Where to Start?
A short guide to care


back to Homecare Planning

Decisions about caring for yourself or your relatives in old age can be daunting. These are life-changing decisions that can involve house moves, building projects and medical treatment.

Where do we start? Should we look at care homes? Should we move to be closer to family? What is assisted living? What do I do if my mother refuses to even talk about it?

Before you start.

The right care needs to suit the individual and their circumstances. Before making any decisions about what type of care to choose, write down a brief summary of your relative’s situation:

  • What sort of support do they need?
  • How urgently is the support needed?
  • How much support do they currently have from family, friends and neighbours?
  • How much time and involvement can family/friends provide and commit to?
  • How involved do they want to be in decisions about their care?
  • How capable are they of making decisions about their own care?
  • What are their expectations?
  • Do they live on their own?
  • Do they have a good network of family and friends around them or are they isolated or lonely?
  • Is being independent important to them?
  • What is important to them?
  • How active are they?
  • Are they aware of their surroundings?
  • Do they find it easy to make new friends and try new activities?
  • Are their health needs going to improve or deteriorate?

Once you have answered the questions above, you will be in a much better position to identify the right care. It is easy to get distracted by the cost of care and the financial circumstances of the individual and/or their family. We suggest putting this to one side for the moment. Like all decisions we make, we won’t always get it right first time and things change, sometimes slowly and sometimes dramatically without warning. Predicting costs of care can be difficult but there is financial help available.

See our articles for further information: ‘How much does it cost to have a carer? ‘What financial help can I get for my Care and Support?’ and ‘Paying for your own care’.

The earlier you can start the conversation with your loved ones about care the better, and you might find it valuable to read our article ‘Starting the Conversation about Care’. It takes time to research all the different options in your area and it is much easier to do this when you are not dealing with an emergency or a relative who is no longer able to discuss anything rationally.

The Options.

We all want to age well and ageing well means connecting with other people and staying active and independent for as long as possible. There are three main types of care – care provided at home, care provided within assisted living accommodation and residential care.

Care at Home.

Care at home can range from a carer visiting once a week to overnight care or around the clock care live-in care in your own home. The carer’s tasks can range from companionship to personal care. This can be provided by:

  • Domiciliary Care Agencies
  • Self-employed carers
  • Introductory agencies
  • Social services
  • NHS

If you would like to find out more about home care in Buckinghamshire, Berkshire or Oxfordshire, feel free to get in touch and we’ll be happy to help.

Domiciliary care agencies usually have a bank of carers. Visits can be very short (as little as 15 minutes) and the carer can change according to the agency’s rota. Many of the carers are on zero-hour contracts and paid close to the minimum wage. Domiciliary care agencies are regulated by the Care Quality Commission (CQC) as they manage the care for you. Due to the cost of their operations, domiciliary care agencies are usually the most expensive option.

Self-employed carers are able to manage their own rota and set their own rates. They are usually more experienced and able to build up a relationship with the person they care for but they are currently unregulated. Self-employed carers may advertise in their local shop or you may hear of them by word of mouth.

Introductory agencies will introduce you to a pre-vetted self-employed carer. They should have done checks on the carer to ensure they are qualified, referenced and DBS checked and can provide high-quality care. TrustonTap is an online introductory agency. Using the latest technology, TrustonTap can match you with the best self-employed carers in your area. The carers set their own hours and availability. They are much better paid and committed to providing excellent care.

Although defined as an ‘Introductory agency’ by CQC, TrustonTap has worked with local authorities in the region to establish a quality standard in which to measure all the carers and to ensuree that they are capable and qualified to deliver excellent care. Carers that fulfill all the criteria of the TrustonTap quality standard are endorsed with the QPC Qualified Proffessional Carer acceditition.


Both Social Services and the NHS can provide care at home if their criteria are met. See our article ‘How much help can you get from the NHS?’. They usually outsource the care to domiciliary care agencies but if you apply for a Personal Budget [See our article ‘What financial help can I get for my care and support?’], you can make your own decisions about who to use to provide care- giving you more choice and control over who comes into the home. Families can ‘top up’ care provided by social services but cannot ‘top up’ care provided by the NHS. This is because the NHS is a free health service and has to provide for all health care needs.

Assisted Living Accommodation or Extra Care Housing.

Assisted living accommodation is usually housing that has been designed for the elderly or disabled. This is also known as Sheltered Housing. The housing will have modifications and adaptions to make life easier but enable residents to maintain their independence. There will usually be a warden on hand in case of emergency, communal areas for residents and activities on offer. The level of care and support available will vary depending on the scheme. Some schemes are limited to a warden, whilst others offer domestic help, personal care and nursing care.

Private assisted living accommodation schemes may require you to buy or lease your house or flat. The standard of the accommodation and facilities on offer vary from scheme to scheme. Some schemes have rules that allow only residents who have a certain level health and independence. Other schemes are linked to a care home. This is called Close Care Housing.

Residential Care and Nursing Homes.

A residential care home provides 24-hour care for its residents. Usually residents have their own room with ensuite bathroom. There are communal areas for residents and activities on offer. All meals are cooked for residents and personal care provided (help washing and dressing). Medication can be administered. Care is managed and provided by the care home and costs between £350 and £1,500 a week depending on location and standard of accommodation.

Nursing Homes are for those of us with more complex needs which requires the services of a qualified nurse or specialised carer. There are higher staff-resident ratios in a nursing home and nurses can change dressings, give injections and help with PEG feeding for example. Costs of nursing homes are normally 25% higher than care homes and can be up to £2,000 per week.

For a more detailed look at the difference between home care and care homes please see our article Care Home versus Home Care – what is the difference?