Live-in care or a care home?

What is the difference between live-in care and a care home?

Both options can give your parent support around the clock, but they work in very different ways. With live-in care, a trained carer moves into your parent’s home and supports them with daily life there. With a care home, your parent moves into a room in a home where staff are on site day and night, and meals, laundry and activities are all provided.

Neither is the right answer for everyone. The better choice depends on your parent’s health, what matters most to them, the layout of their home, and how their needs are likely to change. This guide sets out what each involves in practice, so you can talk it through together and decide with your eyes open.

The information here applies to England. Scotland, Wales and Northern Ireland have their own regulators and funding rules.

What does a live-in carer do day to day?

A live-in carer follows a care plan agreed with your parent and the agency before care starts. The plan sets out what help your parent needs and how they like things done. Typical support includes:

• Help getting up, washing, dressing, using the toilet and getting ready for bed.
• Cooking meals your parent enjoys, and encouraging them to eat and drink well.
• Support with medicines, at the level written into the care plan.
• Keeping the house running: laundry, tidying, changing beds and shopping.
• Company through the day, whether that is chatting, a walk, a hobby or a trip to see friends.
• Going with your parent to appointments, and keeping you updated on how they are.

How do nights work with live-in care?

This is one of the most important questions to ask, and families are sometimes surprised by the answer. A live-in carer needs a proper night’s sleep to work safely the next day. Live-in care usually suits someone who sleeps through most nights, or who needs help only occasionally, such as one trip to the toilet.

If your parent is often up in the night, wanders, or needs turning or checking regularly, one live-in carer is not enough on their own. The agency may suggest a second carer who stays awake overnight, sometimes called a waking night carer, which adds to the cost. Be honest with the agency about nights from the start, so the plan is safe and the carer is not worn out.

Carers also need breaks during the day. Ask the agency how breaks are covered, what your parent will do during that time, and whether a family member is expected to step in.

Who does live-in care tend to suit?

Live-in care often works well for:

• People who feel strongly about staying in their own home, among their own things.
• People living with dementia who are calmer in familiar surroundings and routines.
• Couples who want to stay together at home, where one or both need care.
• People with a much loved pet that could not come with them to a care home.
• People who want one to one attention from the same small team of carers.
• People who have a strong link to their neighbourhood, church, club or friends nearby.

When is a care home the better choice?

A care home is not a failure or a last resort. For many people it is the safer and happier option. A residential home gives help with personal care, meals and medicines. A nursing home also has qualified nurses on duty, for people whose health needs a nurse’s oversight. A care home often suits:

• People who are lonely at home and would enjoy other residents, staff and activities around them.
• People who need two or more staff at once for much of the day, or help most nights.
• People whose health needs mean a nurse should be on hand at any hour.
• People whose home is no longer safe or practical, and cannot easily be adapted.
• Homes with no spare bedroom, or where having a carer living in would not work for the household.

Can a couple or a pet stay together, and is there room for a carer?

Keeping a couple together is one of the strongest reasons families choose live-in care. One carer can often support both partners, as long as their combined needs are manageable for one person. If both need a lot of help, especially at night, the agency may advise a second carer. Expect the price to be higher than for one person.

Some care homes do have rooms for couples, but they are not always available, and one partner may need a different level of care from the other. Ask each home directly.

Pets are much easier to keep with live-in care. Tell the agency about any pet before care starts, so they can match a carer who is happy to help with feeding and walks. A few care homes accept pets, so it is worth asking if this matters to your parent.

A live-in carer also needs their own private bedroom with a bed, somewhere to keep their things, and reasonable access to a bathroom and the kitchen. Agencies often ask for internet access too, so the carer can stay in touch with their own family and the agency.

Think too about everyday details. Will the carer eat with your parent? Is there a food budget? Where will they go during their break? Talking these through with the agency before care starts avoids awkwardness later.

If there is no spare room, live-in care is usually not possible. Visiting home care, with carers calling in at set times, may be an alternative for people who do not need someone there all the time.

Which feels less lonely, and which gives more continuity?

With live-in care, your parent sees a small number of carers who come to know them well. Carers usually work in rotation, handing over on a regular rota, so ask the agency how many different carers your parent is likely to have, and how handovers are managed. A consistent team matters a great deal for someone living with dementia.

Live-in care keeps your parent close to their own friends and neighbours, but their day is shared mainly with one person. A good carer will help them get out and stay connected. In a care home, company is built in, with other residents, staff and planned activities, though your parent will see several different staff across the week.

Neither is automatically better. Think about what your parent has enjoyed in the past. Someone who has always been sociable may flourish in a care home. Someone who values quiet and their own routines may be happier at home.

What happens if needs grow?

Needs often change over time, so ask both options how they would respond. A live-in care agency can review the care plan, add a second carer, or arrange extra support at night. District nurses can visit at home for nursing tasks. Equipment such as a hoist or a profiling bed can be brought in.

There may come a point where care at home is no longer safe or workable, for example if your parent needs two people for most tasks day and night. A care home, or a nursing home, may then be the kinder choice. Ask a care home whether it could keep your parent if their needs increased, or whether they would have to move again.

If your parent has complex, intense or unpredictable health needs, ask their GP or social worker about an assessment for NHS continuing healthcare. This is care arranged and funded solely by the NHS, and it can be given in your own home or in a care home.

How does paying for each one differ?

Your parent can ask the council for a free care needs assessment whichever option you are considering. If they have eligible needs, the council will also do a financial assessment to work out what they should pay. In England, anyone with savings and capital above the upper limit usually pays the full cost of their care.

The value of the home is treated differently. For care at home, including live-in care, the council’s financial assessment does not include the value of the home your parent lives in. For a care home, the home’s value can be counted, although it is ignored for the first 12 weeks of a permanent stay, and it is ignored for as long as a partner, or certain other relatives such as one aged 60 or over, still lives there.

If your parent moves into a care home and does not want to sell their home straight away, ask the council about a deferred payment agreement. The council helps pay the care home fees, and the money is paid back later, when the home is sold or after your parent’s death. Do not sell a home or end a tenancy before the council has made its decision.

What should you ask before you decide?

Start with your parent. Where they can take part, their wishes should lead the decision. Ask what matters most to them: staying at home, company, feeling safe, being near family. Then ask these questions of any agency or care home you are considering:

• Are you registered with the Care Quality Commission (CQC), and what does your latest inspection report say?
• How will you assess my parent’s needs, and who writes and reviews the care plan?
• What training do your carers or staff have, including in dementia care?
• How do nights work, and what happens if my parent needs help more than once a night?
• For live-in care: how many carers will rotate, how are breaks covered, and what happens if a carer is ill?
• For a care home: can we visit at any time, and could my parent stay if their needs increase?
• What is included in the price, what costs extra, and how much notice is needed to end the arrangement?

Making the decision together

Check that any live-in care agency is registered with the CQC. Some introductory agencies only match families with self-employed carers and have no ongoing role in the care, so they do not need to register and the CQC does not inspect them. With a managed service, the agency employs or manages the carers, is responsible for the care and is inspected.

Visit care homes, meet agency managers, and read their CQC reports. Remember that a decision made now can be changed later if it is not working. If you would like to explore care at home, our free matching service can put you in touch with one CQC-registered agency near your parent.