Care homes: Who chooses and who pays?

Advice and information about choosing and paying for full-time care. 

Who chooses the care home?

If the person is able to decide which care home they will move into, they can make the decision themselves. However, in a lot of cases the person with dementia may lack the capacity to choose. And so someone else, perhaps you, will need to make the decision for them.

It’s also important to know that for some people there is no choice – the care home nearby may be the only one, or there may be limited spaces in others, meaning there is only one option. If there is a choice of homes however, the process will be similar to deciding whether or not the person needs to move into a care home. This means the person’s attorney or deputy for health and welfare (if they have one) should make the choice. If the person only has an attorney or deputy for property and financial affairs, they can often make this decision too. If the person has no attorney or deputy, health and social care professionals and those close to the person should decide together. The home also has a choice about whether or not to accept a potential resident.

The decision may also depend on who is funding the care. If the person is paying for their own care, there will be more choice about the care home than if the local authority or NHS (or health and social care trust in Northern Ireland) is paying. If the local authority or trust is paying, the person choosing the home should still have a choice of care home. However the list will be limited to the homes that the local authority or trust will fund. See ‘Who pays for the care home’.

If the person with dementia has made an advance statement – a document that allows them to state their wishes for their future care – or has expressed their wishes in other ways, you should follow this as far as possible. For example, someone may have said they would like access to outdoor space, so you can look at care homes with gardens.

You should also use your knowledge of the person and what they would want in order to act in their best interests. Each person will have different needs and preferences about their care and what they like. These should be taken into account when choosing a care home.

Carers or relatives of a lesbian, gay, bisexual or transgender (LGBT) person may need to consider additional factors when selecting the right care home. This could be choosing a home that is aware and supportive of LGBT issues and the specific needs of LGBT people. Younger people with dementia may also have different needs to older people, and you may want to look for a care home that can provide age-appropriate support.

If the person has cultural, spiritual or faith needs, they will want a care home that can meet these. There are homes that cater for people of specific faith or cultural backgrounds, or where residents and staff speak a language other than English.

For anyone with specific needs like these, it can be a good idea to start thinking about care homes earlier than needed, as it can be harder to find one that will be right for them. You may have to make difficult decisions about the benefits of a local home or a specialist home that is further away.

For more detailed information on things to consider when selecting a care home, see booklet Finding a care home. For advice on some of the issues that affect younger or LGBT people with dementia see Young-onset dementia, and Supporting a lesbian, gay, bisexual or trans person with dementia.

Who pays for the care home?

Who pays for the person’s care will depend on the person’s individual situation. It will be based on an assessment of their needs and (in most cases) their financial situation. For some people, the local authority or the NHS (or health and social care trust in Northern Ireland) will pay the care home fees, and others will need to pay themselves. Sometimes it may be a combination of these.

If a public body (local authority, NHS or health and social care trust) is paying for the care home, there may be less choice than if the person is paying themselves. If the local authority or trust is paying it will sometimes provide a list of suitable care homes to choose from. They consider a care home suitable if it meets the person’s needs, meets the local authority’s budget and has a place available.

For more information on having the person’s needs assessed see Assessment for care and support in EnglandAssessment for care and support in Wales, or Assessment for care and support in Northern Ireland.

For more about paying for care see Paying for care in EnglandPaying for care in Wales, or Paying for care in Northern Ireland. For more information about NHS-funded care in England see When does the NHS pay for care?

Some people will be self-funding – this means they can arrange their place and pay for care home fees independently. This will probably also mean they have more choice over which home to move into, but it still might be limited. For more practical advice on choosing how to decide which is the right care home, see Finding a care home.

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