Who Decides When It’s Time for a Nursing Home? A Guide for Families
Making the decision to move a loved one into a nursing home is never easy. It often comes at a time of growing worry, when everyday care is becoming too much to manage safely at home. Families can feel torn between doing what’s practical and what feels right.
Our guide breaks down who has the authority to decide, how the process works and what your options are so that you can move forward, even under challenging circumstances.
Who Makes the Decision to Move Someone into a Nursing Home in the UK?
In the UK, the person themselves decides to move into a nursing home if they have mental capacity. That means they understand the decision and its consequences. If they lack capacity, someone legally appointed under a Health and Welfare Lasting Power of Attorney (LPA) or a Court of Protection deputy makes the decision in their best interests. If no legal authority exists, social services and healthcare professionals may step in to arrange care, based on a needs assessment and safeguarding guidance.
In more detail:
The number one factor in deciding who makes the call about a move into a nursing home is mental capacity. In simple terms, can the person understand the decision, weigh up the options and communicate what they want?
If they do have capacity, the decision is theirs. Even if family members disagree or are worried, no one can force them into care without their consent.
But if they don’t have capacity, things get more complex.
Someone legally appointed through a Health and Welfare Lasting Power of Attorney, commonly known as an LPA, can make the decision for them. This must be set up while the person still has capacity and only comes into effect if they lose it. If there’s no LPA, the Court of Protection may appoint a deputy to take on that role.
In some cases, if there’s no one with legal authority and the situation is urgent, for example, if someone is at serious risk at home, social services may get involved. They’ll assess the person’s needs and arrange for them to move into care, but it must always be done in their best interests.
So, who gets to decide? It depends on the person’s ability to make choices for themselves and whether the right legal steps have been taken in advance. That’s why planning ahead matters.
Ready to explore...
How Do You Know It’s Time for a Nursing Home?
There’s no single moment when it suddenly becomes obvious that a nursing home is the right step. Small warning signs start to add up, such as your loved one is struggling to stay safe at home and carers are stretched to the limit. Maybe health needs have changed and what used to work doesn’t anymore.
In the UK, the first step of moving to a nursing home is usually a care needs assessment, carried out by their local council. This looks at what the person needs day-to-day, things like washing, dressing, eating, taking medication and whether those needs can still be met safely at home. You can ask for this assessment yourself or a GP or social worker can refer you.
There’s also a financial assessment to work out how the care would be paid for, which is important as some people qualify for support and others will need to cover the costs themselves, depending on their savings, income and assets.
In more complex cases, where there are serious health needs, for example, advanced dementia, Parkinson’s or other long-term conditions, the NHS might carry out a Continuing Healthcare assessment. If the person qualifies, their care costs could be fully covered by the NHS.
What Role Do Family and Friends Play?
You may not always have the legal authority to decide where someone lives, but your involvement still matters.
When the person can decide for themselves
As mentioned previously, if your loved one still has mental capacity, the decision is theirs. But that doesn’t mean you’re sidelined. You can:
- Help them understand their options
- Talk through what’s manageable and what’s not
- Go with them to assessments or view care homes
- Offer reassurance, practical help and honest conversation
When they can’t make the decision
If your loved one can no longer make decisions for themselves, the process depends on whether legal arrangements are in place:
- If there’s a Health and Welfare Lasting Power of Attorney: You can make decisions on their behalf, always in their best interests and in line with their known wishes.
- If there’s no LPA: Unfortunately, you won’t have legal authority to decide, but professionals like social workers and doctors must still involve you, especially if you’re closely involved in their care.
- In some cases: The Court of Protection may appoint a deputy to make decisions, which happens when there’s disagreement or no suitable family member in place.
Are There Alternatives to a Nursing Home?
For some people, a nursing home is the right fit, but there are different types of support that can help them stay comfortably at home.
Here are the main alternatives to consider:
Home care
This can range from occasional help with things like cooking and cleaning, to regular visits for personal care or medication. It works well for people who need some support but are still fairly independent.
Live-in care
A trained carer moves into the home and provides round-the-clock support. It’s intensive, but a good option if your loved one has complex needs but wants to stay in familiar surroundings. It can also be a real relief for families who are reaching burnout.
Day centres and respite care
If someone lives at home but needs more stimulation, company or a break from routine, homes offering day care can help. They offer activities, delicious meals and social time in a safe setting. Respite care gives family carers a proper break, either for a few hours, a few days or longer.
Sheltered housing or supported living
This is a more independent setup, usually in a small flat with emergency support on hand. It’s suitable for people who don’t need full-time care but aren’t managing entirely on their own anymore.
Reaching a Decision That Feels Right
Deciding whether a nursing home is the right step can be difficult – emotionally, practically and sometimes legally. It’s not always clear-cut, and the path forward can bring tough conversations and uncomfortable decisions.
What matters most is that the person’s needs are properly understood and met, with dignity and care. That means taking the time to get the right information, involving the right people and making sure choices are based on what’s best for them.
