Should your care home be a residential home or a nursing home?

If you own a care home, or you are about to buy one, two decisions matter more than any others. Should you be a residential home or a nursing home? And should you provide complex care for people living with dementia? Get either wrong and almost everything downstream — fees, staffing, inspection outcomes, insurance, the relationship with your commissioner, even the eventual buyer of the home — works against you.

I have spent twenty years in the sector and am completing doctoral research on the lived experience of people with dementia in residential settings. What follows is the conversation I have with owners who come to Mac Research & Consultancy with one of two questions: “Should I convert?” and “Should I take the dementia work?” I will lay out the 2026/27 numbers, draw the line between Scotland and England, and end with the view I have arrived at after enough mistakes of my own to feel entitled to one.

A director’s honest view of the most consequential decision a care home owner makes — in Scotland or England, in 2026.