Post No2...Residential Homes Vs Nursing Homes, What's the Difference?

So, here we go, blog post number 2. I thought I’d follow on from the starting point ‘this is new to me’ with this one because, like the last, it is a very common topic that often comes up in conversation. For the infographic version of this topic, please click here.

Like all industries the care industry is made up of lots of jargon, and the problem with jargon is the person who says it seldom stops to think that the person with a blank look on their face probably doesn’t have the faintest idea what their talking about. This often leads to terminology being used but not fully understood, or advise being given such as ‘you need to find a nursing home’ when perhaps this might not actually be the case.

Broadly speaking, in the care industry, there are four types of care that are being offered by the majority of care home providers – residential care, residential dementia care, general nursing care and nursing dementia care. There are of course other types of care available, and in future posts I will be exploring things like ‘challenging behaviour’, but for now we will broadly segmentate into these four care types.

There are also, broadly speaking again, two different types of care home. I tend to think of them as models, you have the old model where a building has been converted into a care home, and then you have purpose-built care homes. Again, the difference between these will be explored later on, but for now it’s worth noting that both residential care and nursing care can be found in both of these types of care home.

So, what then constitutes a person being assessed as ‘residential’, or as ‘nursing’? The answer isn’t simple, and indeed is also subjective based on the assessor’s opinion, once a clinical assessment has been completed. To put that into context, before any person moves into a care home a clinical care needs assessment takes place, and every assessor and every care home will have a different view on what constitutes residential care and what constitutes nursing care.

That may not seem very helpful…. however, there are certain criteria may help to define the difference:

· Mobility – this is quite a big factor, if a person is independently mobile or needs assistants of 1 (AO1) with mobilising they are more likely to be assessed as residential. If a person has restricted mobility, requiring equipment to mobilise (such as a stand aid or a hoist) and is a high risk of falls, there is a higher chance they will be assessed as nursing.

· Personal care – like mobility, if a person is independent with personal care or perhaps AO1 then this is more likely residential, but if full assistance is required this may tip a person into needing nursing care, especially if their mobility is also restricted.

· Eating and drinking – you may start to notice a pattern here, essentially if a person requires assisted feed or a modified diet it may tip them into nursing, especially if there are other concerns with mobility, falls and personal care.

· Pressure damage, skin breakdown or pressure sores.

· Cognitive concerns or diagnosis of dementia

· Other medical conditions, such as diabetes

In a care home that is only offering residential care the needs of the residents they care for will be at the lower end of the criteria stated above. For example, most residents will be relatively mobile, independent with personal care and eating and drinking.

They may have a few things toward the higher end (like diabetes for example) but this maybe manageable with the support of the community nurse team. In contrast, nursing homes will be able to manage a person who may be at the high end of some, or perhaps all, of the points above.

As per the name, one of the key differences between the two is that a nursing home has a registered nurse in the building 24 hours a day, and they will likely also have a clinical management team including a clinical lead. Nursing settings also staff differently in terms of care assistant to resident ratio, so they will have more care assistants to manage the day to day.

To begin summarising this topic, there are a few important things to consider when looking at different care homes:

· What are the care needs of the person now, and are they likely to decline quickly?

· Would you want to be in a position, if care needs changed, to have to seek an alternative care placement if the residential home was no longer able to meet the care needs?

Care needs can change in two ways, slowly over time or very rapidly. If the decline is fast there is normally a reason, perhaps a stroke or a bad fall, that will lead to a hospital admission. Sadly, many older folks who stay in a hospital for a long time do decline and the risk is that a residential home may re-assess the person as needing nursing care.

In a purpose-built nursing home you will often find that the different care types are segmented onto different floors, and as care needs change a person who starts their stay as residential may eventually need nursing care.

In this instance the person would need to move floors rather than move from one home to another, which could be beneficial as a move might be unsettling for the resident.

In summary, there is not always a hard and fast rule to what defines residential care and nursing care. Purpose built residential homes can leverage their new facilities to provide higher dependency residential care, however it is ultimately in a nursing home that a person is less likely to have to move due to increased care needs, which is often a great comfort to families when choosing a care home.

Thank you for taking the time to read my blog, The Care Whisperer, talking about care in a way that no one else is. If you would like to be made aware of future content, please hit the subscribe button and I’ll look forward to seeing you next time