Choosing a care home






   Oxford Dementia Centre

   Institute of Public Care

   Roosevelt Drive

   Oxford OX3 7XR

   Tel: 0845 120 4048












This fact sheet offers information after the difficult decision has been made that it is time for the person you care for to move into a care home. It will provide guidance on selecting a suitable care home.


You may also find the following fact sheets useful


·        Making the decision about future plans for care

·        How will the cost of a care home be paid for?

·        Visiting a care home


The role of your local authority social services

A full assessment of someone’s needs is essential in finding a suitable care home.  Ask for an Assessment of Need for the cared for person from your local authority social services department.  This used to be called a Community Care Assessment but is now called a Single Assessment.


The local authority is responsible for:


·        Arranging care for a person assessed as needing care in a care home

·        Arranging funding for people who are assessed as needing financial assistance.


Before you decide on which homes to look at check whether the person will be:


·        Totally Self – Funding

·        Partly Self - Funding

·        Fully Funded


Accommodation if you are self-funding


The person you care for will have the widest choice of care homes and still have a right to help from social services in finding an appropriate placement.




If they can afford to pay for a home themselves now, what will happen in a few years time?  If there is a chance that you may need help from the local authority, it is highly recommended that an assessment be carried out before you make any private arrangements.


Many care home accountants will want to know that someone has two years fees in the bank before agreeing to a placement.  Fees add up very quickly for example if you are paying £650 a week for a home this is £33,800 a year.  Two years fees would mean £67,600.


If the funding of the person you care for drops down to a level where they are entitled to Local Authority assistance and the person you care for is in a preferred social services listed home, there may be less chance of them having to move.


Accommodation for local authority assisted funding


If the Local authority are assisting with Part Funding or Full Funding of the care home fees the carer and cared for person have the right to choose the home the cared for person is moving into (National Assistance Act 1948) as long as


  • You choose a care home that the Local Authority agree can meet the persons needs.
  • The cost of the home is not more than the authority would usually pay
  • The accommodation is available.
  • The chosen home and the local authority agree to enter into a contract, which would be subject to the authority’s usual terms and conditions.


Additionally - Third Party Top Up Fees are available if the cared for person is receiving financial assistance form their local authority. This is a special provision made if you want to choose a home that costs more than your local authority would usually pay. 


Someone else may pay a third party top up fee: this is usually a family member or friend, or a charitable organisation. If this is an option being considered you will need to think what would happen if the home increased the fees.  Would the local authority have a responsibility to cover part of the fees increase?  How long would the “third party” be able to carry on paying?


Government Guidelines recommend that local authorities have a written agreement with the cared for person (resident), third party (relative or charity) and the person providing the accommodation (care home) when they wish to use their right to have more expensive accommodation (to use third party top up fees) and this agreement specifies:


  • Failure to keep up payments would normally result in the resident having to move to other accommodation.
  • The resident is subject to the 12 week disregard – during which the resident can top-up his or her own fees.
  • An increase in the resident’s income will not necessarily change the need for a contribution (from the third party) because the residents own income will be subject to charging by the authority in the normal way.
  • If the accommodation fees increase, the local authority will not automatically pay an equal share of the increase.

·        If the accommodation breeches its contractual conditions, the authority has the right to terminate the contract.


If the person you care for was a teacher, in the armed forces, or a member of a professional body there are charities such as SAFFAA who may assist with care home fees.


Make sure that any special circumstances are considered in the assessment


These issues need to be included in the decision making process:


  • Is the home close enough to the person you care for? e.g.  if you cannot drive, or if you are elderly yourself
  • If there are religious reasons for wanting to move into a certain home (eg the person you care for wants to move into a Roman Catholic home)


Many care homes will have a waiting list; find out how long the person you care for may have to wait before a place is available. In many areas the number of care homes has decreased which means that there are fewer care home places.


As dementia progresses people usually need increasing care and support


Ask the care homes you visit if they can cope with people with more advanced dementia or the person you care for may have to move later on? Some homes are able to provide residential and nursing home care (called dual registered homes) which would be an important consideration if you want the care home to be a home for the rest of the persons life.


Going into a residential care home from hospital


You still have the right to choose which care home you will move into.  Finding the right one takes time and energy, and the hospital staff should understand this.  Often because of bed shortages staff feel pressured and want you to make a decision quickly.  Remind them of your right to choose.  There is detailed advice on hospital discharge and the NHS complaints procedure in the Age Concern Fact sheet 37 Hospital Discharge Arrangements.  You could get in touch with Senior Line 0808 800 6565, your local Community Health Council or Patient Advisory Liaison Service.


Care homes divide into two types

Care home is a general term used to describe an establishment that offers care or nursing care, twenty four hours a day, seven days a week to a person who lives on the premises.


Those that offer nursing care used to be called nursing homes.  Those that don’t offer nursing care used to be called residential homes. The “old” terms are often still used.


Often when you visit a home, there appears to be little difference between the two (nursing home and care home), although sometimes staff make distinctions with different types of uniform. More expensive nursing care does not always indicate the quality of care and many people with dementia live in care homes without nursing care being on site.


The difference comes down to whether the person has health care needs that can only be met by nursing staff. Nursing homes must have a registered nurse on duty at all times and must have more staff to meet more complex needs. They are therefore more expensive. If nursing care is assessed as being necessary under the Health and Social Care Act 2001, or National Health Service Continuing Health Care Needs the cost of health care will be paid for by the NHS.


The role of Health


In 2001, the government brought in new legislation so that nursing care provided to people in care homes, is free, to people who are Self Funding.  The NHS now meets the costs of registered nurse time spent on providing, delegating or supervising care in all settings. The intention of this is to get rid of the anomaly of people having to pay for care in a nursing home that would be free in residential accommodation or at home.


If you think that the person you are caring for has health needs and may need to be considered for nursing care whether they are self funding or not, they will need to be assessed for the Registered Nursing Care Contribution (RNCC) by a nominated NHS nurse who will decide what level of nursing care the person needs and which of three bands of nursing care needs, the person will be placed in. If they are in the low nursing need category, they may just need a district nurse input and would not necessarily need a nursing home. However if they are placed in the medium or high bands a nursing home placement is likely to be more appropriate and this should all be part of the Single Assessment.


Nursing care is not paid for by the local authority, or the individual, it is paid for by the NHS through the cared for persons Primary Care Trust.

If the person is assessed as needing 100% nursing care


There will be no charge to pay.  Your health authority will carry out the assessment based on their eligibility criteria to determine if the cared for person qualifies for Continuing NHS care.  The eligibility criteria is arduous. If assessed as being eligible the person you care for will not have a choice of accommodation, it is the specialist or consultant who will say what nursing home can meet the needs of the person.


Finding the right home in your area


·        Commission for Social Care Inspection (CSCI) This used to be called the Care Standards Commission.  All care homes have to be inspected twice a year.  Reports on all registered homes are available from the CSCI.

Telephone line to order inspection reports 0870 – 2407535.

CSCI website to view reports.

·        Your local social services department – Will have information and advice about local homes in your area.  They usually have a directory of care homes.  You will be able to find the number in your Yellow Pages.

·        DISC has a list of organisations that will provide further information.



We are constantly looking to improve our information.  It helps if you let us know whether the information in this fact sheet was/was not useful and if there are other fact sheets that you would have found helpful that we have not yet provided.


While the information contained in these fact sheets is believed to be correct DISC does not accept liability for any error/s it may contain.