Home Care or Care Home?

Giving up your own home and moving into a care home is not the only option for dependent or elderly people. Many people prefer to stay in their own homes and this is made possible by the help that they can get from a combination of relatives, friends and home care agencies. Local authorities and independent domiciliary [home care] agencies can also make it possible for  people to remain in their own homes for longer through the use of a range of services - some of which are free (subject to a financial assessment). Examples of such services are:

●  Adaptations to your house or loan of equipment  - for example, installation of a stair lift, making a step into a ramp, widening some doorways for wheelchair access or the loan of a bath seat, hoist or special bed.  The local authority cannot fund major house alterations - but if you own your home it may be that you could consider some form of ‘equity release’ to fund building work, or approach your district council for a “Disabled Facilities Grant” (means-tested).
●    Day care, luncheon club, or community centre.
●    Lunch clubs, including those which cater for a range of ethnic communities.
●    Laundry services.
●    Home help – also known as “Domiciliary Care” or “Home Care”.  
Services that local authorities can arrange (subject to an assessment of the person’s needs) include meal preparation/provision, basic personal care and hygiene, dressing, essential shopping and money management, assistance with laundry, essential cleaning, prompting/administering medication, assistance with mobility and ‘sitting services’ allowing a family carer to leave the dependent person in the care of someone else to do some shopping or attend to personal business.  (There are also home care agencies specialising in providing registered nursing care).
●    Carer Support schemes; including information groups, respite services and training.
●    Mobile Meals - all dietary needs can be catered for.
●    Respite stay in a care home for a short break.
●    Adult Placement Schemes - long and short stays within a small family setting.
●    Befriending Schemes - a range of schemes run by voluntary organisations.
●   Extra care schemes - ’Extra care’ or ‘very sheltered’ housing can provide higher levels of care and support on-site; for example, the provision of meals and social care services and ultimately support at night which for  users and their families is often the key factor which prevents them from remaining at home.

The reasons for choosing to live in a care home are many and varied - living independently is a goal which can be achieved for many,  but not by everyone and  regrettably it may no longer be possible for some people to continue to live on their own,  even with assistance from others.  Also, many frail people find that one of the most difficult problems to overcome at home is the social isolation that they experience -  they get no fulfilment from long days spent with little contact with others,  especially if they become unable to walk or move around without help.   For others, it may not be possible for members of their family to continue to provide full time care and support, or it may be that the extent of care needed is more than the local authority and home care agencies can provide. .  A care home can provide companionship as well as 24/7 assistance. Residents are free to go out with friends and relatives and are encouraged and helped to continue with their interests and hobbies.  It is common for people moving into a care home to re-discover what life has to offer, often making new friends and to start enjoying life again.

The help that a person receives, whether in their own home or in a care home, will be planned to meet their specific needs in such a way that Privacy, Dignity and Independence are maintained at the highest level.  In the case of home care, trained staff will visit the client’s home at arranged times during the day to help with the normal activities of daily living.  In a care home trained staff are on hand throughout the day and night to help with the normal activities of daily living,  and social events are often arranged in consultation with the people living in the care home.  Many care homes do not have 'visiting times' as such but encourage as much continuing social contact as possible between residents and their friends and family members.  

All home care agencies and care homes are registered and inspected by the Care Quality Commission (CQC) according to a set of national standards. The home care standards have been devised to ensure that the person receives the care and assistance they need in a safe and reliable way within their own home. The care home standards  have been produced to ensure quality care is given and to  avoid  residential care being  like a stay  in hospital.

Rights, Choice and Participation are also high priorities.  Whether you receive assistance in your own home or in a care home, you have certain rights including the right to be consulted about the way the care is provided.  If you are at home, it could be by contacting your social worker.  In a care home it may be by means of a ‘residents' committee’ or some other forum,  or it could be by voicing your opinions to the manager or matron.   Of course, in some cases it may not be possible for the care provider to fully meet your request  -  maybe the home care agency or the care home is not allowed to do certain things because of regulations,  or perhaps your request may involve an expense which the care provider could not justify.   Even so, if you believe that your care package ought to be improved in some way, then you have the right to bring it to the attention of a person in authority and if you are not satisfied with the response then you can complain to the CQC or social care services - a relative, friend or advocate could do this for you.  The important thing to remember is that by needing assistance with care you have not lost the right to be consulted about the way you live and that includes the right to ask for changes to be made.

There is a variety of home care agencies which vary in the type of assistance they can provide.  The extent of what each agency can do will have been agreed with the CQC, and they are monitored against that agreement. However, these do not break down into categories. So in this directory we have, in consultation with the agencies, devised a set of three care unofficial categories to help you assess which agencies may be able to help. This year we have listed over 90 home care agencies who have offices in the region registered with the CQC.

There is also variety in the type of care home and each type is designed to provide care for different groups of people.  Apart from care homes for older people, there are care homes which have qualified nurses or specialise in providing care for adults with mental health problems or physical or learning disabilities.  Other care homes specialise in the care of people with drug or alcohol problems.  In the region covered by this directory there are over 320 care homes to choose from,  ranging from small, family-run homes registered for a few residents and offering an 'extended family' atmosphere,  through to large purpose-built homes operated by national companies, as well as local authority homes.   

Some care homes also offer support to people who live nearby.  One service is known as ‘day care’ - where a person can attend the home for the day and return home at night, and there is ‘respite care’ - that involves planned stays in a care home for a short period.  These services can help support carers who may not otherwise be able to have a break, or go on holiday.  Should these services be arranged following an assessment by a social worker the local authority will ensure that services can meet the needs of the person. If you are arranging these yourself you will need to ensure that the care home is able to provide the care needed and clarify the terms and conditions.

An assessment by a social care worker for people in need of assistance, including people who are about to be discharged from hospital, will advise whether home care at home will provide the right level of support or whether returning to home is no longer advisable. If a move to a care home is advised, quite often the best way to decide what is right for you is to take time to visit a number of care homes,  perhaps for a short trial stay, or maybe a few daily visits.  All care homes offer some form of introductory period to allow a new resident sufficient time to make the right choice (but some care homes do have waiting lists).  Important decisions must be made at a time of tremendous pressure and choice could be limited.  The information in this directory is designed to help you prepare in advance by outlining the range of choices available.

The CQC publish inspection reports for every care provider so that you can see what services are expected and how the provider is rated for quality. The reports can be obtained from the care provider, CQC regional office or downloaded from their website at www.cqc.org.uk


Every effort has been made to check that the general information in this section is accurate at the time of data being submitted. Where the editorial contains information on financial matters, this information is given in good faith, and the publishers cannot accept any liability for it's suitability for any individual. The reader should consult a professionally qualified person for advice in their particular circumstances.

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