Care home or home care?

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 and out of the bath.

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

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.

HOOP (Housing Options for Older People) have a useful online tool to help you assess the suitability of your current home.

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

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 providing 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’re not allowed to direct, supervise or control their carers’ work. That would be your responsibility. And if you’re not satisfied with the standard of care you’re getting, it could make it more difficult to complain.

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.

There are dual-registered care homes that accept residents who need either personal care or nursing care. This is useful if a resident's initial personal care needs escalate into nursing care needs, so the individual won’t have to change homes.

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

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.

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’ll 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 might 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 get an estimate of home care costs in your area by using the Cost of care calculator on the Which? website

According to Laing & Buisson care for Older People UK Market Report 2020, the average annual UK care home fees in 2019-20 were:

• Residential (Frail older) -£34,686
• Residential (Dementia) - £35,464
• Nursing (Frail older) - £48,048
• Nursing (Dementia) - £49,712

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. The cost will be affected by the location, quality and service offered, too. 

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

You could end up paying for all your care, some of it or nothing at all.

This will depend initially whether your needs are mostly health-related or more to do with daily living. For example, getting dressed, eating and mobility. The latter is known as social care and how much you have to pay will be dependent on where you live in the UK and the level of your financial assets and income.

Make sure you claim for the help you qualify for:

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

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’s 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?
• Do you qualify 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 make changes that could be costly and stressful.

Thinking about this in advance might help to reduce stress and help you make affordable choices.