A care home is a communal setting where nursing, and or personal care, and accommodation are provided together. The accommodation is purpose built and residents have their own bedroom, usually with an en-suite bathroom. All meals and refreshments are provided, as are housekeeping services such as laundry and cleaning.
Care homes include communal areas such as lounges and dining rooms and often have a garden or other outdoor space. Some offer hair salons and cafes or a bar. Family and friends are welcome to visit (although restrictions were put in place during the COVID-19 pandemic) and residents can expect to have regular social activities organised for them. These homes provide 24-hour care and visits from GPs, dentists, physiotherapists and other providers can be arranged.
There are two main categories of care homes for older adults: care homes that provide nursing care in-house are generally known as nursing homes and those that provide personal care, but not nursing care are generally known as residential care homes.
For many people a care home is their sole place of residence and although they do not legally own or rent their accommodation, it becomes their home. The size of care homes can vary considerably. The average number of beds is 29.5 per care home but the range is from a single bed to 215 beds.
Care homes actually offer accommodation rather than ‘housing’ because it is neither self-contained nor offers security of tenure through tenancy or ownership rights. Care home residents are licensees and are only entitled to minimal notice to leave. They pay an inclusive charge for accommodation, care, food and other services.
Residential care homes
Residential care homes may also be known as care homes without nursing, rest homes or convalescent homes. These homes offer personal care. Personal care involves physical assistance, or prompting with supervision, given to a person in connection with:
- eating or drinking
- using the toilet
- washing or bathing
- dressing
- oral care
- the care of skin, hair and nails (with the exception of nail care provided by a chiropodist or podiatrist).
Nursing homes
Nursing homes may also be known as residential nursing homes, care homes with nursing care or convalescent care with nursing. Nursing homes that offer specialist dementia care have also been known as elderly mentally infirm (EMI) nursing homes. These homes offer personal care with the addition of 24-hour support and care by registered nursing staff, providing medical support that is not routinely available in a residential setting. Nursing care includes any services provided by a nurse and involving:
- the provision of care; or
- the planning, supervision or delegation of the provision of care, which needs to be provided by a nurse.
Care homes can also be dual registered which means that they offer both personal and nursing care.
Number of care homes and care home beds
In 2018 there were approximately 11,100 care homes for older people and those living with dementia. Of these, 42% were registered nursing homes and 58% as residential homes. These homes have the capacity to support 416,000 older people.
There has been a decline in the number of beds per 100 people aged 75+. Care homes (including residential and nursing) have seen a decline from 11.3 down to 9.6 per 100 between 2012 and 2020 (Nuffield Trust, 2021).
Who do care homes for older adults support?
Care homes provide accommodation and care for people who need substantial help and support with their personal care. Trained staff care for residents 24 hours a day. People usually move into a care home when it is no longer feasible for them to live more independently, even with care provided at home.
Residential homes support people who do not need 24-hour nursing care but are unable to care for their own daily needs and so cannot live independently. They can also offer emergency, respite, short-term, long-term and palliative (end-of-life) care to older people.
Nursing homes are particularly suited to people who are less mobile, very frail or have a medical condition or multiple conditions that require regular attention from a nurse. Individuals who need two people to help them transfer, e.g. from bed to chair, or from a chair to the toilet may also need a nursing home because of the higher staffing levels.
Most people living in care homes have multiple health care needs and this may include sight or hearing loss, ‘frailty’ and limited mobility. Age UK report that 70% of people in care homes have dementia or severe memory problems and 60% have a mental health problem. Older people living in a care home are likely to have a high level of dependency and require support with activities of daily living.
Funding
Residents in care homes do not own or rent their room, rather fees are paid to cover costs. These fees can be paid via three key funding sources:
Self-funding
The 2021 savings and assets threshold in England is £23,250. If a person has savings and assets above this they will need to pay for their own care home costs and are known as self-funders.
Local authority funding
People with capital below the savings and asset threshold can get financial support from their local authority, which will pay some or all of their care home costs. This support is means tested. In England, nearly half (46%) of care home residents are part or fully funded by their local authority. This proportion varies by region. When fees paid by a local authority do not cover the fees for that home and a person or their family pay for the rest of the fees, this is known as a ‘top-up fee’.
NHS funding
If a resident’s needs are primarily health based, the NHS may arrange and pay for care home costs under NHS continuing healthcare (NHS CHC). If they do not meet the criteria for NHS CHC, but require nursing care, the NHS pays a contribution towards the cost of the nursing care directly to the nursing home. This is called NHS-funded nursing care (NHS FNC).
In 2021 the average weekly cost of residential care is £704 and for a nursing home is £888. Fees for care homes in England vary and have been found to be highest in the South East.
Currently, the care homes sector is heavily dependent on self-funders and typically, a self-funder will pay more than a local authority for the same care home.
Regulation
Each of the four countries in the UK has its own regulatory body. In England, the Care Quality Commission is the independent regulator of health and social care and inspects and rates residential care homes and nursing homes.
Commissioning
Local authorities: The Care Act 2014 places duties on local authorities who are responsible for commissioning care places for those in their communities who are eligible for public funding support. They also provide advice on available places both for those going into local authority-funded places, and for those who are self-funding.
Clinical commissioning groups (CCG): The CCG’s role is to commission NHS Continuing Health Care (CHC) from nursing homes.
Ownership
Care homes can be run by the private sector, local authority, the NHS or voluntary sector (not for profit). Figures for UK are shown in the table below. Over 80% of all care homes beds are in the private, for-profit sector.
Care home beds by sector
| All care homes | Residential homes | Nursing homes | |
| Private sector | 82.6% | 73.5% | 90.2% |
| Local authority | 3.9% | 7.9% | 0.6% |
| NHS | 0.3% | 0.6% | 0.1% |
| Voluntary (not for profit) | 13.1% | 17.9% | 9.1% |