
Understanding what happens behind the scenes can help families better understand what they are paying for and, importantly, what they should be looking for when comparing care facilities.
Care Doesn’t Stop at 5pm
One of the biggest costs involved in running a residential care facility is staffing. A facility providing 24-hour care cannot operate with one team working normal office hours. Residents require support during the day, at night, on weekends and on public holidays, which means facilities need sufficient staff to cover multiple shifts throughout the year.
Depending on the type of facility and level of care offered, this can include registered nurses, trained carers, management and administrative staff, kitchen teams, cleaners, maintenance personnel and other support staff. In specialised dementia care, staffing becomes particularly important.
Someone living with dementia may require assistance with bathing, dressing, eating, mobility or toileting. They may become confused or disorientated, need reassurance during the night, or require additional supervision to remain safe. Their needs may also change as dementia progresses.
Quality dementia care therefore depends heavily on having appropriately trained people available when residents need them.
Why Carer-to-Resident Ratios Matter
The number of residents each carer is responsible for can make a significant difference to the level of individual attention that can be provided.
At Protea Memory Clinic, the standard care package provides a 1:2 carer-to-resident ratio, meaning one carer supports two residents. For residents requiring a greater level of individual assistance, PMC also offers a 1:1 care package, providing dedicated one-on-one support. These ratios allow carers to spend more time getting to know each resident, understanding their routines and preferences, assisting with daily activities and responding when additional reassurance or support is needed.
This level of staffing is naturally a significant component of the cost of specialised care, but it is also one of the areas that can have the greatest impact on a resident’s everyday experience. For families comparing facilities, it is therefore worth looking beyond the monthly fee and asking what the carer-to-resident ratio actually is.
Food Is About Much More Than Three Meals
Providing nutritious food every day is another significant ongoing cost within residential care. At Protea Memory Clinic, every resident receives three meals a day as well as snacks.
Importantly, meals aren’t based on a one-size-fits-all approach. Residents may have specific nutritional or medical requirements and PMC provides specialised diets that are signed off by nutritionists and dietitians.
Behind every meal are the costs of ingredients, preparation, kitchen staff, refrigeration, electricity, food storage, cleaning and food-safety requirements. But nutrition is only part of the picture. Mealtimes also provide routine, enjoyment and opportunities for social interaction. For people living with dementia, maintaining familiar daily experiences such as sitting down for breakfast, lunch or dinner can be an important part of everyday life.
Running a Safe, Hygienic and Comfortable Facility 24 Hours a Day
There are also many operating expenses families may never see. Electricity, water, cleaning supplies, linen, laundry, security, insurance, equipment, building maintenance and repairs are all ongoing costs. In a residential care facility, however, cleaning involves considerably more than maintaining appearances.
Older and frail residents can be particularly vulnerable to infections and illness, making a consistently clean and hygienic environment essential. With residents, carers, nursing staff, kitchen and cleaning teams, healthcare professionals, family members and other visitors regularly moving through a facility, maintaining high standards of hygiene requires ongoing attention throughout the day.
This means dedicated cleaning staff, appropriate cleaning and disinfecting products, regular attention to high-touch and communal areas, careful laundry and linen management, and established hygiene procedures designed to help protect residents.
A residential care environment also needs to be maintained differently from an ordinary home. Bathrooms, bedrooms, passages and communal areas need to be safe, clean and accessible, while facilities and equipment must accommodate residents with different levels of mobility and independence.
These measures may largely happen behind the scenes, but the staff, products, equipment and processes required to maintain a safe and hygienic environment are another important part of the overall cost of providing quality residential care.
Personalised Care Requires Resources
No two people age in exactly the same way, and no two people experience dementia in exactly the same way either. One resident may be relatively independent but need reminders and supervision. Another may require substantial assistance with everyday activities. Someone else may have mobility challenges or need greater support at mealtimes. This is why quality dementia care cannot simply follow one standard routine for everyone.
Individual care plans, ongoing observation and adapting support as a person’s needs change all require time and appropriately trained staff.
Knowing the individual matters too. Understanding someone’s routines, preferences, personality, history and ways of communicating can help carers provide support that preserves dignity and promotes comfort.
Quality of Life Is Part of Care
Keeping someone safe, comfortable and well-nourished should not be the only measure of good residential care.
Older people still need purpose, enjoyment, stimulation and human connection. Activities, exercise, music, gardening, celebrations, creative projects and opportunities to socialise all require staff, planning, resources and suitable spaces.
At Protea Memory Clinic, meaningful activities form an important part of daily life. They aren’t simply there to fill the day. They provide opportunities for residents to participate, connect with others and continue enjoying experiences that bring pleasure, familiarity and purpose.
These aspects of daily life are another reason families should look at what a facility actually provides rather than comparing monthly fees in isolation.
Understanding What Is and Isn’t Included
When exploring residential or assisted living facilities, it is important to understand exactly what is and isn’t included in the monthly fee. Certain costs are often charged separately because they depend on the individual needs of each resident. These may include medication and incontinence wear, such as adult nappies, as the type and quantity required can vary considerably from person to person.
It is worth asking about these additional costs before making a decision so that you have a clear understanding of the overall monthly expense. A lower advertised monthly fee may not necessarily mean a lower overall cost if certain services, care requirements or everyday necessities are charged separately. Asking for a clear breakdown of what is included – and what isn’t – can make it much easier to compare facilities fairly.
Comparing More Than the Monthly Fee
When families begin exploring assisted living or specialised dementia care, comparing monthly fees is understandable. But comparing the figures alone doesn’t necessarily provide a fair picture.
It can be helpful to ask:
- Is support available 24 hours a day?
- What is the carer-to-resident ratio?
- Is one-on-one care available if it becomes necessary?
- Are trained carers and nursing professionals available?
- How many meals and snacks are provided?
- How are specialised dietary requirements managed?
- Are laundry and cleaning included?
- What activities are available to residents?
- How are individual care plans developed and reviewed?
- Which expenses are charged separately?
- Is the facility specifically equipped and staffed for dementia care if this is required?
Two facilities may have very different monthly fees because they are providing very different levels of care, staffing and support.
What Are Families Really Paying For?
Assisted living and residential care can represent a significant expense for families. There is no getting away from that reality. But providing high-quality care is also inherently resource-intensive.
Behind the monthly fee are people working around the clock, carers providing individual assistance, nutritious meals and snacks being prepared every day, specialised diets being accommodated, buildings being maintained and secured, laundry being washed, activities being organised, care plans being reviewed and countless individual moments of support and reassurance. For specialised dementia care, those resources become even more important.
At Protea Memory Clinic, our focus is on providing personalised, compassionate care within an environment where residents can experience dignity, comfort, connection and meaningful daily life.
When considering residential care, the question therefore shouldn’t only be:
“How much does it cost?”
It should also be:
“What level of care, staffing, support and quality of life does that cost provide?”
Understanding what sits behind the monthly fee can help families make a more informed comparison and, ultimately, choose the environment that is right for the person they love.
References
Older Persons Act 13 of 2006 – South Africa
Provides the legislative framework for residential facilities and services for older persons.
https://www.saflii.org/za/legis/consol_act/opa13o2006188/
Regulations Regarding Older Persons – National Norms and Standards
Includes requirements relating to residential care, staffing, nutrition, safety and services for older persons.
https://www.saflii.org/za/legis/consol_reg/rrop352/
Western Cape Government – Older Persons Programme
Information on services for older persons, including assisted living and frail care.
https://www.westerncape.gov.za/service/older-persons-programme
South African Government – Admission of Older Persons to Residential Facilities
Information regarding residential facilities and full-time care for older persons.
https://www.gov.za/services/social-benefits-retirement-and-old-age/admission-older-persons-residential-facilities
