NURSING/RESIDENTIAL HOME, THE DIFFERENCE. RISK ASSESSMENTS TO EXPECT by Wyn Glencross provided for WhereIsTheCare. Comment by WhereIsTheCare.

Written for WhereIsTheCare by Wyn Glencross


The Difference Between a Residential and a Nursing home

A residential home is staffed by unqualified carers, who deliver care for activities of daily living (ADL’s) such as washing, dressing, toileting, feeding, assistance with mobilizing and administering medications, to name but a few. Any nursing needs that may be required is usually met by the local district nursing service, who will also provide advice and support to care staff on the delivery of care for ADL’s as required.

A nursing home is staffed by registered nurses as well as unqualified carers who work under the supervision of the registered nurses. Nursing care is provided for people who have need for qualified nursing care, which could be due to certain medical conditions such as the frail dementia patient, diabetics, those at increased of falls, those requiring wound care,  and other aspects of care that require qualified nursing interventions such as PEG feeds, syringe drivers, injections and continence care.


Legislation and Policies Governing Care Providers

All health care providers must adhere to The Health and Social Care Act 2008 and the Regulated Activities 2010. This legislation directs on the following expected standards.  The Care Quality Commission (CQC) are the Regulatory Body that inspects all care providers to ensure they are adhering to this legislation, including recommendations made by advisory bodies such as the National Institute for Clinical Excellence (NICE).


Pre-admission Assessments:

If an individual is considering being admitted to a residential or nursing home, a pre-assessment must be carried out by a nurse (from the nursing home) or a senior carer (from the residential home) in order to determine whether or not the care setting has the expertise, appropriate level of skill, competence and resources to provide for the potential residents needs. If they do not have the means to meet the required nursing and/or care needs, or are unable to access appropriate expertise, then they should not accept that individual for admission.


However, it is often the case that a person is accepted for admission to a home but there is insufficient skill to meet a particular need. A typical example of this is when a person is admitted to a nursing home with a leg ulcer that requires compression bandages to heal it, but there is no nurse employed at the home that is competent at delivering this care.  As the district nurses are not obliged to attend a nursing home, this means that the person with the leg ulcer does not receive the necessary treatment, so the ulcer fails to heal, thereby placing the resident at risk of wound infection and possibly sepsis, which could result in death.

In the event a person is accepted as suitable for admission to the nursing or residential home, then there is an assumption that all that residents nursing and/or care needs will be fully met.   If during the admission any aspect of the residents care is not fully met, then it could be argued that the care provider has breached their duty of care to the resident, which then places them at risk of harm or neglect.


Assessments Following Admission to Any Care Setting

All care providers (i.e. residential and care homes, hospitals, district nursing caseload) are expected to assess the ADL’s of a patient/resident in their care on admission and at regular intervals whilst in the care setting.   These are done at intervals specified by local and national guidelines; for example below are examples of time frames commonly specified:

  • Breathing – it is vital that this is done immediately
  • Pressure Ulcer Risk Assessment , using a common risk tool (e.g. Waterlow, Braden, Norton) – within 6 hours of admission (NICE).
  • Skin Assessment – utilizing a Body Map to record any wounds/skin lesions/bruises – within 6 hours of admission
  • Falls Risk Assessment – within 6 hours of admission
  • Bed Rail Assessment (if deemed to be at risk of a fall) – within 6 hours of admission
  • Nutrition Risk assessment (using the Malnutrition Universal Screening Tool – MUST) – within 12 hours of admission


All other ADLs must be fully assessed within the first 24 – 48 hours, for example:

  • Sleeping
  • Personal
  • Hygiene
  • Dressing
  • Mobilizing (can they walk independently, or do they need assistance)
  • Mental Capacity
  • Moving and Handling
  • Activities / hobbies
  • Elimination (bladder and bowel habits or issues such as continence)
  • Communication

Nursing Assessments may consider specific nursing needs such as diabetic care or special risks associated with certain conditions such as Parkinson’s disease or epilepsy, all of which will be done at intervals determined by priority, and all of which should be fully completed by 48 hours after admission.



Reassessments must be carried out at intervals specified by local and national policy and the Regulated Activities 2010. Typical reassessments are as follows:

The Hospital Setting

All of the aforementioned assessments must be carried out on a weekly basis as a minimum, and sooner if there is any change in the patients general or specific condition. For example, if a person develops a pressure ulcer two days after the last assessment, then a repeat pressure ulcer risk assessment must be carried out, along with any other ADL that contributed to the development of the pressure ulcer (e.g. nutrition, reduced mobility).  Weekly reassessments are considered essential given the fact that the person is in hospital usually because they are ill or some aspect of their health has changed, which makes them more vulnerable to harm, thereby requiring closer monitoring.


Nursing & Residential Home Setting

Providing the resident remains stable and does not become unwell, monthly re-assessments are considered reasonable. Of course, if the resident’s condition changes then they will require closer monitoring as with the hospital patient, so weekly assessments will be necessary.


The community Setting (district nurse case load)

All of the aforementioned assessments are typically carried out on at least a monthly basis, and sooner if there is any change in the resident’s condition.

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Please Note:

You relative can decide to leave a residential home and go home to be looked after by their family usually, if you are in a Nursing Home, this is different.  You will have been deemed to have “Nursing Needs” by a Nursing Needs Assessment.  This means you may be refused to take your relative home, even if it is their express wishes to do so, and they have capacity.  You may have to fight for someone’s human rights as we did.  Using MP, solicitors and advocates.  If it is safe to do so, any nursing home resident can go home to live with their family.  If you take your relative home, even out of a situation you and they feel is neglectful, and even if your concerns are founded, you will need to do so with Adult Social Care permission or face arrest and your loved one being taken by force back to the nursing home.

Further Adult Social Care can approach the Court of Protection to take control of your loved one’s care – they need particular grounds under which to do so though.


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