The thought of going into residential care for most of us is less than appealing, with a massive 97% of people saying they wouldn’t ever want to go into a care home (according to OnePoll).
With this in mind, home care is usually the preferred option for many people who need help as they get older, as it allows them to have the support they need, while enabling them to maintain their social connections and independence.
Here, we explore some of the advantages and disadvantages of home care, look at how much it can cost, as well as some of the alternatives.
What are your care options?
Whether you are looking at care options for yourself or a loved one, deciding whether to receive care in your home or move into a residential care facility can be a really difficult decision.
Many people want to stay in their home for as long as possible, and over recent years there has been a bigger push by the NHS to keep people out of hospitals and residential care facilities, and keep them in their communities. In addition to this, the pandemic has heavily affected the residential care industry, making alternative options even more attractive than before.
Being cared for in your own home can have major benefits, as well as often being a cost-effective option for people with a wide range of needs. Home care encompasses a large number of services, and can offer anything from twice weekly visits all the way through to live-in, 24-hour care, so it’s likely there’s a service out there for you. Some of the key care services that are usually available as home care include:
The following types of care tend to be more casual arrangements, which support people who need help with their day-to-day tasks and needs, rather than medical support:
- Domiciliary care – this is often the first type of care that people choose when looking at care options and is to provide support to people who need a little bit of extra help with their day-to-day lives. A carer will usually come into a person’s home at regular times of day to help with anything from personal care through to picking up shopping. Domiciliary care is most suited to those who just need that little bit of extra support
- Companionship care – designed to tackle loneliness, which can have a huge impact on mental and physical wellbeing, companionship care can involve someone dropping in once or twice a week to have a catch up and provide some social support, to someone living with you to keep you company and make sure you are okay.
- Personal care – this type of care is to help with day-to-day personal activities which could be anything from getting dressed to using the toilet. This means that people are able to keep their usual routines and stay independent for longer.
Temporary care is a type of care that you or a loved one might need to meet short-term care needs. For example, it may be needed to help with rehabilitation after surgery, or recovery from illness. The general aim of temporary home care is to allow people to rest and recover in their own home, and reduce the amount of time they have to spend in hospital. Each of these generally provide similar services, but temporary care can fall under a range of different names, which include:
- Intermediate care
- Short-term care
- Convalescent care / After Hospital Care / Postoperative Care
- Reablement Care
- Preventative Care
- Emergency home care
Comprehensive care services are generally more intensive and can be adapted for an array of serious conditions and needs. With some of these options, the cost-effectiveness of home care will decline as you start to need more hours from your carer each day. The following options are available for people with acute care needs:
- 24-hour care – As the name suggests, care is available 24 hours a day, either from one live-in carer, a team of rotating carers or where a team is on call to respond to your or your relative’s needs 24 hours a day.
- Live in care – this type of care involves a carer living in your home and usually working around 10 hours a day to support you. They will be able to help outside these hours, however this is limited and anything excessive will mean you need 24 hour care.
- Overnight care – This type of care tends to be particularly suited for people with degenerative conditions who are more likely to wake in the night and feel anxious and disoriented, or who may need support with washing or going to the toilet.
- Respite care – being a carer for someone can be tiring physically and mentally, so if you need a break, respite care can give you this by taking over your caring activities for a short while.
- Palliative care – if you or a loved one are living with a long-term life limiting condition, injury or illness, then palliative care can provide advanced support for their needs. It is often provided by a varied team of carers who specialise in certain conditions.
What are the advantages and disadvantages of home care?
Home care has plenty of benefits, but it’s not without its downsides. Here are some of the advantages and disadvantages you’ll need to weigh up before deciding whether it’s the right option for you.
Whether you are looking at care for yourself or for a loved one, home can offer a wide range of benefits. Home care can be:
Better for your mental and physical health and wellbeing
The majority of people who end up living in a care home have not actively chosen to do so. Many people are often forced to make this decision in a time of crisis and often as a last resort. A study carried out by The Good Care Group found that rather than people’s conditions improving under the consistent care provided in a care home, many people’s health and wellbeing actually declines while in a care facility. This is obviously not the case for everyone, but for a large number of people, the stress and upheaval of moving, coupled with disconnection from family, friends and their community often meant that their health worsened after moving into a care home.
Can be more cost effective
Not everyone’s health is the same and the level of care each person needs is definitely not uniform. With this in mind, depending on your care needs, home care can work out cheaper as you can choose the level of care that best suits your needs. So if you really only need someone to check in on you once a day you can have just that, or if you need a full time live in carer, you can also do this.
A spokesman from home care services provider Good Care says “There is a popular misconception that 24 hour care is prohibitively expensive when compared to the costs of living in a residential nursing home. In reality, the cost for providing each type of care is similar. Furthermore, in accordance with the UK government’s ‘Personalisation’ framework, anyone deemed eligible to receive care from their local authority or the NHS is granted an allowance which can be used to obtain whichever form of care – residential or live-in – you or your loved one prefers.”
Better suited for a wide range conditions and needs
With home care and the wide range of options available, it is often easier to find care that suits your specific needs rather than a blanket approach, which you might find in a care facility.
Can help maintain independence
For a large number of people, staying in their own home means that they stay more independent for longer, physically, mentally and socially. Often moving into a care facility means that they do less which means that often they lose their independence more rapidly.
Greater control over the care you receive
If you were to move into a residential care facility, you may be able to choose the facility, but ultimately, you can’t choose the staff who work there. With home care, you are able to select individuals that you have a connection with, interview them, check references and so on. This can give you the reassurance that you or your loved one are getting the best care possible from a safe pair of hands.
Maintains familiarity and routines
Nearly 60% of people in care homes have a dementia diagnosis, according to Age UK, and while it may feel like the only option for you if you or a loved one finds themselves in this position, it’s been found that staying in a familiar environment can be more beneficial for those with dementia. Staying in their home can provide familiarity and comfort, regular routines, allow you or them to keep pets and maintain the features of the life they have always had, which may help minimise stress and confusion.
The main disadvantage to home care is that the responsibility for everything sits with you. This includes finding a carer to begin with, maintaining your home and making any necessary alterations. So as time goes on and your or your loved one’s needs change, your carer decides to quit, or your home has to be adapted to meet your changing needs, this is all going to be up to you to do. Some other disadvantages include:
- 24/7 care is not always guaranteed – unlike in a residential care home, with home care, there is not usually 24-hour help available, and if it is, the cost of this service will be considerable. So if you or your loved one needs this level of support, it may not be a cost-effective option.
- Consistency is not always possible – particularly if you are using an agency for your care, while they will generally try to send the same person to you or your loved one at an agreed time, this isn’t guaranteed.
- You could see costs steadily increasing – as we age, it’s likely that our needs will increase, and while home care may have been the most affordable option to begin with, you may find that over time you are paying much more, as you need a greater level of care.
- Home alterations might affect the value of your home – While making adjustments to your home will mean you or your loved one is able to stay there for longer, if they dramatically change the appearance or function of your home, it could affect your property’s value.
How much does home care cost?
The amount that home care costs will vary from person to person, and while some people may only need care services for a week, others may need them on a more permanent basis, which obviously involves a considerable financial commitment.
The average hourly rate for home care is around £15, according to Age UK, but this can fluctuate considerably depending on the care services you require and your location. To get a better idea of home care costs in your area have a look at this Cost of care checker from Which?, which also gives you an idea of what sort of costs the local council might cover for you. You can find out more about paying for home care in our article How to pay for long term care.
There are a number of care agencies who can provide you with fully managed services, which will organise all the various elements involved, including paying your carer, managing taxes and so on. If you intend to find someone and hire them directly rather than through an agency, you may need to think about things like setting up a pension for them, and deducting the right tax.
Can I get any financial help with home care costs?
The good news is that if you are eligible, your local council may help to cover some of the costs of home care, or organise it for you on your behalf. What you are eligible to receive depends on where you live, what you need and whether you can afford to pay for it yourself.
To start the process, you will need to apply for a care needs assessment, which will let your local council identify what help you need. This could be anything from home care help with things like cleaning and shopping to installing disability equipment and making adaptations to your home. If you need help completing this, your local citizens advice should be able to help you.
If the council determines that you do need help, then they will carry out a means test to understand your ability to pay for these services yourself. This is also known as a financial test, during which the council will take account of your income and savings and assess whether you need their financial assistance. Generally, the following thresholds on your savings will apply:
|Savings total||What you need to contribute|
|Over £23,250 +||You will need to self-fund your care, which means you will pay the full cost of the care.|
|£14,250 to £23,250|
If you have savings between these amounts, your local council will normally pay for some of your care, but you’ll be responsible for the rest of the cost.
Exactly how much the council will pay depends on your income and the amount you have in savings.
|£14,250 or less|
If you have savings worth £14,250 or less, it will be assumed in your financial assessment that you won’t have any income from this, and it is therefore disregarded.
The local council will usually fund some of your care, but you may still have to make a contribution based on your income and outgoings.
While you’ll usually be asked to contribute towards the cost of your home care, you must be left with an income of £214.35 if you’re single and over State Pension age, or £163.65 if you’re in a couple and one of you is over State Pension age. This is called the Minimum Income Guarantee.
If you are eligible for help you will get what is known as a personal budget which you can choose to receive in one of three ways:
- A monthly direct payment into your bank account each month, which you will then use to pay for your care. If you choose this option, your local council will usually ask for receipts or invoices to show that you are spending the money on care.
- The council takes responsibility for arranging and paying for your care on your behalf. It’s worth knowing that even if the council is arranging and paying for your care, you still can have input on how the money is spent for you.
- A mixture of the above two payment methods – the council will arrange some of your care and you pay for the rest of your care with a direct payment.
How to find home care providers
When you are searching for carers to come into your or your loved ones home, you want to be certain that you are in safe hands. To find the carer who is right for you, the following are a good place to start:
- Ask family and friends for recommendations – word of mouth is a great way to find tried and tested service providers
- Contact your local adult social services department – they will often have a list of approved providers that they use themselves and may be able to recommend someone to you. Find your local adult social services department here.
- Take a look at UK Home Care Association (UKHCA) – They are the professional association for homecare providers and this list provides a number of care agencies that meet their standards.
What are the alternatives?
While home care is a choice many people prefer, sometimes things just don’t work out that way, so it’s useful to know what the alternatives are.
Residential care homes
A residential care home is designed for people who don’t need 24 hour nursing care but are struggling to live independently, and have trouble performing day to day tasks, such as washing, eating, or dressing. They aren’t designed to provide medical support, but medical assistance is usually available through arranged doctors appointments. You may also find that there are specialist residential care homes for certain conditions such as dementia.
Nursing homes are a good option if you or your loved one have ongoing support requirements for a medical condition, illness or long-term injury. They are much like a residential care home, but as the name would suggest, there is usually 24-hour nursing support available. The on site nursing staff are able to administer and care for a range of conditions and medical requirements.
Extra care housing
Extra care housing bridges the gap between living in your own home and having care on hand when needed. Also known as assisted or supported living, people in extra care housing will have their own flat and will largely look after themselves. In some scenarios meals may be provided and there is often a scheme manager either living onsite or offsite who oversees the wellbeing of all residents. There is often an alarm system in every flat as well as communal areas that provide 24-hour emergency support for residents.
Retirement villages can provide homeowners there with a level of independence whilst also providing support if required. This option often appeals to those who want to be part of a community of people who are at the same life stage as them, and who want peace of mind that help is available if there’s a problem. Retirement village residents will often either buy, part-buy or rent a flat on site and there’s usually a minimum age requirement of 55 or 60. Flats and houses in retirement villages are usually kitted out with alarms so that residents can access help quickly should they need it. Bear in mind that homes in retirement villages can come with hefty service charges, which can make them difficult to sell on.
Adult day care centres
The main aim of adult day care centres is to create a space where people can socialise with others at the same stage of life. They may run a series of activities, provide a forum to talk about certain topics, allow you to exercise gently and help you meet new friends.
Ultimately the decision about which care option or combination of options is the best for you or your loved one is a hugely personal decision, and one that only you or they can make.