Older people’s transition between different care settings

Moves between care settings or services like home care, care homes or extra care housing are challenging for older people, and the family and friends who support them. In this section you can find out about the experiences of older people, their family carers, as well as social care practitioners, by seeing and hearing them share their stories and viewpoints.

We established a co-production group, including older people and family carers, social care practitioners and managers working in different adult social care organisations, and social care researchers. Working together, we co-produced these move-related resources for social care staff, managers and others. The aim of this resource is to inform and support older people’s moves into and between social care settings. These resources are grounded in real-life experience and evidence from our co-production work, the literature review and interviews around care moves and how to improve practice.

Julia Greig, a practitioner researcher in the Better Care Moves co-production team, talks about why it is important to improve move-related practice.

Helen, Janet, Karin and Kate, who are part of the Better Care Moves co-production team, have experienced care moves or have supported care moves themselves. Here they share their stories and how services can be improved:

Terms used in this resource:

For additional information on any of these or other terms, please visit our resources page, which provides links to more comprehensive and in-depth discussions.

Care home – a care home is an establishment that provides accommodation together with nursing or personal care. In general use, a care home (or a residential care home) refers to a care home registered to provide personal care only. Care homes must also provide information about the needs of people who will be accommodated, e.g. dementia or mental health issues. People may live in a care home for a short or long period. For many people, it is their sole place of residence and so it becomes their home, although they do not legally own or rent it. Both the care that people receive and the premises are regulated by the CQC.

Care Quality Commission (CQC) – the independent regulator of health and social care in England. The CQC registers providers of health and social care.

Discharge to assess – this is where people in hospital are well enough to no longer need care in an acute hospital bed, but may still require care services, and are provided with short term, funded support to be discharged to their own home (where appropriate) or another community setting, such as a care home. Assessment for longer-term care and support is undertaken following discharge from hospital. People who have been discharged to a community setting for assessment usually then move back to their own home or to another community setting that has been deemed suitable to meet their needs.

Extra care housing/schemes – the most widely-used term in the UK for housing with care, previously known as very sheltered housing or assisted living. Extra care housing takes a variety of forms, but its main features are self-contained living accommodation, the availability of 24-hour care, and communal facilities and services. Residents have security of tenure through renting or purchasing their living accommodation, and care and assistance is provided by on-site staff according to individual needs, although night-time staff may be on call. Most extra care housing schemes have eligibility criteria, such as a lower age-limit (e.g. 55 or over) and a certain level of care needs. Local authorities support people in extra care housing, according to care needs eligibility criteria. Care services in extra care housing are regulated by the CQC.

Home care – also known as domiciliary care, is care delivered to a person in their own home. The needs of people using the services may vary greatly, but packages of care are designed to meet individual circumstances. The person is visited at various times of the day or, in some cases, care is provided over a full 24-hour period. Where care is provided intermittently throughout the day, the person may live independently of any continuous support or care between the visits.

Integrated Retirement Communities (IRCs) – this term is being used increasingly for all forms of specialised housing, including extra care housing, retirement housing and retirement villages. Specialised housing developments often provide outreach services, sharing their facilities with the wider community.

Nursing home – this is the former term for care homes registered to provide nursing care, and in general use still refers to care homes providing nursing care. Nursing care must be provided by qualified nurses.

Publicly-funded – this is where social care is funded fully or partially by the local authority. People with capital below a certain amount may have to make a contribution towards the cost of their care, which is calculated by the local authority following a financial assessment of their weekly income.

Retirement villages – typically with more than 100 apartments, provide more social and leisure activities than smaller extra care schemes, but also offer care and support, and some are designated as extra care villages.

Retirement homes – known as sheltered housing by social housing providers (local authorities and housing associations), are purpose-built developments for people who wish, and are able to live independently with minimal or no support. This can be an attractive option for those who wish to live in a smaller home that is easier to manage. Retirement housing is usually only available to people over 55 years of age. Whilst features can vary from scheme to scheme, they often include a 24-hour emergency help alarm system, communal areas and gardens, and social activities. Retirement housing is housing provision and care services are not provided. Where residents require home care they use local domiciliary care services.

Respite – respite care provides family and friend carers with a break from their caring role. Whilst respite care can be provided in many ways it is usually provided via a temporary stay in care or nursing home. Respite care can also be provided in the person’s own home via home care, this is usually to enable shorter breaks.

Self funding – this is when someone pays the full cost of the social care services they receive. If a person living in England has capital of more than £23,250, excluding the value of the house they are living in, they will usually be required to pay for the full cost of their social care.