Home care, live-in care or a care home? How to choose

When someone you love starts to need more help, the choices can feel overwhelming. Most families end up weighing up three main options: visiting home care, live-in care and moving into a care home.

Each can be the right answer, for different people at different times. This guide explains what each involves, what they typically cost, who they suit and the questions to ask yourself, so you can make the decision that is right for your family.

A quick note before we start: at Medicare People we only arrange live-in care. We do not provide visiting home care or run care homes. We have tried to write this guide fairly, because the right choice depends on the person, not on what we offer.

The three options at a glance

	Visiting home care	Live-in care	Care home
Where care happens	At home	At home	In the care home
Who provides it	Carers who visit at set times	One carer living in the home, with a second carer for breaks	A team of staff on shifts
How much support	From short visits to several a day	One-to-one, around the clock	Shared staff, 24 hours a day
At night	Usually nobody there, unless night care is arranged	The carer sleeps in the home	Staff on duty
Typical cost	Charged by the hour	Charged by the week	Charged by the week
Couples	Each partner’s visits arranged separately	One carer can support both	Couples may not get a shared room

Visiting home care

Visiting home care, sometimes called domiciliary care or simply “home care”, is where carers come into the home at agreed times. A visit might be 30 minutes to help someone get up, washed and dressed, or an hour at lunchtime to prepare a meal. Some people have one visit a day; others have four.

It can suit someone who:

• needs help at predictable times of day, such as getting up and going to bed
• is safe on their own between visits and overnight
• wants to keep as much independence as possible
• has family or friends nearby who help too

Things to consider:

• Carers usually have a set amount of time, so visits can feel rushed.
• Different carers may visit, which can be unsettling for someone living with dementia.
• There is usually nobody in the house overnight or between visits.
• Costs are charged by the hour, so they rise quickly as the number of visits grows.

Visiting home care is often the first step when someone starts to need a little help, and for many people it works well for years.

How to find visiting home care: contact your local council’s adult social care team, which can carry out a needs assessment and tell you about home care providers in your area. You can also search the Care Quality Commission’s website for registered home care agencies near you and read their inspection reports.

Live-in care

With live-in care, one carer moves into the home and provides one-to-one support, day and night. A second, regular carer covers their breaks and holidays. It is sometimes described as 24-hour home care.

The carer helps with whatever is needed: personal care, meals, medication prompts, housework, getting out and about, and company. Because they live there, the day can be shaped around the person rather than around a timetable.

It can suit someone who:

• needs help at unpredictable times, or often during the day
• is no longer safe alone, or is anxious about being alone at night
• is living with dementia and finds change difficult
• has come home from hospital and needs support while they recover
• is part of a couple who want to stay together
• would be unhappy leaving their home, garden or pets

Things to consider:

• The carer needs a private bedroom and a two-hour break each day.
• Live-in carers are not nurses. If needs are mainly clinical, other care may be needed alongside or instead.
• A carer sleeping in can help if someone wakes occasionally, but they cannot work all day and all night. If someone needs help many times every night, extra night support is needed.
• You are welcoming someone into the home, so matching matters. Choose a provider who lets you meet and choose your carer.

Care homes

A care home provides accommodation, meals and personal care in a residential setting, with staff on duty day and night. Nursing homes also have registered nurses on site for people with clinical needs.

It can suit someone who:

• has nursing needs that require a registered nurse on hand
• enjoys company and would like more social contact than they have at home
• lives in a home that cannot be adapted safely
• would feel more secure with staff around at all times

Things to consider:

• Moving can be unsettling, especially for people living with dementia.
• Staff care for several residents, so support is shared rather than one-to-one.
• Couples may not be able to share a room, or even the same home, if their needs differ.
• The home may need to be sold to pay fees, as the value of the property can be counted in the council’s financial assessment once someone moves into residential care.

How the costs compare

Care costs vary a great deal by area and by how much help someone needs, so treat these as broad guides only and always ask for exact prices.

• Visiting home care is usually charged by the hour. A few visits a week can be the most affordable option, but if someone needs many hours each day, the weekly total can match or exceed live-in care.
• Live-in care is charged by the week. Our carers’ fees start from £1,090 a week, plus an agency fee. See our live-in care costs page for a full breakdown.
• Care homes in the South East commonly cost well over £1,000 a week, and nursing homes cost more.

For couples, the comparison often changes: one live-in carer can support both partners, whereas two care home places mean two sets of fees.

Help may be available from your council, from NHS Continuing Healthcare if needs are mainly health-related, and from Attendance Allowance. Our page on ways to fund live-in care explains each option.

Questions to help you decide

1. When does your loved one need help? At a few set times, or at unpredictable times throughout the day and night?
2. Are they safe alone overnight? If not, visiting care alone may not be enough.
3. How important is home? Some people are happiest in familiar surroundings; others are ready for a move.
4. Are their needs mainly clinical? If they need a nurse regularly, a nursing home or nursing support may be needed.
5. Is this about a couple? Live-in care is often the only way to keep two people together at home.
6. How are you coping? If you are a family carer, your own health matters too. Ask your council for a carer’s assessment.

Signs that visiting care may no longer be enough

Families often notice that visits are not covering everything: meals are left uneaten after the carer goes, medication is missed between visits, there have been falls at night, or confusion is getting worse in the evenings. A family carer may be “filling the gaps” and becoming exhausted.

If that sounds familiar, it may be time to think about live-in care. You can read more in our guide to the 7 subtle signs your parent needs live-in care.

Talk it through

There is no single right answer, and needs change over time. If you would like to talk about whether live-in care could work for your family, call us on 020 3443 9844 or request a call back. We will give you honest advice, and if live-in care is not the right fit, we will tell you.

Medicare People currently provides introductory live-in care services. We have submitted our application to the Care Quality Commission (CQC) and intend to introduce a fully managed live-in care service following registration.