The short answer
- Care at home stretches further than people thinkVisits can become nights, and nights can become a live-in carer, without anybody leaving the house. Some of what looks like the end of care at home is a gap more hours would close.
- Six situations where a care home is the better answerWanting to move, wanting company, clinical needs that keep changing, two people needed at unpredictable times, nights that will not settle, and a family carer with nothing left.
- A move changes the means test as well as the billThe house is disregarded while somebody lives in it, and counted once a care home move is permanent. A care home averages £1,160 a week against £1,120 for a live-in carer.
- The decision belongs to the person firstAn adult who understands the decision can choose to stay or choose to go, even where the family disagrees. Only where they cannot understand it does anyone else decide, in their best interests.
Written for families in England. Scotland, Wales and Northern Ireland charge for care on different rules.
The six situations
Six situations where a care home is the better answer
These come up when care at home has stopped working and adding hours does not fix it. Each is set out three ways: what you are seeing, what can still be done at home, and where a care home answers it better.
What is happening
What can still be done at home
When a care home answers it better
What they want
They have said they would rather move
Said calmly and more than once, not only in a bad week, and they can say why.
What can still be done at home
Ask what the move is meant to fix. If the answer is company, or not wanting to be a burden, talk that through first.
When a care home answers it better
If they still want to go, that settles it. An adult who understands the decision may make it, including one other people think is wrong.
Company
They are alone all day and it is making them unwell
The television on from breakfast to bedtime, and low mood that lifts the moment somebody walks in.
What can still be done at home
Longer visits, a day centre, a lunch club or a dementia cafe, and a carer booked for company rather than tasks.
When a care home answers it better
A home has other residents, a dining room and activities without anyone arranging a lift. For a sociable person that is a real gain.
Nursing
The needs are clinical and they keep changing
A wound that will not close, a syringe driver, feeding through a tube, or a condition that swings week to week.
What can still be done at home
District nurses visit at home, some tasks can be delegated to a trained carer, and NHS Continuing Healthcare pays for care at home too.
When a care home answers it better
A nursing home keeps qualified nurses on duty. If clinical need is the daily problem rather than an occasional one, that is what it is for.
Moving and handling
Two people are needed, at times nobody can predict
Every transfer needs a hoist, and getting to the toilet at 3am needs two pairs of hands.
What can still be done at home
A hoist, a profiling bed, a ceiling track, and two carers for the moves that need them. A council occupational therapist decides the equipment.
When a care home answers it better
Booking two carers for a moment nobody can schedule is the part that does not work. A home has staff on each shift who can both come at once.
Nights
Every night is broken, and it is not settling
Up four or five times, calling out, trying the stairs in the dark, or awake and dressed at 2am.
What can still be done at home
A waking night carer, or a live-in carer with waking nights added, booked a few nights a week while you see whether it settles.
When a care home answers it better
Staff are awake through the night as a matter of course, so somebody is there when a person gets out of bed, not at the next booked visit.
The family carer
The person holding it together has nothing left
A husband, wife or daughter who has stopped sleeping, stopped working, or become ill themselves.
What can still be done at home
A carer’s assessment from the council, respite booked in advance rather than in a crisis, and paid hours put where they take the most weight off.
When a care home answers it better
If the family carer is the arrangement and they cannot carry on, a care home is sometimes the only thing that lifts the load at once.
Two of these carry more weight than the rest. The first is your relative's own view, because it is their life and their home. The last is the state of the person holding everything together, because an arrangement resting on somebody who is ill is not stable. The comparison of care at home and a care home sets the two side by side, and what a care home offers that home care cannot goes further into the parts that are hard to buy by the hour.
What is missing from the list matters as much. Needing help to wash and dress does not belong on it, nor does incontinence, and nor does a dementia diagnosis on its own, because familiar rooms help somebody who is becoming confused. At what point somebody with dementia should go into care covers that.
What to try first
What to try at home before anyone moves
Care at home is not one thing that either works or does not. It goes up in stages, and a family that has only had morning visits has not reached the top of it.
- 1
Ask the council for a care needs assessment
FreeThe council has to assess anybody who may have care needs, whatever it thinks of the level of those needs or of the family’s money. A social worker or occupational therapist writes down what your relative can and cannot manage, and everything else runs off that document. - 2
Ask what the NHS will pay for first
Not means-testedUp to 6 weeks of reablement or intermediate care is free after a hospital stay or to prevent one, and equipment or minor adaptations under £1,000 each come free from the council. NHS Continuing Healthcare, where somebody qualifies, pays the full cost of care at home as well as in a care home. - 3
Put the hours where the problem is
This weekIf the mornings are fine and the nights are the problem, buy nights rather than more mornings. If getting to the toilet needs two people, book two carers for those moves and one for the rest. Care at home is bought in pieces, so it can match the shape of the problem. - 4
Look at a live-in carer before a care home
From £1,050 a weekPast about 35 hours a week a live-in carer costs less than the same hours in visits, and covers the gaps between them as well. It needs a spare room, and it suits some households and not others. - 5
Try respite before you commit either way
A week or twoA short stay in a care home, or a respite carer at home while the family carer goes away, tells you more than any amount of discussion. A person who has spent a fortnight in a home can say whether they would live there.
If the next step is more care at home, you can search for carers near you and compare their rates first. Carers on PrimeCarers charge £18 to £25 an hour with our fee included, against £28 to £35 for an agency visit, and live-in care runs from £1,050 a week. Where nights are the difficulty, night care for falls and trips to the toilet explains what a waking night covers, and transfers, hoists and two carers explains when a second pair of hands is needed. Read the disadvantages of live-in care alongside it.
What changes about money
What a move changes about the money
The weekly figures are closer than people expect. What is not close is the way the two are assessed, because a permanent care home move brings the house into the means test and care at home does not.
| Care at home | A care home | |
|---|---|---|
| A typical week | Live-in care from £1,050, typically £1,120. Hourly visits £18 to £25 an hour on PrimeCarers, our fee included. | About £1,160 for a residential place, in a range of £1,100 to £1,600. A nursing home is nearer £1,410. |
| The house in the means test | Disregarded in full while your relative lives in it, so paying for care at home does not put the house at risk. | Disregarded for the first 12 weeks of a permanent stay, then counted, unless a partner or certain other relatives still live there. |
| Savings | The same rules either way. Above £23,250 in capital your relative pays the full cost. | Below £14,250 savings are disregarded entirely and they pay from income only. |
| Attendance Allowance | Paid as normal, and it can increase Pension Credit, Housing Benefit or Council Tax Reduction. | Usually stops if the council pays the fees. It continues if your relative pays their own. |
| Nursing costs | District nurses visit on the NHS at no charge. | The NHS pays a nursing home £267.68 a week towards nursing care from 1 April 2026. It comes off the fee rather than being paid to you. |
| If the NHS funds the care | NHS Continuing Healthcare pays for care in your relative's own home. | NHS Continuing Healthcare pays the full care home fee, accommodation included. |
| Changing your mind | Notice is 48 hours for hourly care and 7 days for live-in once a carer has worked 168 hours. PrimeCarers charges nothing of its own to cancel. | Set by the home's own contract. Read the notice period, and what happens to fees during a hospital stay, before signing. |
A typical week
- Care at home
- Live-in care from £1,050, typically £1,120. Hourly visits £18 to £25 an hour on PrimeCarers, our fee included.
- A care home
- About £1,160 for a residential place, in a range of £1,100 to £1,600. A nursing home is nearer £1,410.
The house in the means test
- Care at home
- Disregarded in full while your relative lives in it, so paying for care at home does not put the house at risk.
- A care home
- Disregarded for the first 12 weeks of a permanent stay, then counted, unless a partner or certain other relatives still live there.
Savings
- Care at home
- The same rules either way. Above £23,250 in capital your relative pays the full cost.
- A care home
- Below £14,250 savings are disregarded entirely and they pay from income only.
Attendance Allowance
- Care at home
- Paid as normal, and it can increase Pension Credit, Housing Benefit or Council Tax Reduction.
- A care home
- Usually stops if the council pays the fees. It continues if your relative pays their own.
Nursing costs
- Care at home
- District nurses visit on the NHS at no charge.
- A care home
- The NHS pays a nursing home £267.68 a week towards nursing care from 1 April 2026. It comes off the fee rather than being paid to you.
If the NHS funds the care
- Care at home
- NHS Continuing Healthcare pays for care in your relative's own home.
- A care home
- NHS Continuing Healthcare pays the full care home fee, accommodation included.
Changing your mind
- Care at home
- Notice is 48 hours for hourly care and 7 days for live-in once a carer has worked 168 hours. PrimeCarers charges nothing of its own to cancel.
- A care home
- Set by the home's own contract. Read the notice period, and what happens to fees during a hospital stay, before signing.
Care at home figures are what carers on PrimeCarers charge, our fee included. Care home figures are averages for comparison and not our prices. Capital limits are the England figures for 2026/27.
Who decides
Who gets to decide, and what makes the decision easier
A family can agree on every fact and still fall out over this. It helps to be clear early about whose decision it is in law.
An adult is assumed to be able to make their own decisions unless it is shown that they cannot, and a choice other people think is unwise does not by itself show that somebody cannot decide. If your father understands that he is at risk on the stairs and chooses to stay anyway, that is his to choose, and nobody, the council included, can simply move him. Can an elderly person be forced into care in the UK sets out the narrow exceptions.
Where somebody cannot weigh the decision, the Mental Capacity Act 2005 applies and somebody else decides in their best interests, choosing the option that restricts their freedom least. An attorney under a health and welfare lasting power of attorney can make that decision; a property and financial affairs attorney cannot. Lasting power of attorney and dementia explains which is which.
What makes the decision easier
- Writing down the specific thing that has stopped working
- Getting the care needs assessment done, so everyone has the same facts
- Asking your relative what they want, on a good day, and writing down the answer
- A trial stay or a fortnight of respite before anything is permanent
- Agreeing between siblings who makes the final call
What makes it harder
- Deciding on the day of a hospital discharge because a bed is needed
- Promising never to put somebody in a home, then having to break it
- Treating a care home as a punishment, which makes it impossible to discuss
- Moving somebody to solve a problem more hours of care would have solved
- Leaving one sibling to carry it alone and then querying their judgement
If it is a care home
If a care home is the answer, do these four things
A care home is a reasonable answer to the problems above. These four steps keep a move from going badly.
Get the funding position in writing
Before you look at homes
Work out which kind of home you are looking for
Residential or nursing
Read the inspection report, then visit twice
Go at two different times
End the care at home properly
48 hours or 7 days
Inspection reports and ratings for every home in England are published by the Care Quality Commission, the regulator of health and social care. Choosing a care home covers the visits, the questions and the contract, and the difference between a nursing home and a care home is the one to read first if there is nursing involved. If you are not sure yet, respite at home or in a care home is the low-risk way to find out, and NHS Continuing Healthcare pays for care in both settings.
Questions
Questions families ask at this point
Look for the specific thing that has stopped working rather than a general decline. Nights, two people needed for transfers, clinical needs that keep changing, or a family carer who cannot carry on: those are where a care home answers it better. If the problem is that mornings are hard or the house is untidy, that is a gap more hours would close.
For one person the figures are close: £1,160 a week on average for a residential home, against £1,120 for a live-in carer on PrimeCarers with our fee included. For a couple they are not, because one live-in carer looking after both is about £1,350 a week against roughly £2,320 for two places. The week-by-week comparison sets both out.
No. An adult who can understand and weigh the decision chooses where they live, even if their family and their social worker disagree. Where somebody cannot make the decision themselves it is made in their best interests under the Mental Capacity Act 2005, and the option chosen has to be the one that restricts them least. The narrow exceptions are set out here.
For care at home the house is disregarded entirely. For a permanent care home move it is disregarded for the first 12 weeks and counted after that, unless a partner or certain other relatives still live there. Above £23,250 in capital she pays the full fee. A deferred payment agreement lets the council pay and be repaid later from the property, so the house need not be sold straight away.
Yes, through NHS Continuing Healthcare, where somebody has a primary health need. It pays the full cost of care and accommodation, it is not means-tested, and it pays for care in your relative's own home on the same basis. Assessment starts with a checklist, then a full multidisciplinary review, and a decision should normally follow within 28 days. How to ask for an assessment.
Start by asking what they are afraid of, because the answer is usually more specific than it first sounds: losing the dog, losing the garden, or being somewhere their friends will not visit. Some of that can be solved without moving, and a trial respite stay lets them see a home rather than imagine one. If they understand the risk and still choose to stay, that choice is theirs, and the question becomes what care would make staying safer.
Some families arrange extra one-to-one time, for company or for outings, alongside a care home place. Whether that is allowed is between you and the home, which sets what happens on its premises. Ask the manager before booking anything.