Residential, nursing, dementia or respite: the types of care home

A residential home provides accommodation together with personal care: help with washing, dressing, medication, meals and getting about. Staff are care workers, not nurses. Health care comes from the GP and community services, exactly as it would if you lived in your own house, so a district nurse visits to dress a wound or give an injection.

It suits people who are frail, or who cannot safely manage alone, but who do not need a nurse every day. Across England the typical fee on record is £1,350 a week.

A nursing home is registered to provide nursing care as well as personal care, which means at least one registered nurse is on duty at all times. That allows the home to look after people with conditions that need daily clinical care: complex medication, catheters and stomas, pressure sores, PEG feeding, or illnesses that can change quickly.

Fees are higher because nurses cost more; the typical figure on record is £1,586 a week. The NHS pays a fixed weekly amount towards the nursing part for anyone assessed as needing it, whatever their savings, and a small number of residents qualify for the NHS to pay the whole fee. See NHS funded nursing care and Continuing Healthcare.

Being in a nursing home does not mean you need nursing. The assessment decides that, and the NHS contribution follows it.

Dementia is a registered service user band, so a home that says it provides dementia care has told the regulator it is set up for it: staff trained in dementia, a building that is safe to walk about in, and routines that reduce distress. It is not a separate category of home. A residential home can be registered for dementia, and so can a nursing home.

The difference matters when needs change. Someone in the early stages may be fine in a residential home registered for dementia. Someone whose dementia brings physical health problems, or who needs medication managed by a nurse, needs a nursing home registered for dementia. Homes often charge more for dementia care in the same room, because it takes more staff time.

On this site, every council area has a dementia care homes page listing the homes registered for it.

Many larger homes are registered for both personal care and nursing, usually with separate units or floors. The advantage is that you can move into a residential place and transfer to nursing within the same building if your needs increase, keeping the same staff, the same friends and the same view. The fee steps up when you transfer.

Ask whether transfers are automatic or depend on a vacancy in the nursing unit. If the nursing unit is full when you need it, you may still have to move.

Most homes take people for short stays: a fortnight while a family carer has a holiday, a few weeks of recovery after a hospital stay, or a trial before a permanent move. Respite is charged at a weekly rate that is often a little higher than the permanent fee. The council can fund respite after a carer’s assessment, and the means test ignores your house for a temporary stay.

The council’s needs assessment says which kind of home you need, and a nursing home will not take someone without a nursing need being identified. If you are choosing privately, the home’s own pre-admission assessment does the same job. Where a choice exists, a dual-registered home, or a residential home registered for dementia, buys the most room for the future.

Read how to read a CQC report before you shortlist, and what to look for on a visit.