How to choose a care home in England

Choosing a care home is rarely something families plan for. It usually arrives with a hospital discharge, a fall, or the slow realisation that a parent can no longer manage alone. The pressure to decide quickly is real, and it pushes people into choices they later regret. This guide is about slowing the decision down just enough to get it right.

First, work out the level of care needed

Before you look at a single home, be clear about what care is actually required, because it determines which homes can even be considered.

• Residential care covers help with everyday life: washing, dressing, meals, medication and company. There is no nurse on site.
• Nursing care adds registered nurses on duty around the clock, for people with ongoing medical needs.
• Dementia care can sit within either of the above, but the quality varies hugely, so look for homes that specialise in it.

If you are not sure, ask the GP or the hospital discharge team for a view, and read our guide on the difference between a care home and a nursing home. It is also worth asking whether care could be delivered at home instead; our guide on home care versus a care home walks through that choice.

Get a needs assessment and sort out money early

Contact the person's local council and ask for a care needs assessment. It is free, it does not depend on income, and it produces a written picture of what support is needed. A separate financial assessment then decides whether the council will help pay. Do this early. Families routinely choose a home, fall in love with it, and only then discover they cannot afford it or that it has no funded places. Our guide on what care homes cost and who pays explains the numbers and the funding routes most people miss.

Build a shortlist with the ratings and the history

Now look at homes. On InspectedCare you can browse care homes by area and see, for each one, its current CQC rating and, just as importantly, how that rating has changed over time. A home that has quietly held "Good" for five years is a very different prospect from one that has just scrambled back up from "Requires improvement", even though both show "Good" today.

Read the five key questions, not just the overall word. The two that tell you the most are Safe and Well-led: safety speaks for itself, and well-led tells you whether the leadership can keep standards up when staff change or the home gets busy. Check the ownership history too. A recent change of provider is worth knowing about, because standards sometimes move with the owner.

Aim for a shortlist of three or four homes that are the right type, in the right place, and affordable.

Visit, and visit properly

Brochures and websites tell you almost nothing. Visit every home on your shortlist, ideally twice, and try to make one visit unannounced and around a mealtime. While the manager is talking, watch what is happening around you:

• Are call bells being answered, or ringing into an empty corridor?
• Do staff speak to residents, by name, or about them?
• Is the lounge a row of people asleep in front of a blaring television, or is something actually going on?
• Does it look and smell clean, without a heavy chemical cover-up?

Take a list of questions, and pay attention to how willingly they are answered. Our guide on questions to ask when you visit gives you a ready-made set.

Read the contract before you sign

Care home contracts are not light reading, but a few clauses matter a great deal:

• How and when can the fees rise, and by how much?
• What is the notice period, and what happens to fees if your relative goes into hospital or dies?
• What is and is not included (chiropody, hairdressing, outings, escorts to appointments are often extra)?
• What happens if needs increase beyond what the home can provide?

Trust the visit over the brochure

When the sales pitch and the inspection report disagree, believe the inspection. And when a place simply feels wrong on the day, it usually is. A home with a slightly lower rating but warm, attentive staff who know every resident often beats a glossy one where nobody makes eye contact. You are not buying a building. You are buying the people in it on an ordinary Tuesday afternoon.

More guides

• What CQC ratings mean, and what they don't
• Care home or nursing home: what's the difference?
• Questions to ask when you visit a care home

This guide is general information from InspectedCare, an independent site. It is not advice. For the official record of any service, see cqc.org.uk.