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Residential and nursing home care

If the person you are caring for is unable to continue to live at home or you are unable to continue to care for them, you may need to think about residential care.

There are two types of residential care:

residential homes - for people who need help with personal care
nursing homes - for people who need both personal and nursing care.

This section looks at:

  • how you feel about residential care
  • paying for residential care
  • choosing a residential or nursing home.

You can get help and advice from the Carers National Association CarersLine on 0345 573 369 or:

  • a Citizen’s Advice Bureau
  • a Welfare Rights Unit
  • a disablement association
  • an Age Concern branch
  • a carers’ project
  • your local council’s social services department.

In Scotland, social services are managed by the local regional council and the social services department is called the social work department.


In Northern Ireland, social services are managed by the Health and Social Services Trust.
These should all be listed in the phone book. If you can’t find the phone number ask at your local library or council offices.


The Residents and Relatives Association supports relatives of people in nursing and residential homes and long-stay hospitals. 

They can be contacted at:

5 Tavistock Place
London WC1H 9SS

Tel: 0171 916 6055.

How you feel about residential care

From your point of view as a carer, residential care for the person you are looking after might be a difficult option to consider. It’s easy to feel as though you are rejecting someone or giving up on them. Many carers feel guilty or that they have failed in some way if the person they are caring for goes into a residential or nursing home.

But it’s important to remember that you can only do so much as a carer. If the person you are caring for is unable to look after themselves any longer and/or you are unable to provide the care they need for whatever reason, residential care is a sensible and realistic option.


If you have considered all the alternative options and residential care still seems to be the best one overall, you should be happy in your own mind that you are doing the right thing. It’s better to arrange proper care for someone than to struggle on regardless until you reach crisis point. Ideally, you should be able to talk openly and honestly about this with the person you are caring for.

They may accept the situation more readily than you expect and be prepared to make the decision to go into residential care, perhaps with various reassurances. For example, they may want to be in a home near you or in the same home as a friend.


If the person you are caring for is unwilling to discuss the situation, it may help for you to talk it over with someone else who isn’t involved - a friend, someone who has been in the same situation, or perhaps a professional such as your GP or a social worker.

One of the agencies listed above might be able to give you advice and support.


You can also ask the social services department of your local council* to carry out an assessment to determine whether or not residential care is needed.


If the person you are caring for is mentally incapable of making decisions about their own future, you will have to decide on their behalf, perhaps with the help of other family members.

Paying for residential care

Residential care is expensive and most people can’t pay for it themselves. The local authority* is responsible for paying the fees if:

  • they decide the person needs residential care and
  • the person has less than a certain amount of money.

Nursing home care is sometimes paid for by local health authorities.

The rules about paying for residential care are very complicated. The information which follows is a summary. If you need more advice or information, ring CNA’s Carers Line or contact one of the agencies listed above.

Paying for a residential home

Whether or not the person you are caring for will pay for their own residential care will depend on how much they have in capital assets. Capital assets include savings, investments and, in some cases, property.

Less than £16,000 in capital assets

If the person you are caring for has less than £16,000 in capital assets, they can apply to the social services department* for help with the fees.

More than £16,000 in capital assets

If the person you are caring for has more than £16,000 in capital assets, they have to pay the fees for a residential home themselves. As soon as their assets go below £16,000 they can apply for help with the fees.

Property

If the person you are caring for owns their own home, its value can be counted as part of their capital assets and they will be expected to sell it to pay the fees. The social services department* cannot force anyone to sell their home, but if it isn’t sold they have the power to claim back the cost of residential care owed to them when it is eventually sold, for example, on the death of the person who has been in care.


Property is not counted as part of someone’s capital assets if:

  • they are going into residential care temporarily, for example, for convalescence or respite care.
  • their partner still lives there or another relative who is aged 60 or over or who is disabled also lives there.
  • a child under 16 for whom the disabled person is responsible lives there.

The local authority* also has the discretion to ignore the value of a property if someone else lives there even if they do not fit into any of the categories listed above. This means that if you live in the property as a carer, the local authority may decide to ignore the property as an asset and the person you are caring for will therefore not be asked to sell it when they move to a residential home.

If you are in this situation, contact the social services department* and ask them to consider your case. To make a good case, you will need to provide details of how long you have been a carer and how many hours a week you have been caring.

You might want to ask for advice and support from CNA’s CarersLine or one of the agencies listed above.

Income

Most of the income of the person you are caring for must go towards the fees. This includes pensions. The social services department* then pays the balance and gives the person in residential care a small weekly allowance for personal expenses (£14.75 – from April 1999).

If someone gets Income Support, a small weekly Residential Allowance (£59.40 a week or £66.10 in Greater London – from April 1999) is paid towards the fees by the benefits agency.


What about the persons spouse?

The husband or wife of a person going into residential care may be asked to pay towards the fees on behalf of their spouse, because all husbands and wives are obliged to maintain each other.

However, social services departments* can insist only on having the details of the income of the person going into care, plus half of any jointly owned savings. They cannot insist on a spouse giving details of their own income and savings. They can ask the spouse to pay maintenance voluntarily for their spouse if they think he or she can afford it. If the spouse refuses to do this, the local authority can take them to court, although this is unlikely to happen in practice.

If the person going into a home has an occupational pension, they can pass half of it to their spouse. This half is not taken into account when calculations about the fees to be paid are made.


Giving away the assets

The social services department* will look at any assets given away before the person goes into residential care. If they think that assets were given away in the previous 6 months to avoid paying fees, they can ask the person who received the assets to contribute towards the fees.


However they can assess the person going into care as though they still had the assets, even if they were given away more than six months previously if they decide that the assets were given away to avoid paying fees. This might mean that the person is treated as liable for full fees even if they no longer have any money.


Asking for an assesment

If the person you are caring for needs residential care and will need help with the fees, contact the social services department* of your local council. Someone from the department will arrange to see you and the person you are caring for to make an assessment of whether residential care is necessary. The assessment will cover both the person’s needs and their financial situation.


What happens next?

If the social worker making the assessment agrees that there is a need for residential care, they will calculate what help with the fees should be provided (if any) and will either arrange a place at a home or provide a list of registered homes for you to choose from.

If you have already found a home you like, it should be possible for the person you are caring for to go there. The social services* cannot refuse a place in a home you have chosen, even if it is in another part of the country, providing:

  • it meets the person’s needs as assessed
  • it agrees to take the person
  • it charges no more than the local authority normally pays.
  • If it is more expensive, you will be asked to make up the difference yourselves.
  • If the social worker does not agree that there is a need for residential care there will be no help with the fees, even if you and the person you are caring for think that residential care is necessary. The social worker might suggest ways in which the person can continue to live in the community, perhaps with extra help and support.

If you're not happy

If you don’t agree with the outcome of the assessment, you can make a complaint through the social services department’s* complaints procedure. For example, if you are offered a home a long way from where you live, you might want to ask for a home nearer to you.
If the social worker has decided that you can provide the support required to keep the person you are caring for at home, but you feel unable to do this, you can ask to for the disabled person to be assessed again and for you to be assessed separately as a carer for your ability to continue to provide care. You can be assessed separately only if the person you are caring for is assessed as well.

Paying for a nursing home

The arrangements for paying for a nursing home are usually the same as those for paying for a residential home.


However, if someone has complex medical or clinical needs, long-term nursing care has to be provided free of charge by the NHS in a hospital, hospice or nursing home. If you feel that the person you are caring for should be cared for by the Health Service but this has not been offered, get advice from the

CNA CarersLine or one of the agencies listed above.

If you feel that the person you are caring for has been discharged from hospital too soon, you can complain to the General Manager of the hospital or the Chief Executive if it’s a Trust hospital.

See Coming out of hospital

The financial arrangements for someone going into a home temporarily for respite care are different.

See Taking a break.

None of these arrangements apply to anyone who has been in residential care since before April 1993. Unless they are financing themselves, they will continue to have their fees paid by the Department of Social Security.

Choosing a residential home

It is a good idea to visit a number of homes before making a decision. Take the person you are caring for with you if you can. If this isn’t possible, try to talk with them beforehand to find out what things matter most to them. These may not be the same as the things that seem important to you.


If the person you are caring for is mentally incapable of making a decision, you will have to choose a home on their behalf. Try to take someone else with you for a second opinion. The social services department* should have a list of registered residential homes and the district health authority should have a list of registered nursing homes.

Many homes advertise in the local newspapers and the Yellow Pages. Some of the agencies listed below might also be able to provide you with lists of homes. It will probably be easier to start by phoning a number of possible homes to filter out those that are most suitable and therefore worth visiting.


You might find the checklist below helpful when you are contacting or visiting homes. Don’t worry about asking lots of questions. If the home is well run the staff will be pleased to discuss any queries or concerns that you have.


All residential homes for more than four people have to be registered with the local authority and inspected by them at least twice a year. Small residential homes, for fewer than four people, are registered under a simplified process and may not be regularly inspected. 
Nursing homes have to be registered with the district health authority and inspected at least twice a year. They must be run by a qualified doctor or nurse.

Checklist for finding a home

  • Has it got a vacancy? If not, is there a waiting list? How long is it?
  • Is it registered?
  • Can it provide the right kind and level of care?
  • Will it take the person you are caring for? What happens if their condition deteriorates (or improves)? Will they be able to stay there?
  • Is it in the right location?
  • Can it offer a trial period?
  • How many residents are there?
  • How many staff are there and what training do they have?
  • Is it clean and comfortable?
  • Is there a happy atmosphere?
  • What privacy do residents have?
  • What are the rooms like? Can residents have personal possessions? Pets?
  • What is the food like? Is there a choice? Does it cater for special diets?
  • What are the grounds like? Do residents have open access to them?
  • What are the other residents like?
  • Can residents choose when they eat, have a bath, go to bed?
  • Are visits restricted to certain times?
  • Are activities, outings and other forms of entertainment offered?
  • Are there any facilities for worship?
  • What is included in the price? What about extras, eg hairdressing, chiropody?
  • Is there a contract?
  • What happens if we have a complaint?
Carers association