How to Choose a Care Home: A Step-by-Step UK Guide

Start with a care needs assessment, not with a shortlist

A care needs assessment from the local council establishes what help the person actually needs. It is free, it does not depend on income, and anyone who appears to need care can ask for one. The assessment is what tells you whether the answer is a residential care home, a nursing home, or care at home.

Families who skip this step often shortlist the wrong kind of home. A home registered for residential care cannot lawfully provide the nursing care a person may need in a year’s time, and moving someone again is the outcome everybody wants to avoid.

Work out who pays before you fall in love with a home

Funding decides which homes are realistic. The council carries out a financial assessment, separate from the needs assessment, to work out what the person contributes. Some care is paid by the NHS instead of the council where the need is primarily a health need.

Knowing the budget first prevents the most painful version of this process, which is choosing a home the family cannot sustain for more than a year.

Shortlist on care type, location and regulator rating

Three filters remove most of the list. First, the home must be registered for the type of care needed. Second, it must be close enough that the people who will actually visit will actually visit, because visiting frequency predicts quality of life better than décor does. Third, check the current regulator rating and the date it was given.

• Registered for the right care type: residential, nursing, dementia, or a combination
• Within a realistic travelling distance of family, not of the person arranging care
• Current regulator rating, plus the date of the inspection that produced it
• Whether the home accepts the funding that will actually pay the fees

What to look for when you visit

Visit at least twice, and make one visit unannounced if the home allows it. Arrive around a mealtime. Most of what matters is visible in twenty minutes if you watch the staff rather than the building.

• Do staff speak to residents by name, and do residents respond to them?
• Are residents dressed, out of bed and doing something, or parked in front of a television?
• Does the home smell of urine or of air freshener covering it?
• How long do call bells ring before someone answers?
• Ask what the staff turnover was last year, and how many agency staff work nights
• Ask to see the most recent inspection report, and what has changed since

Questions worth asking the manager

The manager’s answers matter less than whether they know the answers without checking.

• What is the ratio of staff to residents on a night shift?
• What happens if the person’s needs increase — can they stay?
• How much notice do you give of a fee increase, and how much was last year’s?
• Are there any charges on top of the weekly fee?
• How do you involve families in care planning?
• What is your policy on visiting, and were there restrictions in the past year?

Read the contract before you sign

The contract is where avoidable disputes begin. Look for how fees rise, what notice each side must give, what happens to the fee if the person goes into hospital, and what happens if the person dies — the number of weeks charged afterwards varies considerably between homes.

A home that will not send the contract in advance is telling you something useful.

Common questions