How the Decision Is Made to Move Into a Nursing Home
When your loved one starts struggling more than usual and isn’t coping at home, declining quickly or facing real safety risks, it’s often clear that more support is needed. For some, that means considering a nursing home.
So, how is that decision actually made? Who decides? What steps are involved?
Keep reading as we discuss how that process works in the UK, so you know what to expect and how the right decision is reached
How is the Decision Made to Move Someone into a Nursing Home?
The decision usually follows a care needs assessment arranged by the local authority. If your loved one can make their own choices, they decide whether to move and a legal best interests process is followed, involving professionals and family if they no longer have mental capacity. Someone with Health and Welfare Power of Attorney is likely going to be responsible for the final decision if that is the case. The emphasis must be on what care is needed and the safest and most appropriate for your relative.
Moving Your Relative to a Nursing Home
Once it’s clear that your loved one needs more care than they’re getting at home, the next step is getting professionals involved:
Care needs assessment
This is arranged through the local authority. A social worker or assessor will look at how your relative is managing with essential daily tasks, including mobility, personal care, nutrition, medication and safety in the home. After the assessment is complete, you can determine whether a nursing home is the most appropriate level of care.
Additional input when health needs are complex
In cases where your loved one has significant medical needs, such as progressive neurological conditions, ongoing nursing requirements or frequent hospital admissions, a separate assessment may be carried out by an NHS team. This is called a Continuing Healthcare assessment. If your relative qualifies, the NHS may fund a place in a nursing home directly.
Other professionals who may be involved
Depending on the situation, other professionals may contribute to the decision:
- GPs may raise concerns or provide medical evidence
- District nurses might be involved if ongoing clinical care is needed
- Occupational therapists can assess risks at home and recommend alternatives
- Hospital discharge teams may initiate this process if returning home is no longer safe
Understanding Who Has the Legal Right to Decide
One of the most important parts of this process is knowing who has the legal authority to make a final decision because in many cases, it’s not as straightforward as families expect.
If your relative can understand the situation, think through their options and communicate a clear choice, they have what’s legally called mental capacity. That means they decide where they live, even if others strongly disagree. Family members, carers and professionals can offer advice or support, but they can’t override a decision your loved one is legally allowed to make.
If your loved one is no longer able to make or understand decisions about their care, for example, due to dementia, stroke or serious brain injury, the decision must be made for them, but within a legal framework.
There are two main routes:
- Health and Welfare Lasting Power of Attorney – If this was set up while your relative still had capacity, the appointed attorney can decide care and living arrangements.
- Court of Protection deputy – If no LPA exists, a family member or trusted person can apply to become a deputy. This legal process takes time, so it’s not a quick solution in urgent situations.
What if no one has legal authority?
If there’s no LPA or deputy in place, and your loved one can’t make decisions themselves, then health and social care professionals will lead the process. They’ll consider your views, but they are legally responsible for making a decision based on what’s in your relative’s best interests, not just what the family prefers.
This part of the process is often where things become tense. It can feel like control is being taken away, but the aim is to protect your loved one and ensure any move is necessary, justified and handled with care.
Inside the Decision-Making Process for Nursing Care
If your loved one can no longer make their own choices and you don’t have legal authority, decisions will be made by professionals using the best interests framework.
You might be asked, but not always heard
Professionals are expected to involve family, but that doesn’t guarantee agreement. You may feel that your concerns are dismissed or that what you know about your relative’s wishes isn’t fully understood. That’s not uncommon. It helps to be clear, specific and calm when explaining what your loved one would have wanted and why.
When views don’t align
Sometimes families themselves don’t agree and there might be tension between relatives and professionals. Know that even in these situations, they don’t want to push anyone out — it’s to reach a safe, justified decision that holds up legally and ethically and is right for your loved one.
What you can do
You may not have the legal power to decide where your family member lives, but you do have a voice. You can:
- Provide context that others may not have
- Make sure concerns are properly recorded
- Ask for clarification on decisions being made
- Request a review or a second opinion if needed
When the Decision Matters Most
Moving into a nursing home is a major step and is a big change for everyone involved. It’s rarely straightforward, often coming at a time when emotions are high and energy is low.
What matters most is that the decision is made for the right reasons, in the right way. That means proper assessments, legal clarity and knowing what your family member genuinely needs to stay safe and well cared for.
You might not always have the authority to make the final call, but your role in the process is still important. The information you share, the questions you ask and the way you speak up for your loved one all help shape what happens next.
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