What are the alternatives to care homes?

If you need support to look after the person you are caring for or are keen to enable them to stay living in at home then there are alternatives to care homes which you can consider.

Home care services are provided by a range of organisations and private individuals.

There are lots of advantages to exploring home care services. They allow people to stay in their own homes for longer and may prevent or delay a move into sheltered housing or a care home.

This means that people can maintain contact with their friends and local community. If someone is a pet owner, they can continue to enjoy their pet’s company too.

Having care at home can provide peace of mind for family members as they know that regular and reliable support is in place.

Your choice of home care services may be limited by what’s available in your area.

Home care services can be flexible. You can have as little or as much help as you need and care can be tailored to fit your needs.

However, unless you have a live-in carer, carers will not be around 24/7.

If you need this reassurance, it may be better to consider extra care housing or a care home. You could also consider an alarm system and perhaps other devices such as a fall detector or bed sensor.

Home care agencies must be registered with national regulators who check that they are working to set standards. In England, the regulator also rates their services.

Individual agencies are responsible for vetting their staff.

While the aim is usually to provide consistency of care, sometimes different staff may be used in times of staff sickness, holiday or when there is a shortage of carers.

Carers will try, but might not always call at the arranged times. For example, if they have to deal with an emergency at their previous call. This can be challenging, especially if there are certain personal care tasks that the carers are helping with, such as going to the toilet, washing and getting dressed.

The cost of receiving care at home may be a lot less than the cost of moving into a care home, depending on the amount of care needed.

Local authorities have a duty of care to provide help to those with eligible needs.

You might want to consider employing a personal assistant. However, there can be a lot to think about if you are employing a personal assistant or helper directly.

You will have responsibilities as an employer, for example managing their pay and contracts and ensuring that the employee is doing their job properly.

Individual personal assistants don’t have to be registered with a workforce regulator. This means that there is no national body to check up on them. If this is something that concerns you, you could use a regulated agency instead.

If personal assistants or helpers are self-employed/private individuals, you could be left without any replacement cover if the helper is absent from work.

This could, however, be addressed by using agency cover.

Sheltered accommodation is normally available for people over a certain age and allows for more independence. Accommodation is usually very accessible and while people live in their own home, they are normally able to access support, for example from a warden if they need help, for example if they have a fall.

This type of accommodation is probably less suitable for people living with dementia, especially if they have increasing need of support as access to additional care services is not typically provided.

Extra care housing offers residents additional care services. Care staff, sometimes employed by local councils, care agencies or social landlords, can visit residents in their flats to help them with getting in and out of bed, washing and dressing. They might also help with cleaning or provide meals. Care staff are sometimes based onsite, but can also be community based. They are typically available 24 hours a day, seven days a week.

It’s common within extra care housing for all residents to have to pay a minimum contribution towards care services, regardless of whether they require any support themselves. So, it’s advisable to enquire about these charges and the typical costs for higher levels of care, should you need them in the future.

Extra care housing is regulated by the Care Quality Commission, which carries out inspection reports and ratings, available on their website.

Some extra care housing schemes have been built with special consideration given to residents with dementia. They may contain features such as:

• the use of familiar objects and furniture to aid orientation
• different rooms/sections of the house painted different colours instead of a clinical white throughout, to aid orientation
• curved furniture, so residents are less likely to bump into it
• safe outside spaces so that residents can enjoy the fresh air without getting lost or wandering too far

However, extra care housing shouldn’t necessarily be viewed as an alternative to a care home. People living with dementia often have complex care needs, and a care home may be better placed to provide the best levels of support required to ensure their safety. 

There are several different types of tenure or ownership to consider if you are thinking about a move to extra care housing.

All residents rent their property from the housing provider. There will be a weekly or monthly rent and usually an additional service charge. There may be charges for additional services, such as care and meals.

All residents have bought the property from the housing provider and pay a monthly service charge. There might also be additional care charges. You should check this before purchasing.

Some residents have bought the lease and some residents are renting from the housing provider. Both tenants and leaseholders are eligible for the same personal care and support services if they meet the criteria or are paying for the services.

Some extra care housing developers will have a shared ownership option where tenants can part buy and part rent. Typically, you can purchase between 25% and 75% of the scheme and you’ll pay rent based on the share of the property that you do not own.