Home Care or a Care Home? How to Compare Them for Your Parent
This decision usually arrives at the worst possible moment. Someone has had a fall, or come out of hospital, or a GP has said the words nobody wants to hear, and a family who have never thought much about care suddenly have a fortnight to decide.
The comparison most families run is a care home against a few hours of visiting care, which is not a fair comparison at all. Here is a more useful way to think about it.
Start with the honest question
Not "which is cheaper" but "how much support does Mum actually need, and when?"
Someone who needs help getting up, help at bedtime and someone looking in at lunchtime is comfortably supported at home. Someone who cannot safely be left alone at any point in the day needs either live-in care or a care home, and that is where the real comparison sits.
If your parent is somewhere in between, visiting care at home almost always wins on cost and on quality of life. The comparison below is for families facing the bigger decision.
What each option costs
Care home fees in England for someone paying their own way average around £1,300 to £1,400 a week for residential care, and around £1,500 or more for nursing care. Specialist dementia nursing costs more again. Over a year, that is roughly £67,000 to £78,000.
Those are averages and the regional spread is wide. The South East sits at the top of the range and the North East at the bottom.
Live-in care, where a carer lives in your parent's home, costs around £200 a day with Gladys, which is around £1,400 a week. So for one person, live-in care and a residential care home cost broadly the same.
Two things families rarely know when they start comparing:
Self-funders usually pay more. People paying privately typically pay more than the council pays for an identical room in the same home. Care homes do not tend to advertise this.
For a couple, the maths changes. Two people in a care home means two sets of fees. One live-in carer can often support both at home.
Our comparison of live-in care and care homes and our guide to what home care costs go into the numbers in more detail.
To compare the two properly you need a real figure for care at home, not an average. Request a callback and we will work one out for your mum or dad.
What care home fees do and do not include
Fees usually cover a room, meals and personal care. They often do not cover hairdressing, chiropody, toiletries, some activities and trips out. Ask for the list of extras in writing.
Ask two more questions that catch families out: how much have fees risen each year for the last three years, and what happens to the fee if needs increase? Moving from residential to nursing rates within the same home can add several hundred pounds a week.
The part that changes the arithmetic
For care at home, the value of the house your parent lives in is not counted in the council's financial assessment. For a permanent move into a care home it normally is, unless a partner or certain relatives still live there.
So the two options do not just cost differently. They affect the family's assets differently. Our guide to whether you have to sell the house to pay for care explains how this works.
When a care home is the right answer
We arrange care at home, so read this section as us arguing against our own interest. It is exactly why it is worth reading.
A care home is often the better choice when:
Nursing needs are genuinely clinical. Complex wounds, complicated medication, or conditions needing a registered nurse on hand every day.
The house cannot be made to work. Stairs that cannot be adapted, a bathroom that cannot be reached, or no room for a live-in carer.
Someone needs eyes on them at all times. A live-in carer sleeps. If the risk at three in the morning is real and constant, a setting with staff awake through the night is safer.
Loneliness is the main problem. Some people are happier in a care home. Company, structure and people around them can transform someone who has been alone for a long time, and pretending otherwise helps nobody.
When care at home tends to work better
Continuity matters more than facilities. The same one or two people, who know how your mum takes her tea and what her grandchildren are called.
The person is settled where they are. This matters particularly with dementia, where familiar surroundings do a great deal of work and a move can set someone back. Our guide to dementia care at home versus a care home covers this in depth.
A couple want to stay together. Often the deciding factor, and not only for financial reasons.
Needs are likely to change. Care at home can increase or reduce as needs change. A care home place is broadly all or nothing.
The person still has a life locally. A neighbour who calls in, a church, a garden, a dog.
The comparison worth doing
Get three real numbers rather than three averages:
A written fee quote from two care homes you would genuinely consider, including extras and the annual increases over the last three years.
A written quote for the care at home that would actually meet your parent's needs, based on an honest assessment of the hours rather than a hopeful one.
The financial assessment position in both cases, including whether the house would be counted.
Then ask your parent what they want, and give that real weight. Most older people, asked directly, want to stay at home. That is not always possible and it is not always right, but it should not be dismissed as sentiment.
Questions families often ask
Can my parent try care at home first and move to a care home later?
Yes, and many families do. Starting with care at home does not rule out a care home later. The important thing is to review how it is going regularly rather than letting things drift.
What happens to my parent's pension if they move into a care home?
If the council contributes to fees, most of your parent's income goes towards the cost, and they keep a Personal Expenses Allowance of £31.80 a week in England. If they pay their own way, their income and savings fund the fees directly.
Does NHS Continuing Healthcare pay for care at home as well as care homes?
Yes. If your parent has significant ongoing health needs, NHS Continuing Healthcare can fund care in full wherever they live, and it is not means-tested. Families are not always told about it, so it is worth asking.
Can we visit a care home without an appointment?
Yes, and it is worth doing. Visiting at a mealtime, unannounced, tells you more about daily life in a home than a planned tour.
Talking it through
We cannot help you choose a care home. What we can do is tell you honestly what care at home would look like for your parent, what it would cost, and whether we think it would work. If a care home is the better option, we will say so.
Call 01225 63 77 19, request a callback, or read how Gladys works first.
