How to find good care
Most families start by searching for care homes near them and end up with a list of twenty names and no way of telling them apart. This guide works the other way round: start with the need, narrow the type of care, then judge individual providers on things that actually predict whether the care will be good.
Start with the need, not the building
Almost every difficult care decision we see began with a family choosing a setting before anyone had written down what the person actually needs help with. Once a deposit is paid and a room is furnished, changing course is emotionally and financially costly. Half an hour spent describing the need properly saves months.
Write down a typical fortnight
Not the worst day, and not the day the family visits. A typical fortnight. What time does the person get up, and who helps. What happens with medication. What happens at night. How many times has someone had to drop everything and drive over in the last two weeks. Care assessments, funding decisions and provider matching all turn on what is usual, and families routinely under-describe it because so much of the help has become invisible to them.
Ask the council for a needs assessment
In England, anyone who appears to need care and support has a right to a free assessment from their local authority under the Care Act 2014. That right does not depend on income or savings. Even where a family is certain they will be paying privately, the assessment is worth having: it produces a written record of need, it establishes eligibility, and it is the document everything else refers back to. If the person is in hospital, the process runs differently and faster, which we cover in the hospital discharge guide.
Separate the health question from the housing question
If the need is substantially about health rather than daily living, the NHS may be responsible for the whole cost through Continuing Healthcare. That is a different route with a different assessment, and it should be considered before a placement is agreed, not after. Our CHC funding guide explains who qualifies, and the checklist tool gives you an honest indication in about five minutes.
- A one-page summary of a typical fortnight, with times
- The current medication list
- Any diagnoses, and who is treating them
- Mobility: stairs, transfers, falls in the last six months
- Continence and night-time needs, described plainly
- What the person wants, in their own words if possible
- Who holds power of attorney, or that nobody does
- A rough picture of savings, property and income
The six kinds of care most families are choosing between
Home care (domiciliary care)
Carers visit for set calls through the day — typically thirty or forty-five minutes each. Suits people who are safe between visits. Falls apart quickly when the need is unpredictable or largely at night.
Live-in care
One carer lives in the home. Costs sit in the same territory as a good nursing home but keep the person in their own house and preserve continuity. Needs a spare room and a plan for the carer's breaks.
Residential care home
Accommodation, meals and personal care with staff on site around the clock. No registered nurse on the premises. Right where the need is about supervision, prompting and company rather than clinical care.
Nursing home
As above, with registered nurses on shift. Needed for things like PEG feeding, complex wounds, unstable conditions or end-of-life care. Attracts NHS-funded Nursing Care towards the nursing element.
Specialist dementia care
Residential or nursing, registered and staffed for dementia. The registration matters: a home that is not registered for dementia can give notice when behaviour changes. Covered in the dementia care guide.
Extra care and supported living
Self-contained flats with care available on site. A genuine middle option that is often overlooked, though availability is patchy and waiting lists are real in most areas.
Which type of care fits which situation
The table below is a starting point, not a decision. The most common mismatch we are asked to unpick is home care that was never going to be enough, bought because it felt like the smaller step.
| Type of care | Works well when | Starts to fail when | Check before you commit |
|---|---|---|---|
| Home care visits | Needs are predictable and fall at set times of day | Needs are at night, or the person is unsafe between calls | Call times in writing, and what happens when a carer is off sick |
| Live-in care | The person is settled at home and continuity matters most | Two people are needed for transfers, or nursing tasks are required | Break cover, the replacement carer, and who supervises |
| Residential care | Supervision, meals, company and prompting are the main need | Clinical need appears and the home cannot meet it | Whether they can keep the person as needs increase |
| Nursing home | There is a genuine, ongoing registered-nursing need | Rarely fails on care type, more often on cost or distance | Nurse numbers on a night shift, not just on paper |
| Specialist dementia | Behaviour, wandering or distress need trained staff | The home is registered for dementia but not staffed for it | What behaviour would lead to notice being given |
| Extra care housing | The person wants independence with a safety net | Needs become continuous rather than intermittent | What happens if care needs outgrow the scheme |
How a good search actually runs
Define the need in writing
One page. A typical fortnight, the medication, the mobility, the nights. Everything else follows from this, and every provider you speak to will ask for it.
Fix the money question early
Work out who is likely to pay before you fall in love with a home. Use the care fees calculator and read the care costs guide. A placement you cannot sustain for three years is not a placement.
Build a shortlist of five or six
Not one. Availability moves week to week, and having alternatives is what stops you accepting something unsuitable under time pressure. Check the CQC register for each one.
Visit properly, twice if you can
Once by appointment, once unannounced if they will allow it, and at a different time of day. Late afternoon tells you more than eleven in the morning.
Read the contract before the deposit
Fee reviews, notice periods, what happens if funding changes, what is genuinely included. This is where avoidable money is lost.
What a CQC rating does and does not tell you
Every care home and home care agency in England has to be registered with the Care Quality Commission, and most carry a rating of Outstanding, Good, Requires improvement or Inadequate. The rating is real evidence and you should always check it. It is also a snapshot, sometimes years old, of a service that may have changed hands, changed managers, or changed entirely since.
Read the report, not the badge
The overall rating hides more than it shows. A home rated Good overall may have been rated Requires improvement on safety. Open the report and read what the inspector actually wrote about staffing, medicines and how concerns were handled. The narrative sections are where the useful information is.
Check the date and the manager
Two things predict current quality better than the rating itself: how long ago the inspection was, and whether the registered manager is still there. Homes with a stable manager and low staff turnover are usually the ones that hold up. Ask directly how long the manager has been in post and what the agency-staff usage looks like on nights.
Trust the smell test, then verify it
What you notice on a visit is worth something. Are residents dressed and up, or in nightwear at midday. Do staff speak to people or about them. Is anyone doing anything, or is the television on to nobody. Then verify the impression with questions that have factual answers, because a warm welcome is not a care plan.
- How many staff are on shift tonight, and how many are agency
- How long has the registered manager been here
- What is your staff turnover in the last twelve months
- Who reviews care plans, and how often
- What would make you give someone notice
- How do you handle a fall at three in the morning
- When did you last have a safeguarding concern raised
- What is not included in the weekly fee
- How much notice do you give of a fee increase
- Can I speak to a relative of a current resident
Four things to settle before you sign
Fee reviews and top-ups
Ask what the increase has been in each of the last three years, not what the policy says. If a third party is expected to pay a top-up above the council rate, get the amount, the review terms and who is liable in writing before anyone moves in.
What the fee excludes
Chiropody, hairdressing, escorted appointments, newspapers, some continence products, sometimes physiotherapy. Individually small, collectively a few thousand a year. Ask for the extras list as a document.
Notice periods both ways
What notice must you give, what notice will they give, and what happens to fees after a death. Four weeks' fees charged after a bereavement is common and lawful if it is in the contract you signed.
What happens when funding changes
If self-funded savings fall towards the capital limits, or CHC is granted or withdrawn, does the home keep the person. Get the answer now. It is the single most useful question nobody asks.
Questions families ask about finding care
How do I find a care home near me that has a bed available?
Availability is not published reliably anywhere, and directory sites are usually out of date. The only way to know is to ring. That is why the shortlist matters: five or six suitable homes, rung in the same week, gives you a real picture of what is actually available at the level of care you need.
Do I have to accept the care home the council offers?
No. Where the local authority is arranging and funding a placement, you have a right to choose a different setting provided it is suitable, there is a place available, the provider will accept the council's terms, and the cost is met. If the preferred home costs more, a third party may be asked to pay a top-up. You cannot normally be asked to top up out of the resident's own income or protected capital.
Is home care cheaper than a care home?
It depends entirely on how many hours are needed. A few calls a day is far cheaper. Once you get past roughly four or five hours a day, or once nights are involved, home care and live-in care start to cost more than a residential placement. Work it out on the actual hours before assuming.
What is the difference between a residential home and a nursing home?
A nursing home has registered nurses on shift; a residential home does not. The distinction matters for funding as well as care: a nursing placement attracts NHS-funded Nursing Care towards the nursing element, and it is usually the setting where Continuing Healthcare is considered.
How quickly can care be arranged?
Home care can often start within a week or two. A care home placement can move in days if a bed is free and funding is clear, and can take weeks if it is not. Hospital discharge runs to a much shorter timetable, which is exactly why decisions made there are so often the wrong ones — see the hospital discharge guide.
Should I use a care home comparison website?
Use them for names and locations, then verify everything independently. Most directories are paid listings, availability is rarely current, and reviews are thin. Treat them as a source of candidates, never as a source of judgement.
Can we move someone if the home turns out to be wrong?
Yes, subject to the notice period in the contract. Moving is disruptive and should not be done lightly, particularly for someone with dementia, but staying somewhere unsuitable is worse. If the concern is about safety rather than fit, raise it with the home in writing first and with the local authority safeguarding team if it is not resolved.
What if the person refuses to accept any care at all?
This is common and it is not automatically a reason to override them. An adult who has capacity to make the decision is entitled to make an unwise one. Where capacity is genuinely in doubt, an assessment under the Mental Capacity Act is the correct route, and any decision then has to be made in their best interests. We cover this in planning ahead.
Do we need a solicitor or a financial adviser?
Sometimes. Powers of attorney and deputyship are legal work. Long-term care funding products are regulated financial advice. We are neither: we do not provide FCA-regulated financial advice or carry out reserved legal activities, and where those are needed we will tell you and introduce you to someone who does.
What does My Care Direction actually do here?
We do the part families do not have time to do well: turning the need into a written brief, checking funding routes before a placement is agreed, building and testing a real shortlist against current availability, and being in the room for the questions that are awkward to ask. We are independent, nurse-led and take no commission from providers — see how we work.
How urgent is this, and what comes first?
Five questions. No email, nothing stored. The result gives you an order to work in, based on how much time you actually have.
Take it further
Who pays for care
Capital limits, means testing, and the funding routes families miss.
NHS Continuing Healthcare
When the NHS should be paying the whole cost, and how to argue for it.
Hospital discharge
Fast timetables, pressured decisions, and how to slow them down safely.
Care fees calculator
Work out the weekly shortfall and how long savings realistically last.
You don’t need to know which service you need.
Just tell us what’s happening.
No pressure. No care-provider commissions. Just a conversation about what may help.Independent · no commission from any care provider · fees published
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