Choosing a Care Home & Understanding the Costs

A care home is a place where people live and receive help with personal care, such as washing, dressing, eating, taking medication and moving around. Some homes also provide nursing care for people with medical needs. Others specialise in dementia, learning disabilities, mental health, or end-of-life care.^[1]CQC[5]NHS

The two main types are:

• Residential care homes — provide personal care, meals, activities and a safe place to live. Nursing care is not usually provided on site.
• Nursing homes — provide 24-hour nursing care by registered nurses as well as personal care. These are often needed for people with complex health needs, pressure ulcers, or conditions that need frequent medical attention.

In England, care homes are regulated by the Care Quality Commission (CQC). Scotland, Wales and Northern Ireland have their own regulators, and each publishes inspection reports you can read before you choose.^{[1]CQC[9]Care Inspectorate[10]CIW[11]RQIA}

Start by thinking about need first, not just location. A care home must be able to meet the person's health needs, personal preferences, and daily routine. Ask the hospital discharge team, social worker, GP, or occupational therapist for recommendations. Then compare homes using inspection reports and visits.^{[7]Alzheimer's Society[2]Age UK}

Useful steps:

1. Check the inspection report. Look at the overall rating and whether safety, staffing, effectiveness, leadership and responsiveness are rated good or outstanding. Read the latest report in full.^{[14]CQC inspections}
2. Visit more than once. Go at different times of day if you can, including a mealtime, to see what everyday life is like.
3. Talk to staff and residents. Ask about staff ratios, training, night cover, and how they handle falls, incontinence, pain, and confusion.
4. Ask about activities. Loneliness and boredom can quickly harm health and wellbeing. A good home has meaningful things happening every day.
5. Think about the future. If needs change, can the home provide more care, or will the person have to move again?
6. Trust your instincts. A clean, kind, well-run home feels different from the moment you walk in.

For people with dementia, specific questions matter: is the layout easy to navigate, are there quiet spaces, do staff use person-centred techniques, and is there a meaningful activities programme?^{[7]Alzheimer's Society}

Care home fees vary widely across the UK. As a rough guide, a self-funded residential care home place in England can cost £800 to £1,200+ per week. Nursing care is usually higher, often£1,000 to £1,500+ per week. Fees in London and the South East are typically higher than in other parts of the country.^{[3]Which?[6]MoneyHelper}

A weekly fee usually covers:

• Accommodation and meals.
• Personal care, such as help with washing, dressing, and toileting.
• Some activities and laundry.
• Use of communal spaces and basic furnishings.

Fees may not include:

• Hairdressing, newspapers, toiletries, or outings.
• Specialist equipment or therapies.
• Telephone, TV, or internet charges.
• Visiting health professionals, unless arranged by the NHS.
• Higher-cost food choices or private rooms.

Always ask for a full written breakdown of what is included and what is extra. This helps prevent unexpected bills and disputes later.^{[3]Which?[4]GOV.UK}

If the local council arranges your care home place, they will do a means test to see how much you can afford to pay. In England, if your savings and assets are above £23,250, you will usually pay the full cost. If they are between £14,250 and £23,250, the council pays some and you pay a tariff. Below £14,250, you contribute from income, not savings.^{[13]Age UK}

The rules differ across the UK:

• England: £23,250 upper capital limit; £14,250 lower capital limit. Your main home is not counted while you, your partner, or certain relatives still live there.
• Scotland: personal care is free for people aged 65+ who are assessed as needing it; nursing care is also free. You still pay accommodation costs.
• Wales: the upper capital limit is higher and a single rate applies.
• Northern Ireland: the capital limits and thresholds are different again.

Your home may be counted if no one lives there and you are in a care home long-term. However, there are protections for couples and certain relatives. You should never be forced to sell your home during your lifetime in every case — some councils offer deferred payment agreements.^{[12]GOV.UK[2]Age UK}

If your main need is a health need, you may qualify for NHS Continuing Healthcare (CHC). This is not means-tested, so your savings do not matter. It can cover the full cost of a care home, including nursing and personal care.^[16]GOV.UK

A hospital or care home should arrange a CHC checklist if you have complex, intense or unpredictable health needs. If the checklist suggests you may qualify, a full assessment using the Decision Support Tool is carried out. People with advanced dementia, significant nursing needs, or rapidly changing conditions are most likely to qualify.^{[16]GOV.UK CHC}

If you do not qualify for full CHC but need nursing care in a care home, you may receive a set weekly amount called NHS-funded nursing care towards the nursing component of your fees.^[5]NHS

If you are paying for your own care home place, you can choose any home that accepts self-funders and can meet your needs. You do not have to take the cheapest option the council offers. However, you are responsible for making sure your money lasts.^{[13]Age UK}

Key points for self-funders:

• Ask about fee increases. How often do fees rise, and by what method? Are increases linked to inflation, staff costs, or something else?
• Understand the contract. What notice period is required? What happens if you run out of money? Can family visit without extra charges?
• Ask about top-up fees. If the council's usual rate does not cover a more expensive home, a third party (usually a family member) can pay a top-up. This must be agreed in writing.^{[15]NHS[17]Citizens Advice}
• Plan ahead. Speak to a financial adviser who is accredited by the Society of Later Life Advisers (SOLLA) or a charity specialist. Independent financial advice can be free for some people.
• Check if you can claim benefits. Attendance Allowance, PIP or Pension Credit may still help even if you are self-funding.

A care home contract is a legal agreement. Before signing, read it carefully and ask questions. The contract should be clear, fair and in plain English.^{[4]GOV.UK[3]Which?}

Check the contract for:

• The weekly fee and exactly what it covers.
• How and when fees can increase.
• Notice periods for both sides.
• What happens if the person's needs increase — will the home still be suitable?
• Charges for extras such as hairdressing, toiletries, outings, or special diets.
• Deposits or advance payments and when they are refunded.
• Policies on missing items, damage, or complaints.
• Whether the home is registered for the type of care needed.

Do not feel pressured to sign on the day. Take the contract away, show it to a family member, or get advice from Citizens Advice or a solicitor. If you are unsure about the fees or a top-up agreement, get written confirmation from the council.^{[17]Citizens Advice}

• What is the CQC / regulator rating and the latest inspection report?
• What is the staff-to-resident ratio during the day and at night?
• Are staff trained in dementia, Parkinson's, stroke, or other relevant conditions?
• How are medicines managed and who reviews them?
• What happens if the person falls or becomes unwell?
• What food is provided and can special diets be catered for?
• Can residents choose when to get up, go to bed, and have meals?
• What activities are available and how often?
• Can family and friends visit at any reasonable time?
• What is the total weekly fee and what is not included?
• What happens if the person runs out of money?

• Care Quality Commission (CQC) · find and inspect care homes in England · cqc.org.uk/find-care-home^[1]CQC
• Care Inspectorate · Scotland · careinspectorate.com^{[9]Care Inspectorate}
• Care Inspectorate Wales · careinspectorate.wales^[10]CIW
• RQIA · Northern Ireland · rqia.org.uk^[11]RQIA
• Age UK Advice Line · 0800 678 1602 · free, 8am–7pm, 365 days · ageuk.org.uk^{[2]Age UK}
• Independent Age · free advice on care homes and costs · independentage.org.uk^{[8]Independent Age}
• Alzheimer's Society Dementia Connect · 0333 150 3456 · alzheimers.org.uk^{[7]Alzheimer's Society}
• MoneyHelper · free, government-backed money guidance on paying for care · moneyhelper.org.uk^{[6]MoneyHelper}
• Citizens Advice · advice on care contracts, top-up fees and rights · citizensadvice.org.uk^{[17]Citizens Advice}
• SOLLA · Society of Later Life Advisers · find a regulated financial adviser · solla.org.uk
• Local council · find yours at gov.uk/find-local-council