Hi jj
Assuming esme is the same as EMI (Elderly , Mentally Infirm), as Sylvia suggests, the other main difference, as I understand it, is that there has to be a RMN (Registered Mental Nurse ) on duty as all times. EMI homes units are not necessarily for people in the last stages of AZ, though a nursing EMI will care for these too. The essential point is that they offer secure and more specialized care for people with a whole range of dementia and other mental health problems. They are usually the only option for people whose illness causes them to be very agitated, constantly moving etc as ordinary residential homes cannot meet their security and safety needs. EMI units, in my experience, vary hugely in the quality of care. They are often in rather short supply and you may have to look outside your immediate locality. It is worth visiting several as well as looking at inspection reports. On an initial visits they can seem rather frightening places as, by the nature of them, the residents may be behaving rather oddly. A good EMI unit will let the residents behave as they need to, gently stopping or modifying behaviour where it is infringing on others or is likely to become unsafe. The best ones are where the staff get to know the residents and work with them individually and with the relatives to support their care needs. Talk to the staff, the carers as well as the nurses, as it is the carers who actually do most of the day to day caring, ask them about the routines of the home, how they cope with residents who are agitated. Through conversation, and observing how they ineract with the residents while you are there, you will get a feel for the sort of home it is. I would try to make 2 or 3 visits, at different times of the day, to any homes you are seriously considering. A nurse from the home will need to assess your mum to decide whether the home willl be suitable for her, so it is a two way process. By the way, EMI homes should not accept people whose illness is causing extreme aggression or violence. There are more specialized units with much higher staffing ratios run as part of the national health service for such patients. You should be reassured, therefore, that if your mum does need to be in an EMI home, it will be a safe environment for her.
This will be a very difficult time for you. Don't let anyone rush you into a decision. It is very difficult to assess needs when the person has been on a variety of medication - it does take time for things to settle. Also every move causes a period of instability, so you want to be as sure as possible that decisions are being made after careful consideration and after your mum's condition is stabilised. If I can be of any more help, I am happy to respond to a PM. My father was in an EMI home for several years, as well as going through various assessment units and many different attempts at medication as a result of the problems his agitation caused.
Blue sea