When families begin looking at care homes, the terms residential care and nursing care are often used as though they mean the same thing.

They don’t.

Both can provide accommodation, personal care, meals, support with everyday activities and a safe environment. The important difference is the type and level of healthcare and nursing support the person needs.

And this is where things can become confusing.

Someone may need a great deal of personal care without needing nursing care. Another person may look relatively independent but have complex health needs that require registered nursing support.

What is residential care?

Residential care provides 24-hour accommodation alongside care and support with everyday living.

Depending on the individual and the care home, this can include help with:

• Washing and bathing
• Dressing and undressing
• Toileting and continence
• Eating and drinking
• Mobility
• Transfers
• Medication support
• Personal routines
• Activities and social interaction
• Supervision and reassurance

Residential care can therefore involve a substantial amount of hands-on care.

It should not be thought of as a setting only for people who need a little help.

What is nursing care?

Nursing care is intended for people whose needs include a level of healthcare or nursing intervention that requires the skills and oversight of registered nurses.

This might include people who require ongoing support with complex or changing health needs, depending on the capabilities of the individual nursing home.

Examples may include:

• Complex medication requirements
• Wound care
• Catheter care
• Enteral feeding
• Some respiratory care needs
• Clinical monitoring
• Management of complex health conditions
• Other interventions requiring nursing expertise

The exact nursing services provided vary between homes, so families should always ask a prospective home exactly what it can safely provide.

Residential care vs nursing care at a glance

Does needing a lot of personal care mean someone needs nursing care?

Not necessarily.

This is one of the most important distinctions to understand.

A person may need two carers to help them get out of bed, assistance with washing and dressing, continence care and help eating their meals, but still be appropriately cared for in a residential setting.

The amount of personal care someone needs does not automatically determine whether they require nursing care.

The question is whether they also have healthcare needs requiring nursing expertise.

Does having dementia mean someone needs nursing care?

No.

Dementia can result in very significant care needs without automatically meaning that nursing care is required.

Someone living with dementia might need extensive assistance with personal care, communication, eating, continence, mobility and supervision but remain appropriately supported within residential care.

However, dementia can occur alongside other complex health needs. In that situation, nursing care may become appropriate.

It is therefore important to assess the person’s whole care picture, rather than assuming that their diagnosis determines the type of home they need.

You can explore our wider dementia resources for further information.

What about someone who is physically frail?

Frailty can involve substantial care needs.

Someone may struggle to walk, need assistance with transfers, require help with personal care and be at significant risk of falling.

That does not automatically mean they require nursing care.

However, if their health needs are complex or require ongoing nursing intervention, a nursing placement may be more appropriate.

What if someone needs nursing care sometimes, but not all the time?

This is where the situation can become less straightforward.

People’s needs are not always neatly divided into “residential” or “nursing”.

Someone may have periods of greater health instability or develop additional needs after they move into a care home.

This is why it is important to discuss the person’s specific needs with prospective providers rather than relying solely on the category of the home.

What questions should you ask a nursing home?

If your loved one may need nursing care, don’t simply ask whether the home has nurses.

Ask specific questions about their needs.

Can someone move from residential care to nursing care?

Sometimes.

Care needs can change considerably over time.

Someone may initially move into residential care because they need help with everyday activities and personal care. Later, they may develop additional health needs.

If that happens, their care should be reviewed.

Depending on the home and the person’s needs, the existing placement may be able to accommodate the change. In other situations, moving to a nursing setting may be necessary.

What about funding?

Residential care and nursing care can have different funding implications, but the type of care home alone does not determine who pays.

Funding can depend on the person’s financial circumstances, assessed care needs and whether they meet the criteria for particular sources of support.

For example, someone assessed as requiring nursing care may potentially qualify for NHS-funded nursing care.

Where a person’s needs are primarily health needs and meet the relevant criteria, NHS Continuing Healthcare may also be relevant.

It is therefore important not to assume that a family automatically has to fund the entire cost of a care home themselves.

How do you know which type of care your loved one needs?

Start with their actual needs.

Think about the last few weeks rather than one unusually good or bad day.

Consider:

• How much help do they need with personal care?
• Can they transfer and move safely?
• How often are they falling?
• Do they need help with continence?
• Can they manage their medication?
• Do they need supervision?
• What happens overnight?
• Do they have dementia or significant cognitive impairment?
• Do they have complex health needs?
• Do they require nursing interventions?
• How much support does the family currently provide?
• What is likely to happen if their needs increase?

Looking at these areas together gives a much better indication of the type of care that may be appropriate.

Residential care or nursing care: which is better?

Neither is automatically “better”.

The right setting is the one that can safely and appropriately meet the person’s needs.

For one person, residential care may provide everything they require. For another, nursing care may be necessary because of complex healthcare needs.

The aim should always be to find the least restrictive and most appropriate setting that can safely meet the person’s needs, while preserving dignity, independence and quality of life wherever possible.

Choosing the right care home matters too

Once you have a better idea of whether residential or nursing care is appropriate, the next decision is choosing the individual home.

Two residential homes can provide very different experiences. The same is true of nursing homes.

Look at staffing, management, the atmosphere, how residents are treated, the home’s ability to meet specific needs, activities, food, family involvement and the overall quality of care.

Our guide to choosing the right care home explains what families should look for when comparing potential homes.

What should you do next?

If you’re at the stage of trying to work out whether your loved one needs residential or nursing care, don’t feel that you need to make the decision immediately.

1. Write down their current care and health needs.
2. Consider what support they need during the day and overnight.
3. Identify any complex nursing or healthcare needs.
4. Use the free Type of Care Assessment.
5. Speak to appropriate health and social care professionals where necessary.
6. Once you understand the likely type of care, start comparing suitable homes.