Care home or home care: how to decide

What is the difference between a care home and home care?

Home care, sometimes called domiciliary care, means that trained care workers come to your relative's own home. Visits might be 30 minutes to help with getting up and washing, or longer calls to help with meals, medication, shopping and company. At the most intensive end, live-in care means a carer lives in the home and provides support throughout the day, with breaks and some night-time help depending on the arrangement.

A care home is a place where a person lives and receives care. In England there are two main types. A residential care home provides personal care, meals and accommodation. A care home with nursing also has registered nurses on duty, for people with more complex health needs such as wound care, injections or conditions needing regular clinical monitoring.

Both types of service in England are regulated by the Care Quality Commission (CQC), which publishes inspection reports and ratings for care homes and for home care agencies. That makes the CQC website a sensible first stop when you shortlist providers.

How do you know when more help is needed?

Most families do not reach this decision in a single moment. It tends to build up through small signs. A relative may be missing meals, struggling with personal care, or leaving the cooker on. There may be falls, near misses, or confusion about medication. Perhaps they have become isolated, or a family carer is exhausted and no longer coping.

Ask yourself a few plain questions. Can your relative get to the toilet, wash and dress safely? Can they prepare food and drink? Do they recognise danger, such as a smoke alarm or an open door at night? Are they lonely? Is the person who currently provides most of the help able to carry on?

When does each option work best?

Home care

Home care tends to suit people who want to stay in familiar surroundings and whose needs can be met in planned visits. That might be someone who needs help with washing and dressing, meal preparation or medication prompts, but who is otherwise safe for much of the day and night. It can also work well for people recovering after a hospital stay, or for couples who wish to stay together at home.

Its strengths are continuity and independence. The downsides are that visits are time-limited, a person can be alone and at risk between calls, and missed calls or staff turnover can disrupt care.

Care home

A care home is often the safer choice when someone needs help at any hour of the day or night, for example because of advanced dementia, a high risk of falls, complex nursing needs, or behaviour that puts them at risk if left alone. It can also be right when the home itself cannot reasonably be adapted, or when the person is socially isolated and would benefit from company and organised activities.

The strengths are round-the-clock staffing, meals and activities in one place, and relief for family carers who can go back to being a son, daughter or partner rather than a full-time carer. The trade-offs are the loss of a familiar home, less privacy, and the need to adapt to a shared community. Some people settle well, while others find the move distressing.

How do the two options compare?

This table gives a general comparison. Every person and every provider is different, so treat it as a prompt for questions rather than a rule.

How much do home care and care homes cost?

Costs differ by region, by provider and by the amount of care needed, so we do not quote averages here. As a general pattern, a few short visits a week usually costs far less than a care home place, whereas many hours of daily care or live-in care can approach or exceed the cost of a care home. A care home fee normally bundles accommodation, food, heating and care into one weekly charge, whereas with home care you still pay for your relative's rent or mortgage, bills and food on top of the care itself.

Who pays depends on a financial assessment carried out by the local authority. In England, the means test looks at income, savings and, in some situations, property. Those with savings above the national threshold are generally expected to pay for their own care, and those below it may receive help. Thresholds are set by government and change over time, so check the current rules on GOV.UK or with your council. If you pay for your own care, you can still ask the local authority for a needs assessment and for advice.

Other support may be available. Attendance Allowance is a benefit for people over State Pension age who need help with personal care, and it is not means-tested. NHS continuing healthcare can fund care for people with a primary health need. Free NHS-funded nursing care contributes towards the nursing element in a care home with nursing. An independent adviser can help you check eligibility.

What is a care needs assessment and how do you ask for one?

A care needs assessment is a free conversation, usually carried out by a social worker or occupational therapist from the local authority's adult social care team. Under the Care Act 2014, any adult in England who appears to need care and support is entitled to one, regardless of their finances. The assessment looks at what your relative can and cannot do, the risks they face, what they want to achieve, and the help they already receive.

To request one, contact the adult social care team at the council where your relative lives, by phone or through the council website. The assessment is often done at home, and a relative or friend can be present to support them. If your relative may lack the capacity to make decisions about their care, the assessment should consider this, and the Mental Capacity Act 2005 applies.

The council then decides whether your relative's needs meet the national eligibility criteria. If they do, it prepares a care and support plan and, after the financial assessment, tells you what it will contribute. If they do not, the council should still provide information and advice about other options. If you disagree, you can ask for a review.

What if your relative wants to stay at home but needs a lot of care?

This is one of the most common dilemmas. A strong preference to stay at home deserves real weight, and if your relative has capacity, the final decision is theirs, even where you disagree. A good starting point is to ask what would make home safe enough. Options include increasing the number of daily calls, adding night checks, installing a pendant alarm or other assistive technology, adapting the bathroom, arranging meals to be delivered, or using day centres and respite stays to ease the load.

How do you choose a good care home or home care agency?

Start with the CQC's published inspection reports, but do not stop there. Visit more than once, at different times of day if possible. In a care home, notice whether residents look occupied and cared for, how staff speak to people, whether the place smells fresh, and whether there are meaningful activities rather than a television in the corner. Ask about staffing levels at night, staff turnover, how they handle falls and complaints, and how they support residents with dementia.

For a home care agency, ask whether the same small group of carers will visit, how they cover sickness, what happens if a call is late or missed, how care plans are reviewed, and whether staff are trained in dementia care. Ask for the contract in writing, including fees, notice periods and how price increases are handled.

How can you support your relative through the transition?

Involve your relative in choices as far as possible, and share a short "life story" with the care team covering their career, family, hobbies and likes, because carers who know the person provide better care. Family members often feel guilt, especially around a care home move. Choosing professional care is not abandoning someone; it is making sure they receive the right support.

How do the rules differ in Scotland, Wales and Northern Ireland?

Social care is devolved, so the details change across the UK. This article describes England. In Scotland, local authorities carry out community care assessments, and free personal care is available for adults who are assessed as needing it, which changes the cost picture, although accommodation costs in a care home still apply. Care services are inspected by the Care Inspectorate. In Wales, assessments follow the Social Services and Well-being (Wales) Act 2014, and care services are regulated by Care Inspectorate Wales. In Northern Ireland, assessments are arranged through the Health and Social Care Trusts, and services are regulated by the Regulation and Quality Improvement Authority.

If you live outside England, check with your own local authority or Trust before relying on the details above.

Frequently asked questions

Activities and games to support memory and attention

Whether your relative stays at home or moves into a care home, enjoyable mental activity can support wellbeing, routine and shared moments with family and carers. DYNSEO offers resources designed for older people and the people who support them:

• Memory games on a tablet: short, friendly exercises that your relative can play alone or with a visitor, covering memory, attention and language.
• Shared reminiscence and play: activities that help carers and family start conversations and build on what the person enjoys.
• Training for families and professionals: practical courses on cognitive stimulation and on understanding Alzheimer's disease in everyday life.

Explore SCARLETT, brain games for seniors, read about cognitive stimulation for seniors, learn about Alzheimer's disease and everyday solutions for families, or see supporting seniors differently through play. You can also browse our tools and our training courses.