Adult and Community Services

Residential Care and Nursing Home Services

These pages have been prepared to help you if:

You are looking at the option of moving into a care home
You need a short stay in a care home
You are helping a friend or relative who may be considering moving into a care home
You would like to know more about help in your own home

Moving into a residential care home or a nursing home is an important decision and this page is only a brief summary of some of the issues to consider.

What are care homes?

There are significant differences between Residential and Nursing Homes and the type of care provided. Both types of homes have to be registered and regularly inspected by the Care Quality Commission. They provide accommodation, meals, care and support from staff, which is available 24 hours a day. You can also see a GP in both types of home.

Residential homes

Provide support to people who can not be supported in their own homes even with a comprehensive package of care. They provide trained care staff and residents have access to visiting District Nurses.

Nursing homes

Provide even more care by having qualified nursing staff on duty 24 hours a day, to support people's needs where these are too complex to be met within even residential homes.

Who pays for care homes?

A local authority may consider funding a care home for an adult with very high needs which meet their eligibility criteria if a care home is considered by the assessment team as the most appropriate way of meeting those needs.

In these situations the adult is financially assessed to determine whether they pay some, or all of the cost of that placement from their savings or property. In some cases the NHS will pay the cost of Residential or Nursing Homes where they determine a person has a continuing care need for fully funded NHS care.

Many people choose to enter a care home as a private arrangement for a week or 2 or even on a permanent basis using their savings or capital, although adults considering this should ask their social services (Adult and Community Services) for an assessment to look at other alternatives.

In some cases people have moved into a care home and after a few years the money from their savings or property has been spent. When they then request an assessment by their local authority to consider taking over the payments to the home, they find that we do not agree that a care home is appropriate and may offer different support services.

Who runs the care homes?

Most care homes these days are run by the private sector although some are owned by charitable or voluntary organisations. Councils tend not to own and run their own care homes these days and so local authorities are the main purchasers of beds in care homes.

How does a council decide when to offer place in a care home?

In the London Borough of Barking and Dagenham, the social services function is provided through the Adult and Community Services Department.

This department employs Care Managers and Registered Social Workers to undertake assessments of adults 18+ to determine their need for community care services. When needs are assessed, they are matched against our eligibility criteria.

Depending on the type and level of needs, we may offer a care home placement, although in practice most people, even those with very high care needs, are supported in their own homes.

Whilst we do consider the wishes of the adult concerned, and of other professionals such as doctors, nurses and family members, the decision whether to offer a local authority funded placement in a care home does rest with us.

In some situations a care home placement may be offered where the cost of providing a package of care is not considered by the department as the appropriate way of meeting eligible needs.

Common misunderstandings about why people should go into care homes

Becoming widowed or a widower

Sadly after a lifetime together, in later life a partner or spouse may die leaving behind an older adult.

Bereavement is a difficult, yet important time to go through for the remaining partner. Someone in that situation should wait at least a year before making any decisions around selling a property, moving to another area or even moving in with relatives.

Family members including adult children should not try and coax the remaining parent to move into a care home simply because their other parent has died.

Becoming confused or developing a dementia

For some people, growing older can bring with it deterioration in memory. Perhaps starting with forgetting dates, to becoming disorientated in unfamiliar environments. For most people who are experiencing a loss of memory, they will function best in their own homes where they feel secure and find surroundings reassuringly familiar.

Unfortunately it is often in these situations that families and adult children want 'peace of mind' by having their relative placed into a care home. Families will often justify their reasons for wanting this, we hear these fears expressed throughout our assessment process.

"Dad might fall", or "Mum keeps telephoning day and night"
"Mum might wander off and get hit by a car"
"Dad could fall down the stairs"

Too much risk living alone

We do appreciate the anxiety felt by family but as professionals we really put the older person at the centre of our planning process.

Experience and research shows us that for the many people, leaving their familiar surroundings increases their confusion, sometimes quite rapidly. Being amongst strangers in unfamiliar surroundings can increase depression, agitation and reduce overall quality of life.

All through life an adult takes risks, from crossing the road, to horse riding, to dangerous sports. Often taking risks makes people feel alive or that life is worth living.

For some people, trying to get in and out of the bath, use the stairs or the toilet on their own provides this same sense of achievement and control in their life. But older people can face barriers to taking risks.

For some people their family members believe they should not be 'allowed' to live alone because 'they might fall down the stairs'. Often with best intentions, families can put their own need for piece of mind above the needs of their vulnerable older relatives.

Why care homes are not a 'magic wand' solution

Social Workers and Care Managers try to work with concerned family members to explain that whilst older frail relatives may fall in their own homes, they can just as easily fall in a care home.

Sometimes people are more likely to fall in care homes because they are unfamiliar with the layout, unsure where the toilets are, there may be objects leaning against chairs such as walking sticks, or even spillages on the floor. Even people that wander can still wander away from care homes.

If someone has tended not to socialise with many people all their life, they are not likely to want to socialise with other people simply because they share living arrangements in a care homes. So residential care is not always a way of providing social integration for lonely relatives.

Legislation and policy changes since the 1980s

It was the NHS and Community Care Act 1990 that really brought about the main changes to the way that adults with care needs are supported.

The aim of this law is to enable people to stay in their homes for as long as possible. The Community Care Act has resulted in a growing number of different services designed to support people in their own homes and a move away from placing people into residential care.

Different types of support services in the home

There are a range of services able to support people to remain in their own homes. Not all of them are provided by us, some are provided by the local Primary Care Trust or other voluntary groups or charities.

We provide funding to a range of voluntary organisations to provide additional service to our community. The types of services available to support adults in their own home can include the following:

Domiciliary services such as Home Carers and District Nursing services
Daytime activities outside of the home, such as luncheon clubs, adult education, keep fit classes or library services
Hot cooked or frozen microwave meals delivered to the home
Respite care, which allows carers and people they care for to have a short break from each other
Night time services
Befriending and advocacy, form completion and letter writing services
Provision of equipment to help with daily tasks

This Council is committed to the provision of Direct Payments, where cash funding is provided to adults or their carers to enable them to take charge of employing or purchasing support services.

We are also a pilot Council for the new Individual Budget scheme, which builds upon the success of Direct Payments.

Having an assessment

If you believe that an adult has need of community care services, then in the first instance you can request an assessment of their needs by a Care Manager or Social Worker by contacting the Adult Intake and Access Team at the address shown.

Questions and Answers|

Financial Questions and information|

Sources of Information, Advice and Help|

We need to put Dad in a home|

Advice and information leaflet on care homes.

Care Directory 2008-2009 PDF 652K