Could home care be an option? When should you start looking for extra help with care at home? How might you broach the subject? Can your elder afford it? Where do you find good carers and what preparation do you need to do? It feels like a big responsibility and can be overwhelming. Our experience may help guide you (spoiler alert – don’t wait for a catastrophe).
When did we need extra help for Marj at home?
When Marj first moved in with us, she was able to walk around relatively easily. As time passed, keeping her balance became harder and she came to rely on her stick and hand rails. We bought a wheel chair on eBay for longer distances and eventually for moving between rooms. For much of this time we were just about able to give Marj the support she needed while we worked full time. Prescribed exercises, other living aids, and removing rugs all helped but Marj was starting to lose her balance more and more.
A heavy fall changed things overnight. Marj broke a shoulder and was admitted to hospital for weeks until she was well enough to be discharged. This spell in hospital knocked her confidence and restricted her mobility so much that on leaving hospital she was wheelchair dependant. This was our trigger for home care. It’s the trigger for most people too. Next time, I’ll engage carers earlier, if only once a day.
[I don’t cover ‘live-in care’ in this post, but that is an option you may want to explore.]
Tips on staying strong:
- get information on how to prevent falls from your GP
- exercise as much as possible every day to keep safe and mobile as long as possible. There are exercises you can do while seated too.
How social services help with home care
When Marj was deemed fit enough to be discharged from hospital, we refused to take her home until carers were arranged for her. This sounds hard-faced, but I’m glad we did. Otherwise my husband or I would have had to pause paid work for a while and I don’t know how we could have done that. A ‘care package’ (in the lingo) of Local Authority (LA) contracted carers was arranged to help Marj get up, prepare breakfast and lunch. My husband or I dashed home to give Marj tea, help her to the bathroom and put her to bed.
For LAs, supporting someone at home is about 25% of the cost of supporting them in a residential home, so you may find help available from increasingly enlightened councils.
LA contracted ‘social’ care workers have high case loads and long travel times (that’s before we talk about low pay). It’s a tough gig. This results in various ladies (usually ladies in our experience, though you never know exactly who) dropping by at unpredictable times. You never know exactly when you’ll get help getting up, having lunch, tea or going to bed. Carers arrive to dispense what seems like 15 minute chunks of ‘care’.
For the carers, imagine how hard it is to help someone to the bathroom, make their lunch and help them eat in 15 mins. Especially when you’ve never been to the home before, never mind not knowing where the cutlery drawer is.
You cross fingers that carers arrive in time to give you the help you need, when you need it. To someone living with dementia and recovering from a fall, this was often overwhelming. Marj would often decline any help, saying she was OK rather than letting a strange person help her with anything more intimate than preparing a meal. Can’t say I blame her.
Despite best intentions, the LA funded carer service often falls short for its older clients. [It’s seldom the fault of the undervalued and overstretched carers themselves. It seems to be the result of outdated national and LA policy, prioritisation and allocation of scarce resources. We’re well overdue for a rethink.]
Tips on hospital discharge:
- After a hospital stay, don’t agree to discharge unless a ‘care package’, aka ‘reablement support’ has been arranged. The elder will no doubt feel able to look after themselves, but is very likely to need help until fully back on their feet.
- At the very least, physiotherapy is likely to be needed, make sure this is arranged.
- If you can, prepare the home for support before the elder is discharged (eg hand rails and other mobility aids). You may need an Occupational Therapist’s help with this.
- If the elder is a ‘self-payer‘, ie has savings above £23,250, then the LA social services’ ‘care package’ will be withdrawn as soon as possible. So start recruiting private in-home carer support asap.
- Make sure you are getting all the financial help you’re eligible for.
How do you find private home care?
Fortunately, Marj could just about afford to ‘self-pay’, so I explored privately funded options. I googled local home care (also known as ‘domiciliary’ care) and shortlisted companies within a 10 mile radius. I then rang them all to find out i) whether they came out to our postcode ii) whether they had any carer availability (or could recruit any) iii) prices (hourly rates) iv) when we could arrange a home visit (and a potential contract).
Since then, I’ve found the Care Choices directory. You can use their website to find any type of care provider within a geographical radius. They’ll post you a booklet too, if you prefer. Not all care companies near you may be shown though, as they pay to be listed. Other websites that rate home care include NHS and Homecare.
Marj has employed three domiciliary care companies so far, with two different business models:
- The care worker is self employed yet affiliated to a care company that handles the admin for you. A monthly management fee (including profit) is charged ‘on top’ of the carer’s invoiced take-home hourly rate. Unlikely to be regulated by the Care Quality Commission (CQC), but don’t let that put you off finding out more.
- The care worker is employed by a care company. The (higher) hourly rate invoiced accounts for the additional overheads (NI, pension etc), but there is no management fee. The carer’s take-home pay is net of overheads (and profit). You’re likely to be asked for a deposit towards the first month of care. Likely to be regulated by the CQC, check the CQC website for ratings. Don’t necessarily rule out a company with a poor rating straight away, but do ask about it and their progress since the last inspection.
Only ever consider employing a carer directly if you are prepared to draw up a contract of employment. This includes wrangling with National Insurance and, if you pay the carer over £10,000 per year, pension contributions.
Some carers drive themselves to and from client appointments. In more densely populated areas, sometimes a minibus drops carers at a multi-client location and collects them afterwards. It’s great for everyone when carers can walk to a client, so try to recruit locally.
How much can you expect to pay?
Over the years, I’ve noted the following pricing: £13 to £28 per hour. Sometimes there are extra charges for weekends and bank holidays and/or an allowance for fuel if the carer is travelling far. On-top small gifts and/or bonuses recognise those carers who’ve gone the extra mile.
Shift lengths tend to be a minimum of 30 mins, 45 mins or 1 hour. Some carers will only visit for a minimum of 1 hour. Carers are paid extra if they need to work over their shift time.
How many carers do you need?
Arrange to meet your shortlisted care companies. If you can find one company to manage all the shifts you need, all the better. You’ll need 2 to 4 carers depending on the number of shifts, to make sure you have flexibility for holidays and sickness (theirs and yours). Currently Marj employs two different companies and has employed up to three (a nightmare of an admin load, try not to do that).
How do you prepare for your first meeting with a private home care company?
First of all, the elder needs to be OK with the idea. I discussed what we were planning to do with Marj and asked for her preferences eg when to get up, have breakfast, lunch, tea and go to bed etc. Having said that, some flexibility may be required on timing. Whether a male / female only carer is preferred is important too.
- You may need to produce a lasting power of attorney (health) if you are arranging care on your elder’s behalf.
- At the very least, involve the elder in the recruitment process as much as possible, offering a choice of carers if possible.
Getting the most out of the meeting with the home care company
Prepare a care plan or at the very least know how much help you need. In the beginning, Marj didn’t need much help and then only on week days. Nowadays she needs 1 hour in the morning to get up and have breakfast, 1 hour for lunch and laundry and (usually) only 30mins at bedtime to get into bed. I pop in at tea time to give Marj a light bite and a cup of tea and settle Marj in bed, last thing. Marj now needs this help at weekends too, not just during the week.
- Prepare the care ‘brief’ and involve the elder as much as possible. How much time do they need, when and on what days? Consider:
- shift start times and activities per shift eg help going to the loo, washing, laundry, ironing, bed linen changing, food preparation, eating etc
- the number of carers (fewer regular and familiar faces are more reassuring)
- holiday and sickness cover, will the care company sort the logistics for you? I handle any re-arranging of shift cover myself, direct with Marj’s self-employed carers. My second (’employing’ model) care company handles this for me, for their allocated shifts. This works for me but you may prefer or need a 100% ‘turn key’ operation.
- what extra support you might need if circumstances change eg should needs change, you work away or take a holiday.
- An ’employed carer’ company is likely to perform a risk assessment of the elder’s home.
- Make sure the home is secure and safe, eg fire and carbon monoxide alarms are fitted. Fit a key safe outside the front door so that carers can enter and leave securely.
- Appropriate equipment will help you maintain one carer per shift. Employ two carers per shift and the costs ramp up. Make an appointment with an Occupational Therapist asap if your elder finds it hard to move around the home or between furniture.
- Responsibility for preparing medicines eg preparing pill dosage dispensers is usually down to the primary carer (ie, you), but you can delegate this.
- Paid carers don’t usually do routine cleaning of the home. You may have to recruit a cleaner too.
What does a good home care company look like?
For me, the best home care companies:
- recognise Marj as an individual
- review the care plan regularly with you
- take the time to review specific care needs, make suggestions and offer solutions they’ve learned elsewhere
- suggest ways to help you all stay safe eg back health when ‘moving and handling’ (a traditional ‘care’ expression that makes a person sound like a piece of luggage)
- screen and recruit carers who genuinely want to do the job
- train their carers (eg in ‘moving and handling’ again), current dementia care, dental hygiene, basic nutrition and hydration, health care and general comfort
- provide ‘on top’ services like pre-screened cleaners, handymen or gardeners (not all do this)
What are great carers like?
You’re likely to ‘click’ if they:
- are the right ‘fit’ for the person needing care, kind and patient, firm when needed. Your ‘gut’ and intuition are as important as any rationale in making your choice.
- take time to get to know the individual they are caring for, their needs and preferences (checking with the care plan from time to time).
- know about contemporary dementia support (or any other relevant conditions).
- have oodles of common sense (eg how to keep a home cool in hot weather)
- are happy to keep a shared care diary
- keep their time sheets legible and up to date (easier admin for everyone)
- happily to collaborate with the primary carer (ie you and me)
New tech / platform based home care services
Last but not least, I recently met William at Trust On Tap, an Oxfordshire homecare business expanding into Bucks and beyond. When I searched on the Trust on Tap website, I immediately found carers available near us. I’ll definitely try them in the future when we need extra help as I’ve found that many ‘traditional’ carer agencies can be at full client capacity when I call.
I’m very interested in how new tech can share information with elders and carers, keep us well and better supported in our homes. So I’ll write more extensively on this in the future.
In the meantime, if you have any more tips on finding home care, please share them.