Care for the elderly

Care (also known as social care) comes in many forms, including:

• informal care carried out by a spouse, relative or friend
• care at home provided by a professional carer, and
• residential care provided in a care home.

The Homecare Association represents providers of care delivered in people’s homes, while Care England advocates for care home providers. Both organisations support high standards in adult social care and help people find high-quality, appropriate care for their needs.

The type of care you need usually depends on the reason you're seeking support. For example:

• if you have a degenerative neurological condition, you may require specialist assistance in a residential setting
• if you need physical help due to reduced mobility or frailty, care could be provided in your home, once it has been adapted to ensure safety and ease of movement.

Moving into a care home permanently isn’t always the most appropriate way to meet someone’s care or support needs.

There are services available to help you continue living in your own home, such as:

• domiciliary care (also known as ‘care at home’ and ‘home care’)
• meals on wheels, and
• home adaptations.

There are also many innovations that can support independent living at home, including:

• stairlifts
• sensors
• community alarms
• assistive technology

Your local authority’s adult social services team may be able to arrange suitable care and support services. These can include reablement services, helping you to relearn skills you may have lost due to illness or disability.

Some of these services are free. Others may be subsidised, VAT-exempt, or means-tested, for example, grants for home adaptations.

Home care

Given the opportunity, most of us would choose to stay living in our own home for as long as possible.

The benefits include staying close to our social and personal support network and retaining a greater degree of independence.

It’s possible to stay in your home if you get the right level of care and support for your needs. This can include making any necessary changes to your home, such as:

• installing a stair lift
• adapting the bathroom
• widening doors to accommodate a wheelchair, or
• moving to a more suitable property.

If you’re staying in your own home, you can arrange nursing home care. You can also consider:

• using a day centre
• attending a lunch club, or
• visiting a dementia café (if appropriate) to help involve you in your local community.

You can also employ somebody directly to help you at home (either as an employee or on a self-employed basis). This will cost money, but it’ll also give you more control over who provides your care for you.

If you’re employing someone to care for you at home, make sure you get proper contracts drawn up. It’s also a good idea to take legal advice before you enter into such an agreement.

While receiving care in your home, you may want to consider using respite care (a short care home stay) to:

• allow your carers to have a holiday or short break, or
• to support your own recovery from an illness, surgery or a hospital stay.

With respite care, you move into a care home for a short stay and then go back home.

If staying in your home isn’t possible, other options include:

• living with family or moving nearer to supportive relatives
• moving to sheltered, retirement, extra care or assisted-living housing, or
• moving to a care home.

Your local authority can offer help and advice regarding:

• minor adaptations to your property
• home aids, or
• organising an occupational therapy assessment or a means-tested grant
• Home Improvement Agencies (also known as ‘care and repair’ or ‘staying put’ agencies), are local not-for-profit organisations.

They’re set up to help older or disabled homeowners, as well as private tenants. They can arrange and pay for repairs, improvements, and adaptations to people’s private homes.

Many Home Improvement Agencies also offer additional services, such as:

• a handyperson
• help with gardening
• checking home security, or
• preparing for coming home from hospital.

The Elderly Accommodation Counsel (EAC) is a national charity supporting older people that has a comprehensive directory of home services.

Residential care homes

Residential care homes, often simply called care homes, provide personal care, such as help with dressing, washing, and other everyday tasks.

In a care home, several older people live together and are supported by care workers. Typically, each resident has their own bedroom, which may include an en-suite toilet or shower room.

Some care homes are also registered to provide nursing care. If you think your care needs may change over time, you might consider a care home with dual registration, offering both residential and nursing care.

If you require more specific support, such as for dementia, you can choose a residential care home that specialises in dementia care. There are also dedicated dementia care homes.

In some cases, you may be eligible for help with care costs.

Nursing homes

If you need medical or nursing care, look for a care home registered to provide nursing services, commonly known as a nursing home.

Nursing homes have qualified nursing staff on duty 24 hours a day, which is why their fees are typically higher than those of residential care homes that provide only personal care.

Some nursing homes specialise in particular medical needs, including dementia care. However, it’s important to note that dementia care doesn’t always require a nursing home or nursing staff.

When choosing a nursing home, consider the following:

• Avoid paying for services you don’t need.
• Plan ahead to ensure the home can meet your future care needs, especially if your health is likely to decline. This can help you avoid the disruption of moving later on.

What are nursing needs?

Examples of nursing needs include:

• Wound care (e.g. dressing open or surgical wounds)
• Administering injections or managing complex medication regimes
• Artificial feeding (e.g. via PEG tubes)
• Monitoring and managing unstable health conditions
• Rehabilitation following serious illness or surgery
• Planning and overseeing care that must be clinically managed

Your GP, or the hospital doctor discharging you, can advise whether you need nursing care and for how long. They can also help determine whether a short-term recuperative stay or a long-term arrangement is more appropriate.

Choosing a care home in a hurry

Sometimes, you may need to choose a care or nursing home quickly, for example, after:

• An illness
• A hospital stay
• A fall

In such cases, you may have limited time to make decisions about where to go and how to fund your care. Availability may also be restricted, as some care homes have waiting lists.

The more time you can spend researching and selecting the right care home for your needs, the better.

Sheltered housing – and other special types of accommodation

Sheltered housing allows people over the age of 55 to live in self-contained flats or bungalows, supported by staff such as support workers and, in some cases, a warden.

This type of accommodation promotes independent living while offering varying levels of care and support. It is often considered an alternative to residential care homes.

Sheltered housing typically includes communal areas, such as a garden, laundry room, and lounge. 24-hour emergency assistance is usually available.

The aim is to help residents maintain their independence while enjoying the companionship of neighbours.

Sheltered housing can be:

• Privately rented
• Privately owned
• Shared ownership
• Provided by a social housing landlord
• Shared Lives Schemes

There are also Shared Lives schemes, which offer care in a family home. In this arrangement, you live with an approved carer and become part of their family and community life.

Extra care housing

If you need more support, you may consider extra care housing. This offers self-contained homes with features designed for older people, for example, adapted bathrooms. It also provides a higher level of care and support, such as:

• Additional wardens
• Full-time carers
• Domestic help
• Meal provision

Extra care housing is also known as:

• Very sheltered housing
• Housing with care
• Retirement communities
• Retirement villages
• Assisted living

You may be able to own or part-own your extra care accommodation.

Almshouses

Another form of sheltered housing is an almshouse, typically run by charitable trusts. Each charity sets its own eligibility criteria, such as supporting people from a particular trade or those living in a specific area.

Abbeyfield Societies

Abbeyfield societies are voluntary organisations that offer a smaller, more family-oriented style of sheltered housing, usually for 8 to 12 residents. These homes are not suitable for people who require nursing care. If nursing care is needed, a nursing home may be more appropriate.

Working out your care needs

If you're unsure about the level or type of care you need, you can request a free care needs assessment from your local adult social services department.

A member of the team will visit you at home to discuss your situation and assess the type and frequency of care that would best meet your needs.

You’re welcome to have a friend or family member present during the assessment to help ensure everything is covered.

Some common examples of care needs include:

• Managing a healthy diet
• Maintaining personal hygiene
• Using the toilet
• Getting dressed and choosing appropriate clothing
• Moving around and using your home safely
• Managing household tasks
• Maintaining personal relationships with family and friends
• Accessing work or learning opportunities
• Engaging with the local community