What nursing care in a care home actually means, and how it differs from residential care

The definition that matters

A nursing home is a care home registered with the Care Quality Commission to provide nursing, which means a registered nurse is on duty at all times, day and night. A residential care home has care staff but no nurses on site; nursing needs are met by community nurses and the GP visiting. Both provide a room, meals, personal care and company. The difference is who is in the building at three in the morning when someone's blood sugar drops, a wound starts bleeding or a person in the final days of life becomes distressed. Every Abbey Total Care home is registered to provide nursing care.

What nurses do on a shift

Registered nurses in a care home are responsible for the clinical side of each resident's care plan. On a typical shift that includes administering medication, including controlled drugs and injections; managing wounds, pressure areas and catheters; monitoring people with diabetes, heart failure, breathing problems or Parkinson's; setting up and checking syringe drivers for people receiving end of life care; recognising when someone is becoming unwell and calling the GP or an ambulance; and supervising the care staff who do most of the hands-on personal care. The nurse in charge also speaks to families, GPs, hospital teams and social workers, and keeps the records that the CQC inspects.

Nurses are registered with the Nursing and Midwifery Council and revalidate every three years. In our homes they are supported by care assistants, activity staff, catering and housekeeping teams, and in some homes by physiotherapy and hairdressing visits.

Who needs a nursing home rather than a residential home

The decision is made by assessment, not by the family's preference, and it comes down to whether the person's needs can be safely met without a nurse on site. Nursing care is usually needed when a person has one or more of the following:

• Medication that has to be given by injection, through a feeding tube, or that needs clinical monitoring.
• A long-term condition that can change quickly: unstable diabetes, heart failure, severe COPD, epilepsy.
• Pressure sores, leg ulcers or surgical wounds that need regular dressing.
• A catheter, stoma or PEG tube.
• Dementia at a stage where swallowing, mobility or behaviour needs clinical management.
• A stroke, hip fracture or other event that needs rehabilitation and close observation.
• A terminal illness, where symptoms have to be managed in the home rather than by hospital admission.

A person who needs help with washing, dressing, meals and medication reminders but has no clinical needs is usually suited to residential care. One practical reason families still choose a nursing home in that situation is to avoid a second move if health declines; a nursing home can provide residential-level care and step up when needed. Our residential care service covers that first stage.

How nursing care is funded in 2026/27

Because nursing is a health need, the NHS contributes to it. If a person in a nursing home is assessed by the NHS as needing care from a registered nurse, the NHS pays the home a flat weekly rate called NHS-funded nursing care: £267.68 a week in England for 2026/27. It is not means-tested, and it is deducted from the fee before the family or council pays the rest. A person whose health needs are very high may instead qualify for NHS Continuing Healthcare, which pays the full fee. The council means test, with the 2026/27 capital limits of £23,250 and £14,250, applies to the balance. The funding guide covers each route.

Nursing care in practice at Abbey Total Care

Across our eleven homes the nursing service covers four situations. Long-term nursing care for people whose conditions are stable but need daily clinical management. Short-term rehabilitation after a hospital stay, where the aim is to go home. Nursing dementia care, including advanced dementia. And palliative and end of life care, delivered in the person's own room with the GP, community palliative team and, where involved, a hospice advising. Where a person needs constant presence for a period, one-to-one care can be arranged alongside the normal staffing.

Local NHS hospitals for each home include Whipps Cross and King George for Forest Place; Queen's Hospital in Romford for Ashbrook and Moreland House; King George for Abbey Care Complex and Woodlands; Barnet Hospital for Abbey Ravenscroft Park; St Helier for Bridge House; Epsom Hospital for Parkside; Croydon University Hospital for Parkview; and St George's in Tooting for Uplands and Bhakti Shyama.

Nursing care and dementia

Dementia does not by itself mean nursing care is needed. Early dementia in a person who is physically well can be met in residential dementia care. Advanced dementia with swallowing problems, pressure sore risk, repeated infections, hoisting or distress that needs clinical review is nursing care, and many people with dementia reach that point over time. All eleven Abbey Total Care homes provide nursing care and dementia care, so a resident who starts in residential care may not have to move when their needs change, subject to assessment.

What to ask when you visit

• How many registered nurses are on duty by day and by night, and for how many residents?
• Who is the nurse in charge tonight, and how long have they worked here?
• How does the home decide when to call the GP, and when to send someone to hospital?
• What does the latest CQC report say about safe care and treatment?
• Can the home manage end of life care, or would my relative be moved?
• Will the NHS-funded nursing care contribution be shown on the invoice?