The Difference Between Residential & Nursing Homes

This is a question often asked when someone is first looking to move into a care home.  Just what IS the difference between a residential home and a nursing home.  The clue is really in the name.  A residential home is somewhere where you live and have assistance from staff to help you wash and dress, moving around the home and going to the toilet.  A Nursing home is for someone who needs nursing care, whose care needs are more complex and cannot be assisted by carers alone.

But unfortunately it's more complicated than that, as things often are.  My experience is mainly in Scotland and so that is what I shall talk about, but there maybe other differences in England and Wales.

Residential Homes

As I have mentioned, these are for people who need some help with their daily living.  They may need a hand to get washed and dressed, to get to the toilet. to have a shower or bath etc..  There does not need to be a qualified nurse in the building and carers are responsible for planning and carrying out care.  They can assist you with medication but do not have the knowledge or experience with medication of a qualified nurse.  District nurses would come in to attend to any nursing needs that someone might have such as a dressing just as they would if you were in your own home.

Because Residential homes cater for people who are more independent, on the whole the residents have less communication difficulties or memory problems.  Any activities organised therefore tend to be directed towards those with more physical and mental abilities than Nursing homes.

Nursing Homes

Nursing Homes always have at least one qualified nurse in the building, twenty-four hours a day.  The home cares for people with more complex needs.  This includes things like

• one to one assistance with eating and drinking
• assistance from two people and and a mechanical aid to move from bed to chair
• regular assistance throughout the night
• regular supervision to help maintain safety
• high levels of emotional support either during the day or at night
• at high risk of pressure sores

The nurses can attend to any nursing needs such as dressing changes and are more knowledgeable regarding medications.  They can administer medications by injection.  District nurses can still be involved as care home nurses can often turn to district nurses for advice.

Dual Registered

Some homes cater for both residential and nursing clients and this is often a good choice if your needs are currently in the residential bracket.  Whilst any home will do their utmost to assist you for as long as possible, a dual registered home will be able to cater for you if your condition deteriorates and you require nursing care.

Now all that sounds pretty straight forward I know but it can all be a bit grey as to which category someone might fit into.  This has only become more of a muggy area in Scotland since the funding system changed.  People living in Scotland, who have a certain amount of money, are required to pay for their care.  But from 2005 they have been refunded a certain portion of that money.  If they are in residential care they get back a personal care allowance but if they are in nursing care they get a nursing care allowance on top of the free personal care.  

This has meant that from 2005 it has been important that are placed in the right category as this can at current rates make a difference of around £3800 per year.

For further information about free personal and nursing care in Scotland click here

But what has tended to happen and I have certainly noticed this myself is that what was once considered a nursing need is now being considered as something that could be managed in a residential home.  Local councils in Scotland carry out an assessment of needs and then this is then put forward to a funding panel.  This panel decides if a) the person needs to be in a care home and b) if they qualify for the nursing care element.  I feel this is important to know, as if a social worker or care manager visits you to assess your needs it is really important that you do not hide or underplay any of your needs as it may mean that you are not funded appropriately.  Please bear this in mind.

And Finally

If you have had any experiences of the differences between nursing and residential homes, or if you can advise on the different homes in England or elsewhere in the world I would love to hear from you!

Please leave a comment below.

Care Homes - Does size matter?

Large Versus Small

When you are choosing a care home the number of people it can take should factor into your decision.

There are advantages and disadvantages to both and I'll try to cover these factors as comprehensively as possible.

Large

A large care home can seem more impersonal.  It can be very difficult for staff to know all your needs, likes and dislikes, when they have a lot of other people to care for.  Even if the home has certain staff working in the same areas, there will be times when they will have to work elsewhere to help cover for staff holidays or sickness.  If there are different staff it will be more difficult for you to get to know them, especially if you have a memory problem.

But a larger home generally has a larger pool of funds to dip into for equipment.  If you need a profiling bed for example (this is a bed that can be lowered almost to the floor and is used for people at risk of rolling out of bed to minimise the risk of injury) then a smaller home may have to delay purchasing it until funds are available.  They should, in fact, buy any equipment you need, but sadly in practise this is often not true.

A larger home should also have a larger pool of staff to call on at short notice if someone calls in sick.  There are nursing agencies that will supply staff to homes to help maintain staffing levels, but they don't know any of the residents, the lay out of the building, or your normal routine.

Larger homes tend to be purpose built and so are designed with you in mind. They have larger corridors and bathrooms for easier wheelchair access and the layout of the bedrooms and communal areas can be easier for people to find their way around.  Purpose built homes generally have a large number of fire escapes.  Any care home being built now in Scotland has to install a sprinkler system and all bedrooms have to have en suite shower rooms.

Small

A smaller care home is one catering for around 30 residents or less.  Here it is far easier for every member of staff to know all your details.  They can, for example, remember how many sugars you take in your cup of tea. But, in a smaller home, everyone seems to know everyone else's business.  The staff will do their utmost to protect your confidentiality but the residents are only human and there will be some among them who enjoy a good gossip.

Whilst there will be some smaller, purpose built home, most tend to be conversions from hotels, or large country houses.  This may mean the layout is not ideal, rooms may have irregular shapes and may not have en suite facilities.  But this may also help if you have memory problems.  In a home with different size corridors and doors it may be easier for you to find your room than one where all the corridors and rooms look identical.  Care homes often put the name of the resident on their bedroom door, but this won't help if you have a visual impairment.  

Another advantage of a home that has been converted is that they often have a more homely feel, rather than an institutional one.

Decisions

It is probably better not to rule out a home at this stage because of it's size, but simply bear these points in mind for when you come to make your decision. 

If you have started a spreadsheet, you could use the next column to add the size of the home.  This information can be found on the inspection reports.  Click here to go to the page where I talked about spreadsheets.

What do you think?

Are you already in a care home?  Do you prefer a large or a small home?  Was that an important factor when making your decision?

I'd love to receive your comments