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Care home or home care?

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 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.

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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 might 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 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.

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 aren’t 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 carers might change. The agency you use will probably try to send the same person every time. But they might 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.

  • 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 might need a cleaner, a gardener or need hairdresser to visit.

  • Home modifications and equipment might affect the value of your property – depending on how they look.

  • Quality of care can vary. You can check the quality on the Care Quality website

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.

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.

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 don’t qualify for local council 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 as independently as you can. You might lose some 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.

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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’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

Care home costs

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

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 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 dependant 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

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.

Respite care, intermediate care and sheltered housing

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Looking for us? Now, we’re MoneyHelper

MoneyHelper is the new, easy way to get clear, free, impartial help for all your money and pension choices. Whatever your circumstances or plans, move forward with MoneyHelper.

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Looking for us? Now, we’re MoneyHelper

MoneyHelper is the new, easy way to get clear, free, impartial help for all your money and pension choices. Whatever your circumstances or plans, move forward with MoneyHelper.

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