How to choose the right care for an older relative
By sima kornbluth · Published 2025-12-08 · Last reviewed 2026-09-18
Choosing the right care starts with what your relative needs and wants, not with a list of homes. Ask the council for a free needs assessment, involve your relative in every decision they can make, compare care at home, specialist housing and care homes against their needs, check inspection reports, and understand costs before committing. If they cannot decide, the choice must be made in their best interests.
The right care for an older relative is the option that meets their needs safely while fitting, as far as possible, how they want to live. The best way to get there is a step-by-step process: get a proper assessment of needs, put your relative's wishes at the centre, compare the realistic options, check quality, and understand the costs before signing anything.
This guide focuses on England, with notes on the other UK nations. It is general information; get personal advice on money and legal questions.
Step 1: What does your relative actually need?
Start with a free needs assessment from the council's adult social care team. Anyone can ask for one, whatever their income. It looks at everyday tasks, such as washing, dressing, eating, moving around and staying safe, and at what matters to the person, such as keeping in touch with friends or staying in their community.
Before the assessment, it helps to write down:
- what your relative struggles with, and at what times of day or night
- recent falls, hospital stays or near misses
- how much help family members give now, and whether that can continue
- any health conditions that need nursing or specialist care, such as dementia
If you are a family carer, ask for a carer's assessment too.
In Scotland and Wales the council carries out the assessment; in Northern Ireland it is the Health and Social Care Trust.
Step 2: What does your relative want?
It is their life and, if they can make the decision, it is their choice, even if the family would choose differently. The Mental Capacity Act (which applies in England and Wales) starts from these principles:
- assume a person can make their own decision unless it is shown they cannot
- help them to make it, for example by explaining options simply and at a good time of day
- do not treat them as lacking capacity just because a decision seems unwise
- if they cannot decide, any decision made for them must be in their best interests and the least restrictive option
If your relative lacks capacity to decide where to live, the decision is made in their best interests, involving family and any attorney under a health and welfare lasting power of attorney. Scotland and Northern Ireland have their own mental capacity laws built on similar principles.
Step 3: Which options could meet those needs?
Work through the options from least to most change, and ask whether each could realistically work:
- More help at home: visiting carers, equipment, a personal alarm or home adaptations.
- **Live-in care**: a carer living in the home.
- Day centres and respite: to support a family carer who wants to keep going.
- Specialist housing: sheltered or extra care housing, with support on site.
- **A residential care home**: 24-hour personal care.
- **A nursing home**: 24-hour care with registered nurses on duty.
Questions that help you decide
- Does your relative need help at night, or only at set times of day?
- Do they need nursing care, or personal care only?
- Are they lonely at home, or strongly attached to it?
- How much longer can family carers keep going?
- If needs increase, could this option adapt, or would they have to move again?
Step 4: How do we check the quality of a provider?
Whatever type of care you choose, check the regulator's latest inspection report:
- England: the Care Quality Commission (CQC), which rates services outstanding, good, requires improvement or inadequate
- Scotland: the Care Inspectorate
- Wales: Care Inspectorate Wales
- Northern Ireland: the RQIA
Then visit, or meet the agency, more than once. Look at how staff speak to people, whether residents seem occupied and comfortable, and how open the manager is about staffing and complaints. The NHS guide to care homes has a useful list of things to consider.
Step 5: How will the care be paid for?
Understand the funding before you commit:
- Council support depends on a financial assessment. In England, people with capital above the upper limit usually pay in full.
- The home is not counted if your relative receives care at home, and is ignored for the first 12 weeks after a permanent move into a care home.
- NHS Continuing Healthcare covers the full cost for people whose needs are mainly health needs; ask for a checklist assessment if needs are complex.
- Attendance Allowance is not means-tested and can help with costs.
- In Scotland, personal and nursing care payments are made to everyone assessed as needing them.
If you choose a care home that costs more than the council's budget, a relative or friend may be asked to pay a top-up, under a written agreement.
What if the decision has to be made in hospital?
Hospital discharge can feel rushed. Staff should plan discharge with the patient and family. Many people go home, sometimes with short-term reablement or intermediate care, which is free and usually lasts up to six weeks. That can give time to see how your relative manages before a long-term decision is made.
If a care home is suggested straight from hospital, ask whether it is a short-term placement, who is paying, and when the long-term assessment will happen. Ask whether an NHS Continuing Healthcare checklist has been considered.
Step 6: Make the move and keep reviewing
Care needs change. Whatever you choose:
- agree a trial period, especially for a care home
- read the contract carefully, including notice periods and fee increases
- ask for the care plan to be reviewed regularly, and after any hospital stay
- keep talking to your relative about how it is going
Frequently asked questions
Who has the final say on where my parent lives?
Your parent does, if they have the mental capacity to make that decision. If they do not, it must be made in their best interests, involving family and anyone with a health and welfare lasting power of attorney.
Do we have to accept the care home the council suggests?
No. In England you can choose a home, as long as it can meet the assessed needs. If it costs more than the council's budget, someone may need to pay a top-up.
How do I know if my relative needs a nursing home rather than a residential home?
The assessment will show whether they need care from a registered nurse. If they do, a nursing home, or a home offering both types of place, is usually needed.
Is it better to try more help at home first?
Often, yes, if it is safe. Many people prefer to stay at home, and more support, equipment or reablement may make that possible. A care home becomes more likely when needs are round-the-clock or carers cannot continue.
Can we change our minds after choosing?
Yes. Care arrangements can change as needs change. Check notice periods in any contract, and ask for a review if the arrangement is not working.
Key takeaways
- Start with a free needs assessment, and a carer's assessment for yourself.
- Put your relative's wishes first; if they cannot decide, act in their best interests.
- Compare options from least to most change against real needs.
- Check inspection reports and visit more than once.
- Understand the funding before signing, and keep the arrangement under review.