Care home or home care? Pros and cons explained

Most families start thinking about home care or a care home after something has shifted. It might be a fall, a dementia diagnosis, or a hospital stay that left a parent struggling once they got home. Or it might be the slow realisation over months of phone calls that a parent isn’t coping at home on their own anymore.

The question that follows is whether your loved one would be better supported in their home, with carers visiting on a schedule, or in residential care where staff are on site around the clock. 

This article walks through what each option involves, the pros and cons, what they cost, and how to choose between them.

At a glance

• Home care: Helps people stay independent while continuing to live at home with scheduled visits or live-in support, while care homes provide 24-hour on-site care.
• Care homes: Usually better for complex or advanced needs, including dementia and nursing care, where constant supervision is needed.
• Costs: Depend on care levels. Home-based care starts lower for light support, but full-time care can become more expensive than residential care.
• Safety: A major deciding factor, especially if someone is falling, forgetting medication, or struggling at night.

Home care vs care home: a quick comparison

These two very different types of care offer different solutions. Home-based care brings support into your loved one’s house for a few hours a day. A residential care setting has staff on site at all times.

	Care home	Home care
Where care is given	Residential setting with other residents	The person’s own home
Staffing	24-hour care support on site	Scheduled visits, or live-in care
Meals and housekeeping	Included	Arranged separately
Best suited to	Higher or complex needs, advanced dementia	Lower to moderate needs
Typical cost	£1,298/week residential, £1,535 nursing	£26–£38 per hour

What is a care home?

A care home is a residential setting where older people live and receive support. Staff are on site at all times, and meals, laundry, activities and personal care are included.

There are two main types:

• Residential care homes support people who need help with washing, dressing, medication prompts and meals, but don’t require nursing input. 
• Nursing homes also have qualified nurses on site, suited to people with conditions that need regular clinical attention, such as wound care after a stroke or support in the later stages of dementia. Some are registered for both, and many offer specialist dementia care in dedicated units.

Residential care settings in England are regulated by the Care Quality Commission, with equivalent regulators in Scotland, Wales and Northern Ireland. Inspectors give the homes different ratings according to their standards of care and the full report is published online.

What is home care?

Home care, also called domiciliary care, is paid support delivered in your loved one’s own home. A care worker visits on a schedule and helps with the tasks that have become difficult.

A morning call might involve helping someone out of bed, into the shower and downstairs for breakfast before the carer moves on. Most families start with one short call a day and add more as needs grow. For higher needs, live-in care carers can provide care in the home full time. 

Domiciliary care is regulated like residential care, with most providers inspected by the CQC or its national equivalents.

Care home pros and cons

Care homes suit people whose needs have grown beyond what visiting support can safely provide.

Pros

• Round-the-clock staffing means help is moments away, which matters for families worried about a parent leaving the hob on or falling in the night. 
• Social contact happens naturally throughout the day. Residents share meals and activities without having to organise them.
• Building design is shaped by the people living in it, with dementia-friendly signage, hoists, secure gardens and accessible bathrooms.
• Specialist support, including dementia care, end-of-life care and complex nursing, is delivered by staff trained for those situations.

Cons

• Leaving home. Moving out of a long-time house is often the most emotionally difficult part of the process.
• Less flexibility. Day-to-day life works around set mealtimes, shift patterns and shared living spaces.
• Cost. Self-funded residential care averages over £1,200 a week, and the local authority means test takes property into account in most circumstances.

Home care pros and cons

Home care works best when needs are manageable and the home is reasonably suitable.

Pros

• Familiar surroundings help people with dementia in particular, where the kitchen is where it has always been and the photos on the wall are theirs.
• Flexibility. You can start with one short visit a day and add more as needs change, and the same care worker can build a relationship with your loved one over time.
• Community connection. Your loved one can still walk to the post office and be recognised when they get there, see the same GP, and stay in touch with neighbours they have known for years.
• Pets can stay. Most residential care settings cannot accommodate animals, which is very difficult for someone whose dog or cat is their main daily companion.
• Couples can stay together when one would otherwise move into residential care alone.

Cons

• Home adaptations. Stairs, narrow bathrooms and worn flooring become obstacles, and an occupational therapy assessment through the local authority can identify what’s needed.
• Gaps between visits. If a carer leaves at 10am and the next call is at 6pm, anything that happens in between depends on your loved one reaching a phone or pendant alarm.
• Changing needs. Someone who manages with two visits a day this year may need four next year, and at higher levels the cost can end up being more than a residential care setting.
• Loneliness. A 45-minute visit isn’t the same as company, and their family may live far away.

How much does residential care and domiciliary care cost?

Costs vary by location, provider and level of care, but the national averages give a useful starting point.

Home-based care costs between £26 and £38 an hour. Two hours of support a day at £30 an hour works out at £420 a week, £1,680 a month, or £20,160 a year. Live-in care costs considerably more.

Average weekly fees in a residential care setting for self-funders are:

Type of care	Average weekly cost
Residential	£1,298
Nursing	£1,535
Specialist dementia (residential)	£1,343
Specialist dementia (nursing)	£1,564

Residential care works out at around £67,500 a year. Fees in London and the South East are higher, while parts of the North and Northern Ireland are lower.

A few details are worth knowing before you compare:

• Round-the-clock care at home can cost more than residential care. Two hours of domiciliary care a day is around £420 a week, but care that runs day and night costs many times that.
• Top-up fees may apply. If the council is funding care but you choose somewhere that costs more than the local authority rate, a third party such as a relative can pay the difference.
• Funding may be available. A local authority needs assessment is the route to council-funded care. People with significant ongoing health needs may also qualify for NHS continuing healthcare, which covers the full cost and is not means-tested.

Choosing between home-based care and residential care

Instead of a checklist, try to picture a typical week. If your loved one is still enjoying their garden and seeing neighbours but needs help with a shower and dinner, domiciliary care is likely a good fit. If they are increasingly isolated, declining invitations and struggling with night-time confusion, the company and safety of residential care may work better.

Things to weigh up:

• How much care does your loved one need? A few hours a week points to domiciliary care. Round-the-clock supervision or complex nursing needs points to residential care.
• Is the home safe and suitable? Stairs, bathroom and outdoor access matter most. Some homes can be adapted, others can’t.
• What is the budget? Cost both options against the level of support needed, and ask the local authority for a financial assessment.
• How socially connected is your loved one? Someone with regular visitors and a partner at home loses more by moving. But someone who lives alone in a quiet house can end up feeling lonely and may welcome the interaction and social atmosphere of a care setting.
• What might a typical week look like in a year’s time? Domiciliary care can be increased, but if a move is likely anyway, planning it beats waiting for a crisis.

A good first step is a free local authority needs assessment. Involve your loved one and their GP throughout. The Mental Capacity Act 2005 provides the framework to respect their choices. Visit any shortlisted homes in person before deciding.

Choosing between a care home and home care needs to be thought about carefully over time and in conversation with the people who know your loved one best. Whichever route fits, you can find local fees, CQC ratings and family reviews on carehome.co.uk to help with the next step.

FAQs