Care home or home care: a comparison of elderly care options

97% of us don’t want to go into a care home. Thankfully, private care at home is a cheaper and more personalised alternative – which is also better for health and wellbeing

What’s best for your elderly relative – care at home, or a care home? In this article, we’ll explore the two options in detail, including some of the main benefits and drawbacks. While we can’t tell you what’s the right fit for you, we hope to provide enough information for you to make an informed choice.

Home care and care homes – what’s the difference?

While the two sound similar, they are completely different.

For the purposes of this article, when we refer to ‘home care’ or ‘care at home’, we mean receiving support from Care Professionals in your existing home. In many situations, this support is provided by other family members or volunteers rather than professionals – although this isn’t something we have discussed in detail here.

Meanwhile, ‘care home’ is a broad term, encompassing residential homes and nursing homes that a person typically moves into when their needs demand it. This move may or may not be permanent.

Benefits of home care

Most people want to be cared for at home

Home care is the most popular option amongst elderly people who need care. Most people want to receive private care at home.

97% of people surveyed said they don’t want to go into a care home when they’re older (OnePoll, 2014), and 71% of us would prefer to reach the end of their life in our own home.

Home care is proven to be better for health and wellbeing

A number of studies have shown that person-centred care at home has a greater positive impact on wellbeing, happiness and reduced hospital admissions than admission to a care home. Leading care agency The Good Care Group recently published a detailed report on this topic, combining academic research with their own results.

Perhaps for this reason, it is the aim of the NHS to keep people out of residential care and in their own homes for as long as possible. Home care also forms an important part of the World Health Organisation’s 2020 strategy.

Home care is more cost-effective

Contrary to popular belief, home care is typically cheaper than going into a residential care home or nursing home.

In addition, if you are living in your own home, its value will not be included in means-test asset calculations which decide if you qualify for public funding.

Home care is better for those living with dementia

Those with dementia in particular benefit from private care at home. This is partly from being around their own belongings in a place full of memories and stimuli (such as photographs and books). A 2013 study showed that dementia sufferers who live at home experienced higher activity levels, quality of life and social connectedness than those living in institutional care. The study’s recommendation was that people with dementia should be cared for at home wherever possible.

Home care maintains independence

It is harder to maintain a sense of independence and self when you are institutionalised, particularly if the decision to go into a home was not yours. By being supported at home, elderly people can continue living aspects of their previous life, surrounded by reminders of the life they carved out for themselves.

Support at home is designed to meet your needs

Support can be tailored to the caree’s needs and adjusted over time to fit a changing situation. For example, you might start with a few hours twice a week to help with tasks like shopping and cleaning – then move up over time to daily care, or even a live-in Care Professional. You can always transition to a care home later if you feel it’s necessary.

You have more direction over the care

If you’re working directly with self-employed caregivers, you can hand-pick the individuals looking after yourself or your loved one – so you can be sure they’re the right fit. This also enables continuity of care, where routines can be learned and bonds formed.

Drawbacks of home care

A struggle to find the right Care Professionals

It can be difficult to find the right caregiver yourself. If you try to find a caregiver through personal connections, you may need to carry out background checks to check their suitability – including the right to legally work in the UK.

Your home may need significant alterations

If mobility is an issue for the person needing care, extensive adjustments may need to be made to your home to make it safe and practical. While it is possible to get funding for this kind of modification, like any other building project coordinating the work can be stressful.

You’ll need to maintain your home

Staying at home means the usual upkeep and administrative tasks will continue to exist – from paying bills to dealing with faulty plumbing. This can be more of a challenge if the person who owns the home has dementia and is unable to process these without aid – particularly if Lasting Power of Attorney has not been given to another family member in advance.

Benefits of a care home

The number of older people living with frailty is rising, as well as the number of those living with long-term physical and mental health problems. Care homes are an important part of caring for older people, with more than 400,000 older people living in independent UK care homes.

You might choose a care home if you don’t feel that living at home is a viable option anymore – or if for some other reason the person needing care must leave their home.

Care homes provide constant care

In a care home, residents receive round-the-clock care. In some places this includes support form medical professionals (although these nursing homes tend to be at the upper end of the price spectrum).

While it’s also possible to have round-the-clock care from home care professionals, you can be reassured that there are always a few extra pairs of hands around.

Care homes provide social contact

Care homes provide older people with social contact with their peers. This can be preferable to feeling isolated and alone at home.

Formally organised activities and outings also help individuals stay active and engaged, while still receiving specialist support.

Care homes are measured against external standards

All care homes are regulated, meaning that they are regularly assessed against a set of public standards. The Care Quality Commission is responsible for setting these standards and carrying out inspections. Their website contains details of their inspections, including their ratings against several important criteria – from safety to good management.

Care homes lower your administrative burden

With a care home, you’re freed from the worries of maintaining a private home. Utility bills and council taxes are all included in the overall price of living in the care home.

Care homes are often flexible

It’s possible to adjust the amount of help on hand as the caree’s needs change, since it is provided by staff who are always onsite.

Drawbacks of care home

Care homes have a bad rep

Care homes often have poor images, resulting in many people fearing the day they might go into one. This fear is likely a contributor to the statistic we mentioned earlier, that 97% do not want to go into a home.

Care home residents can experience a decline in health

A number of medical studies have suggested that a move from familiar surroundings can cause distress and a decline in health.

The average care home resident has a life expectancy of 12-30 months, and mortality rates are higher when people leave their familiar environment. It has been suggested that leaving one’s leads to a state of mind called ‘move trauma’, worsening medical symptoms and hastening decline.

Care homes are expensive

Care homes can be very expensive as a long-term care option. The yearly cost of a residential care home is minimum £65,312 a year in London and minimum £35,204 a year in the rest of the UK, based on this cost of care calculator. It is higher for nursing homes, which offer support from professional nurses: minimum £78,936 a year in London and minimum £43,316 a year in the rest of the country. We’ll cover the cost of care in more detail in the next section.

Care homes do not always have great dementia provision

People often enter a home when their needs have become too difficult to manage at home. This is often driven by behavioural challenges, with 80% of people in care homes have a form of dementia.

Despite this, according to a report from the British Geriatric Society in 2012, 41% of those living with dementia in care homes could not access specialised dementia services.

In addition, some dementia sufferers can find it distressing to be around so many others with the same condition, particularly if they have conflicting challenging behaviours.

Care home options are limited

When choosing a care home, unless you are prepared to travel to visit your relative you are typically limited by availability in your area. Quality varies hugely between care homes, and waiting lists for the best homes can be very long.

Care homes can have strict rules

As you might expect, care homes need to have a set of rules to ensure the safety of all their residents. Unfortunately, rules put in place to protect the most vulnerable can have a negative impact on those who are able to enjoy more freedom. For example, many homes do not allow couples to remain living in the same room.

Most homes also won’t take on pets, leading to a separation which can be damaging to wellbeing.

The cost of care

The cost of care homes varies by location, but the average is £42,536 per year for a residential home, and £51,376 per year for a nursing home. These numbers are based on this useful calculator. Cheaper care homes subsidised by the state often have much longer waiting times (years versus months), while the more expensive care homes may be out of reach for many people.

There is also a huge range when it comes to the cost of UK home caregivers. If you are working directly with a self-employed caregiver for companionship, you will only need to cover their pay rates – which can be as low as £10 an hour, depending on experience and average local wages. If you’re just hiring someone to run errands and for companionship this may cost as little as £10, while more intensive care like mobility support increases costs. The average is £16, but some caregivers can cost up to £30 an hour.

Which? has provided an excellent Care Calculator that helps you work out potential costs for care in your area.

Home care is typically cheaper than a care home.

Historically, care homes have been considered by many to be the only safe and practical option for those with advanced care needs. This is no longer the case, thanks to a combination of more home care organisations, more flexibility on spending care budgets from Local Authorities, and a variety of technologies and other adaptations available to make homes safer and easier to navigate. As a result, both care homes and care at home are viable options for most people requiring care.

Ultimately, whether you choose a care home or home care should be based on personal preferences and that person’s individual care needs.

If you have more questions about how home care works, or about what option might be best for you and your family, feel free to get in touch