Care home or home care?

Most of us want care services at home when we get older. But sometimes we need to consider going into a care home instead. How do you decide?

Thinking through your care options

The most important decision to make when considering your care needs is whether you can stay in your own home or need to move into a care home.

The decision will be based on what you want and what care you need. But you’ll also need to consider how much it will cost.

Our needs change as we get older, and aspects of living independently become more difficult. For example, getting up and down stairs or in the bath.

The sooner you consider what will work the better. This can help avoid rushing into a choice that is not right for you particularly in a time of crisis, such as following a stay in hospital.

It can help to answer the following, you could even write it down. It can help to priorities your needs:

Here are some useful questions to help you prioritise your needs. Writing it down can be helpful:

  1. What does ‘home’ mean to you? For example, is it comfort, security, familiarity?
  2. What makes a good home in later life? For example, proximity to family or your GP.
  3. What things might become more difficult? For example, getting into and out of the bath, steep stairs or a large garden.

The Elderly Accommodation Council has a useful online tool to help you assess the suitability of your current home.

Home care services - pros and cons

Home care can include regular visits from a home care worker to help with personal care, shopping and preparing meals.

Other services include ‘meals on wheels’, monitored personal alarms and household equipment, and adaptations to help with everyday tasks.

You may be able to visit local day centres where you can socialise and enjoy various activities, with transport to get you there.

Understanding how home care agencies work

Not all home care agencies are the same. It’s important to know whether the agency:

  • employs its own carers; or
  • has access to a network of self-employed carers and will charge a fee for recommending one.

Agencies who recommend a carer aren’t responsible for the delivery of the care you would get. These businesses fall outside the scope of the Care Quality Commission (the body that ensures that agreed standards of care are met) This means they are unregulated.

It also means they are not permitted to direct, supervise or control their carers’ work. That responsibility would lie with you and if you’re not satisfied with the standard of care you’re getting it could make it more difficult to complain.

Pros

  • The cost of care at home might be cheaper. However, as the amount of support you need increases, it might become cheaper to move into a care home.
  • You get to stay near friends and family. Staying in the same neighbourhood is really important to some people.
  • You have more control over the care and support you get. You’ll be able to tailor how much help you get as your needs change.
  • You can continue to live with your pets. If you need help looking after them, try contacting the Cinnamon Trust – they might be able to help.
  • You might get more money for care The value of your home isn’t taken into account when calculating how much you have to pay towards your care. It might if you move into a care home, although this will depend on who’s still living there.

Cons

  • Carers are not around 24/7. This might mean you feel less safe in your home. A live in carer, an alarm system, fall detectors or a bed sensor might help you feel better.
  • Your carer may change. The agency you use will likely try to send the same person every time. But may not be able to due to sickness and time off.
  • Carers might turn up late. This could be because they have an emergency at their previous call. If you have a strict schedule, this might be difficult for you.
  • It could get more expensive if you need more help. For example, you may need a cleaner, a gardener or need hairdresser to visit.
  • Home modifications and equipment might affect the value of your property. This is especially the case if they are unsightly.
  • Quality of care can vary. You can check the quality on the Care Quality website

For more information, see our guides on:

Moving to a care home - pros and cons

There are two types of care homes:

  • Care homes without nursing care that provide help with personal care.
  • Care homes with nursing care that have registered nurses providing 24 hour nursing care and experienced care assistants providing personal care.

Both are places where you can live (often with a spouse) where trained staff meet your care needs.

Some also have accommodation and support specifically designed for older people with dementia.

Pros

  • Trained staff are always on hand. This means you might feel more safe and secure.
  • No need to worry about utility bills, meals and household chores. It’s all sorted for you, which might mean it’s warmer, safer and cleaner.
  • You’ll always have company. There will always be someone to talk to, as well as organised activities.
  • They can manage any medication you need to take.

Cons

  • It might be more expensive. This is especially the case if you’re not eligible for local authority funding.
  • Quality of care can vary. All homes need to reach a minimum standard to be registered, but quality does vary. You can check the quality on the Care Quality Commission website.
  • All your belongings will need to fit in one room. This might mean that you can’t be surrounded by all the personal items you’d like.
  • You might feel you’ve lost some of your independence. A good home should help minimise this by helping you live independently as you can be. There might be some loss of privacy though.
  • Pets might not be allowed. If they do claim to be ‘pet friendly’, check what that means. It could be that pets are allowed to visit but not stay.
  • You might not enjoy the company of the other residents.
  • Family and friends can feel guilty. If they’re not able to help more or visit as much.

Find out more in our Choosing the right care home guide.

Comparing the cost of care

Costs can vary around the country. But your local social services department (or Health and Social Care Trust in Northern Ireland) will be able to give you an idea of how much you’ll need to pay for services you arrange through them.

Charities and disability groups are a good source of information too, but if you’re thinking of using a private home care agency or care home, you might need to make your own enquiries.

Home care costs

Costs are very different depending whether you need support during the day or at night, on weekdays or at weekends.

It’s tricky to work out what you will pay in advance but contacting some local providers can help you get more realistic costs. We’ve provided a few estimates to get you started.

  • £15,000 a year, for 14 hours of care a week. Based on the UK Homecare Association’s estimate of what councils should pay as a minimum it’s £20.69 an hour. If you’re self-funding, you may pay more.
  • If you need full-time care during the day, costs could be more than double the above.
  • If you need carers to move in around the clock and you have complex needs, it could cost about £83,200 a year. In those circumstances, residential care is usually more cost-effective. If you don’t have complex needs, fees should be less – about £41,000-£65,000 a year.

You’ll still have the cost of maintaining your house, but you have the advantage of being in familiar surroundings.

If you and your partner both need care, home care might be more cost-effective. Some home care providers only charge a supplement to cover the second person, rather than doubling the cost of care for one person.

If you live in England, you can use the Which? Cost of care calculator to get an estimate of home care costs in your area.

Care home costs

According to, a report by healthcare specialists Laing & Buisson in 2018, care homes costs can range from:

  • £27,000 to £39,000 a year for a residential care home, or
  • £35,000 to £55,000 a year if nursing is required.

Remember, you might have to pay extra for things like trips out, hairdressing and some therapies – check what’s included in the care-home fees.

For more personalised results of care in your area, use the care costs calculator on the Paying for Care website.

How to fund your long-term care

You could end up paying for all your care, some of it or nothing at all. This will depend on where you live in the UK and whether your needs are mostly health-related or more to do with daily living. For example, getting dressed, eating and mobility. This is known as social care.

Make sure you claim for the help you’re eligible for:

  • If your needs are health-related, you may be eligible for free NHS care.
  • If you have social care needs, your local authority (or Health & Social Care Trust in Northern Ireland) may help find and fund the care.

Find out more in our How to fund your long-term care – a beginner’s guide.

Case studies

Care homes

“When Joan died suddenly, I realised how much I’d relied on her. After my stroke, she was always the one who looked after me.

“At first, I was determined to stay at home and although I got loads of help from the council, I soon realised that it wasn’t working for me.

“The house seemed so big and empty without Joan. And because my walking’s really bad, I spent every day on my own in front of the telly. I got so lonely – felt like giving up.

“So, I sat down with the family and talked it through. I was worried that selling the house meant the kids wouldn’t get much of an inheritance but they told me not to be stupid.

“Well, I’ve been in Beechacre for nine months now, and it’s turned out to be the perfect solution. I’ve got my own room – much more modern and easier to manage than the old house – and with staff on hand day and night I feel really safe.

“The best thing is I’ve got lots of people to talk to, and there are plenty of organised activities to keep me occupied.” – Jim

Find out more in our Choosing the right care home guide.

Care at home

“Dad has lived in the house since he was first married. It’s home for the whole family. But when dad had his stroke, we were faced with some difficult decisions – our hearts said he should stay at home but our heads said a care home was probably best.

“That was until we looked into the options. It’s amazing what the council can provide – everything from ‘meals on wheels’ to someone to cut his lawn. Carers come in twice a day to prepare his main meal and do the little things he can’t manage, like having a bath.

“Dad would be lost without them and they give us the peace of mind of knowing he’s got someone coming in every day. He’s also got a falls alarm and a panic button for the rest of the time.

“It all costs, but because the value of the house is excluded from the calculations, we were surprised to find that dad gets some financial help from the council.

“There will probably come a day when he has to go to a care home. But for the moment he gets a lot of pleasure from pottering about in the garden and talking to the neighbours.” – Dawn

Find out more about Care services to help you stay in your own home.

Moving in with family

Moving in with family can work well, but it can have a significant impact on everyone’s lifestyle. If you can afford other options such as a care home, this could be less stressful for everyone.

It’s important to be realistic and make sure you all have the same expectations. It is important to understand that support is available.

Here are some things to consider when thinking about moving in with your family:

  • If your family members are claiming benefits, will these be affected? What about Council Tax?
  • Will you pay rent or help towards bills for rent and utilities?
  • Will the home need to be adapted? Who will pay for this?
  • Are you eligible for support in adapting your home or getting home care support?
  • Have you thought about family issues? Do you all get on? What if the couple split up? What happens if the arrangement stops working?
  • What sort of care will you need and who will be able to provide this for you?

Your family should want the best for you. But it’s still important to protect yourself by getting independent legal advice. A formal agreement drawn up can help protect you and them.

Find out about getting legal advice on the Solicitors for the Elderly website.

It might seem awkward to discuss these things, but it’s better to discuss possible scenarios before you’re make changes that could be costly and stressful. Thinking about this in advance might help to reduce stress and help you make affordable choices.

For hints and tips, see our Talking with older people about money guide.

Respite care, Intermediate care and sheltered housing

Other forms of care you might want to investigate include:

  • Respite care – this involves short-term care, either at home or in a care home. It can be suitable if you’ve been ill or had an operation.
  • Intermediate care – an NHS service that provides temporary care, free of charge for up to six weeks, when you’re discharged from hospital.
  • Sheltered housing – a type of ‘housing with support’ that can be rented or bought.

Useful contact and more information

In Northern Ireland

Find more details on residential care and nursing homes on the nidirect websiteopens in new window.

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