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  • 09 May 2019
  • 7 min read

What is the difference between a residential home and a nursing home?

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Both provide care for people needing support, but what are the variations between the two? Keep on reading to find out.

Good question!

On one level residential care is a term that means care in a permanent residential setting as opposed to care in the community for example.

The other way the word is used is to make the distinction between a residential care home and a nursing home.

Both look the same, both do the same thing (care for people needing support) but the levels of needs regarding the people (residents) they support and the manner in which they are cared for are subtly different.

A residential home is for people with a lower level of need/physical dependency to those living in a nursing home.

Typically those who can’t safely continue to live at home, they typically need some help with everyday tasks – washing, dressing, having food cooked for them etc but their level of physical needs are low to moderate – they don’t need to be under the continual supervision of a nurse.

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All residents living in a care home will be registered with a GP –staff will assist them to be seen by the GP as needed.

If they have certain health conditions that need specialist support, a district nurse will come and see them to provide support as needed as it is with other visiting professionals.

The district nurse is not managed by the home manager but will feedback to staff in the home what is happening and update care notes as needed.

This means there is a lighter level of clinical responsibility for a home manager managing a residential home versus a nursing home due to this difference.

A nursing home is for people with a higher level of need (this is determined by a detailed assessment of their needs.)

Nursing beds often cost considerably more than a residential bed so a person is not deemed to need a nursing bed unless it is absolutely needed.

Someone requiring nursing care may retain their sense of mobility or maybe bed bound but the significance is that they have a combination of needs which means that for their safety, they need to be under the supervision of a qualified nurse.

A nursing home is required by law to have a nurse on site 24 hours a day / 7 days per week to meet this obligation.

Depending on the size of the home and the complexity of the needs of the existing residents, there may be several nurses on at any one time.

With the current severe nursing shortage, in some homes, this is creating significant problems; it can be the quality of nurses available is lower which could compromise the service.

It could mean an over-dependence on agency nurses, without continuity, this can introduce a higher level of risk to the residents and home manager.

It can also make the nursing home to be financially unsustainable.

The home manager MUST ensure the nursing staffing minimum is maintained as it is reportable to the regulator if this is not met even for one shift.

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If there are nursing shortages in the home, it can be a significant ongoing challenge to maintain the high levels of clinical safety and good practice.

The Home Manager is accountable and responsible for the well-being of all the residents in their care so they have a vested interest to ensure the nursing team is as stable as possible.

This is something to consider when taking up a nursing home position.

To keep a good reputation as a home manager (avoiding serious incidents where the home is at fault) requires the management and reduction of risk at all times.

The non-clinical nursing home manager needs a nurse qualified clinical lead to ensure that the nursing residents are being managed in accordance with good practice and the law and that the nurses are given proper training, supervision and support.

Nursing homes often have long-serving staff with deep experience.

Sometimes there can be tension between senior care staff and nurses.

Often senior care staff have deeper experience around practical skills in patient care.

They sometimes feel they are more skilled than the nurses but in my view, this is missing the point - the nurse is an accountable graduate medical professional bound by very detailed and specific codes of conduct as per their NMC / RCN registration.

They ensure a person’s care is being suitably managing according to the law.

Both sets of skills and backgrounds are needed. They strengthen each other.

The level of support that is required for a resident is what differentiates the two types of homes.

What is the difference between a combined residential home with nursing?

It is common to have combined homes – that is residential beds and nursing beds – often it could be 70% residential, 30% nursing.

There is a good reason for this; in many instances, a resident will come in at a lower level of need (residential), over time they decline and eventually become in need of a nursing bed.

It is good for the families and for the resident to not have to move home – this gives better continuity, being around staff and management that know them.

This often works well.

As a home manager, it means you effectively have a small nursing home with a higher level of need to manage in conjunction with the residential side which tends to run more smoothly as the residents there have a lower level of need / less complex conditions to manage.

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What about assisted living/retirement villages?

Assisted living/retirement villages are a hybrid concept that can often work well.

The key feature is that people retain their own homes, front door etc, live in some sort of groups setting eg 40 flats to 200 flats and there is some degree of central provision.

This could be in the form of a restaurant or onsite manager, extra safety features, a team of people available to book to assist with cooking, cleaning, care on call on a discrete / as needed basis.

The main benefit of the concept is that people retain their sense of independence and choice but have help on hand when everyday living becomes too much.

In my experience, this concept works well up to a certain level of need.

There is a point where the depth of support in a care home outweighs the benefit of a person living on their own and struggling, just waiting for their carers to visit.

There are several large operators of these retirement living apartments and they have been joined by several operators adding very large retirement villages over the last 15 years.

These require large sites and very specific demographics to be financially viable. They won’t appear in every town but they often work well in terms of resident wellbeing and satisfaction.

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About the author

Liam Palmer is the author of 3 books on raising quality standards in care homes through developing leadership skills. In Oct 2020, he published a guide to the Home Manager role called "So You Want To Be A Care Home Manager?". Liam has been fortunate to work as a Senior Manager across many healthcare brands including a private hospital, a retirement village and medium to large Care Homes in the private sector and 3rd sector. He hosts a podcast "Care Quality - meet the leaders and innovators”.

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