Types of care explained
Written by Dr Mustafa Ghafouri, a medical doctor and data scientist. Last reviewed 5 Aug 2026.
When someone close to you suddenly needs care, the words are unfamiliar and the decisions feel enormous. This is a plain-English guide to the main kinds of adult social care in England, who each is commonly used for, and — the two things that matter most — who decides what care is right, and who pays for it. It explains the choices; it does not make them for you.
The main kinds of care
Broadly, care is either brought to the person in their own home, or the person moves somewhere staff are on hand. Which fits depends on how much support someone needs, whether they need nursing, and what they want — and that is what the council’s needs assessment (below) is for.
Care at home
Also called home care or domiciliary care.
Carers visit the person in their own home to help with things like washing, dressing, medication, meals and getting around — from a single short visit a day to several longer visits.
Commonly used for: People who want to stay in their own home and need help with daily tasks rather than round-the-clock supervision.
A care home (residential)
Also called a residential home.
The person moves into a home where care staff are on site day and night, with meals, personal care and company. A residential home does not have nurses on site.
Commonly used for: People who can no longer manage safely at home, or who would be isolated living alone, but do not need day-to-day nursing.
A care home with nursing
Also called a nursing home.
A care home that also has at least one registered nurse on site. This is a different registration, not a better home and not a sicker person’s home — a residential home can support very high personal-care needs, and its residents get nursing from the community district nursing service through the GP, exactly as people do in their own homes. What a home with nursing adds is a nurse on the premises.
Commonly used for: People for whom a task has to be done by a registered nurse, and done often or unpredictably — tube feeding, a syringe driver, a wound needing daily dressing, a tracheostomy, complex catheter care. Dementia on its own is not a nursing need. Which side of that line someone falls is decided at assessment, not by a website.
Supported living
The person keeps their own tenancy or home and support workers come in to help them live as independently as possible. The housing and the support are usually separate arrangements.
Commonly used for: Younger adults, and people with a learning disability, autism or mental health needs, who want to live independently with the right support around them.
Not sure which fits? Use the care finder — tell it who the care is for and where, and it shows the local services registered for those needs, each with its CQC rating and the date it was published.
The options in between
The four above are the ones with a CQC registration you can search here. Families are often not told about the rungs in between, and the gap between “more visits” and “a move” is where most of them actually sit.
- Live-in care— one carer lives in the house and needs their own room. Where two people are required for transfers, or while the carer takes their breaks, cover has to come from somewhere else. It is the standard step before a move, and it is often costed against a care home without anyone comparing like with like.
- Night cover alongside visits — a sleep-in (there overnight, expected to sleep, up for the occasional call) or a waking night (awake throughout). The difference between those two is large, and it is usually what decides whether staying at home is affordable.
- Respite and short stays— a planned short stay in a care home, day services, or replacement care at home so a carer can rest. Its other use is rarely mentioned: a short stay is the only way to test whether a care home works without anything permanent being decided.
- Extra care housing (a self-contained flat with your own front door, care staff on site and communal facilities) and Shared Lives(living as part of an approved carer’s household). Both are real; neither has a filter in this site’s finder, so ask the council, or search for “[your council] extra care housing”.
What makes a type stop working later
Moving an older person is itself hard on them, so the question worth asking early is not only what fits now, but what would make it stop fitting. Care at home usually fails on the gapsrather than the visits — the nights, or nobody being there in between. A residential placement usually ends on a specific clinical event rather than a gradual decline: a feeding tube, a syringe driver, a wound that will not heal, or the home saying it can no longer meet the person’s needs.
Two things worth asking any home before anything is signed. First: “What change in needs would mean she had to move, who decides that, how much notice would you give, and can I see it in the contract?” Second, whether the home is dual-registeredfor residential and nursing on the same site — where it is, a change in needs can mean moving along a corridor rather than moving out.
One more thing that catches families out, and it is free to know: the home someone lives in is never counted as capital while they live in it and receive care there, but for a permanent care home it usually is — after a twelve-week disregard, and with exemptions where a spouse, a relative over 60 or a disabled relative still lives there. The same person can be council-supported at home and a self-funder in a care home. How paying for care works.
Who decides what care is right?
Not us, and not a website. If someone may need care, they (or you on their behalf) can ask their local council for a needs assessment — it is free, and it is the formal way the right level and type of care is worked out. You do not have to wait for it before looking at options.
- Ask your councilfor a needs assessment — search “[your council] adult social care assessment”, or start at GOV.UK: apply for a needs assessment.
- If it’s a hospital discharge, the ward’s discharge team arranges the assessment before the person leaves.
- Your GP can advise on health needs that feed into the decision.
How a needs assessment works — the full guide →
Who pays for care?
This is where families are most often caught out. In brief, and as a signpost only — the exact rules are detailed and change, so check the official sources:
- Council-funded careis means-tested — the council looks at savings and income. Above a capital threshold, people usually pay for their own care (“self-funding”).
- NHS Continuing Healthcare (CHC) fully funds care for people whose needs are primarily health-related — it is not means-tested, and it is widely under-claimed. Eligibility varies a great deal by area.
- Check before you pay. The free, independent service Beacon advises on CHC; and MoneyHelper explains paying for care. Start with your council either way.
Paying for care, explained — the full guide →
What the CQC ratings mean
CQC inspects and rates services as Outstanding, Good, Requires improvement or Inadequate, across five questions: is the service safe, effective, caring, responsive, and well-led? A rating is a snapshot from the last inspection — so we always show the date it was published, and flag when a rating is a few years old and a re-inspection could change it. Read every rating with its date, and read the full inspection report on cqc.org.uk for the detail behind it.
How to read a CQC rating — the full guide →
This guide is general information to help you navigate the choices, not advice about any individual’s care or a recommendation of any service. For a decision about what care a person needs, ask the council for a needs assessment. Find care near you →