How to choose a care home

If you've started searching for a suitable care home, you'll need to pick between a residential care home and a nursing home. Our guide can help you make an informed decision.

Residential care homes offer living accommodation, meals and help with personal care, such as dressing and going to the toilet. Meanwhile, nursing homes offer everything available in a residential care home, plus access to 24-hour medical care from a qualified nurse. You might also want to consider an alternative to a care home, such as sheltered housing.

Below, our experts explore when you should consider a care home, also sharing details on care home costs, contracts and inspections.

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Residential care homes vs nursing homes

If you’re unsure which is the right residential care option for you or a loved one, consider the following:

• Medical needs – In residential care homes, carers help residents manage the medication they’re taking, also providing support for day-to-day living. If a resident needs specialist medical attention, a district nurse or local GP will usually be called, or they might need to visit a hospital. Nursing homes with registered nursing staff are typically best suited to people with ongoing health needs or severe physical disabilities.
• Cost – A nursing home usually costs considerably more than a residential care home – about 40% more, on average.
• Activities – Life in a residential care home will usually be more active and varied than in a nursing home. A nursing home will inevitably have fewer active residents than a residential care home, but most nursing homes will still organise appropriate activities, such as small groups playing music or singing.
• Specialist care needs – Many care homes offer specialist support for people with health problems such as dementia, mental health conditions, visual impairment or physical disabilities. But if you have needs of this kind, it doesn’t necessarily mean you need a nursing home. Many residential care homes are registered to provide specialist support for these types of conditions, too.
• Get a needs assessment  – The first step in arranging care for an older person is usually to get a free care needs assessment from your local authority. This will provide a professional assessment of your care needs and the types of support you would benefit from.

There are also settings where you can buy or lease a house or flat in the grounds of a care home. This is known as ‘close care’, and is often set up as sheltered housing or extra-care housing. It enables you to live independently, but with the option of moving into the main care home later on, if you need to.

When should you consider a care home?

Despite what other people might tell you, don’t assume that a care home is the only option when an older person needs extra care. Solutions such as home adaptations, care at home or sheltered housing can also help.

Many people only consider moving into a care home when other options have been exhausted or are no longer suitable. But if residential care provides greater benefits for the individual than any other available option, it’s often the right choice.

If one or more of these situations is a cause for concern, it might be time to consider residential care:

• Daily living – If someone is struggling with personal care or daily tasks, such as washing, going to the toilet, cooking or eating meals, or keeping the home clean and comfortable.
• Safety – If someone can no longer live safely at home because of an increased risk of falls or malnourishment as they’re not eating properly.
• Memory problems – If someone is becoming confused or disorientated. This could include leaving the house at unexpected times or leaving the water running.
• Health needs – If someone requires intensive support for health or mobility needs. A registered nursing home might be the best option if they need specialist nursing care.
• Quality of life – When someone is feeling intensely lonely and isolated at home, moving to a care home might provide much-needed social contact and a sense of community.
• Care support – If you’re the main carer for a vulnerable older person, but you feel overwhelmed and unable to provide support, residential care might be the next step.
• Needs assessment – A social care needs assessment might indicate that moving into a care home is the best way to meet an individual’s needs.

A care needs assessment can help you or a loved one get support for day-to-day activities. See our guide – care needs assessment: how to apply and prepare

When should someone with dementia go into a care home?

Getting a dementia diagnosis doesn't automatically mean someone will need to move into a care home. With the right support and planning, they should be able to continue living at home for as long as possible. However, a care home might eventually be the best option, especially in the later stages of dementia.

If you’re thinking about a care home for someone with dementia, remember to:

1. Start the conversation with your loved one as early as possible. Try to do this while they have the mental capacity to be involved in the decision. Encourage them to set up a power of attorney, as this will enable you to make important decisions on their behalf if they lose the capacity.
2. Get a needs assessment from their local authority – this should recognise their dementia-based needs and recommend suitable care options.
3. Ensure the care home is registered to provide specialist dementia care. Check for a dedicated dementia care unit and, if it's an option, arrange a meeting with an experienced dementia carer to talk about their approach.

We've rounded up the best devices to help people with dementia or memory loss stay safer. For more, consult our guide on choosing the best memory aids.

How much does a care home cost?

According to Carehome.co.uk, the average cost of residential care in the UK is:

• £760 a week (around £39,520 a year) for residential care homes.
• £960 a week (around £49,920 a year) for nursing homes.

These prices are general averages for the UK as a whole. The actual fees can vary greatly depending on where you live, the level of support you need and the standard of facilities provided by the home.

Read our guide to care home fees for detailed information about costs.

What to consider when choosing a care home

1. Get a needs assessment

Before exploring local care homes, make sure that you (or the person you’re caring for) gets a free needs assessment from the local council’s adult social care department.

This is still worth doing even if you think you'll end up paying for your own care. It provides a professional assessment of the type of care and support that’s needed, which will help you to choose a suitable care home.

2. Make a care homes shortlist 

• Think about what's important to you – This might involve location, facilities or specialist care for a specific health problem such as dementia.
• Ask for recommendations – Does anyone you know have a relative or friend who's already in a care home, or has recently lived in one? A trusted GP or another health professional might also be able to make recommendations.
• Search online – There are online directories that let you enter a postcode and see a list of nearby care providers. For example, HousingCare is operated by the Elderly Accommodation Counsel (EAC), a national charity that helps older people make informed choices about their housing needs.

3. Read the care home inspection reports

In the UK, there are four watchdogs responsible for inspecting and reporting on care providers. The reports are publicly available.

In England and Scotland, the care regulators also give care providers a quality rating. The regulators in Northern Ireland and Wales don’t rate the providers they inspect, but you can read the inspection reports.

4. Contact suitable care homes

Contact your shortlisted care homes and talk specifics. Speak with the care home’s manager about how the home can meet your needs, and ask them to be upfront about the fees as this will help you avoid wasted visits.

The home will want to know how you're paying for care: self-funding, local-authority funded or a mixture. You might not know yet, in which case you'll need to explain the situation.

Enquire about availability of places and ask the home to send you written details of costs, together with a brochure.

5. Visit the care homes

It’s important to visit all the homes on your shortlist to get as much information as possible. If you  can, visit with a family member or friend. If you’re unable to see the care home in person, ask a representative from the home to come to you to assess your needs face to face.

When visiting a care home, you should also:

• Use your senses – Do residents look happy, well cared for and relaxed rather than slumped asleep? Do staff sit and chat with residents in a way that you and the residents like? Is there a smell of fresh air, rather than air freshener masking unpleasant smells?
• Make a surprise visit or two – Visit without notice to see what the home’s really like. For example, are sandwiches being served for supper rather than the tempting menu displayed, and is everyone in bed by 7pm?
• Consider a trial stay – If you want to see what living in a care home is like, it might be possible to arrange a trial stay for a week or two.

6. Pay attention to fees and contract terms

If your care is being paid for by the local authority and a care home suggests that a top-up fee could be paid (to cover the cost of the room, or for a room with a better view, for example), explain that you’ll talk to the local authority about this. Third-party top-up fees should always be a voluntary payment and the contract for this should be between the person paying the top-up and the local authority, not the care home.

NHS-funded Nursing Care (FNC) is another area that our research has shown is potentially being exploited by care homes. If an older person is eligible for a nursing care contribution, it’s paid directly to the care home by the NHS. So if you or the person you're caring for is going to be a self-funder, check with the care home that the fee it's quoting includes nursing costs. If FNC is then awarded, this amount should be deducted from the bill.

7. Ask the right questions

• The room – Is it suitably adapted, including the bathroom? Are there grab rails, for example, if needed?
• Communal areas and facilities – Is there a garden or other accessible outdoor space for residents and guests to use?
• Care and support – How will the home assess your care needs?
• Daily life – Can residents go to their room if they want to be alone?
• Staff – Is there a supervisor on duty at all times?

See our downloadable checklist of questions to ask a care home and start thinking about your priorities when choosing a home.

Care home contracts explained

The contract will be between the care home provider and whoever is paying the care fees. There are three likely scenarios:

• Self funding
• Local authority payment
• Shared payment

Regardless of who's paying, you have the same rights and protections under consumer law.

What should the contract cover?

Care home providers are free to use whatever terms they consider reasonable, but the law stipulates that the terms mustn't be unfair.

A good care home contract should cover:

• The type of accommodation you can expect
• The level of care and support you will receive and what will happen if your care needs change
• Full details of fees, including the notice period for any price increases
• Any deposits or advance payments required
• Any additional charges such as extra fees for meals, toiletries, laundry, hairdressing or television
• Details of any trial period, during which the resident or the home can terminate the contract at short notice
• What happens if a resident is temporarily absent from the care home (for example, if they’re in hospital)
• What is and isn’t covered by the care home’s insurance
• The terms of cancellation of the contract, both on your part and the care home’s, including the required notice period
• The complaints procedure

Checking your contract

Before making a final decision about a care home, ask to see a copy of the contract. Competition and Markets Authority (CMA) guidance states that care homes must ensure self-funding residents have received a copy of their standard contract or terms and conditions, and have time to read and understand them, before they agree to move into the home.

Ask the care provider to explain any clauses you don’t understand. If you have power of attorney for a loved one, you might need to sign the contract on their behalf.

For more general information about your consumer rights and protections, see our advice: Consumer Rights Acts 2015.

Care home inspections

Like all care providers in the UK, care homes have to be registered with the appropriate national regulator, for example the Care Quality Commission (CQC) in England and the Care Inspectorate in Scotland.

As a part of their registration, each care home has to say what types of care it specialises in, whether this is residential care, nursing care or other more specialist areas.

Alternatives to a care home

Make sure you research all the options before making a decision.

If you want to stay in your own home and maintain a degree of independence, home care services and other help at home could provide the assistance you need.

When staying at home is no longer viable, moving into sheltered housing might be more suitable. For those who need regular support with personal care, think about assisted living or extra-care housing schemes. These are purpose-built retirement communities that also provide access to care and support.

If a family member or friend is willing to provide support, another possible solution might be to share your home or move in with them.