Could home care be an option for your elder? It feels like a big responsibility and can be overwhelming. Here’s how we worked it out…
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?
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 handrails. We bought a wheelchair 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 the hospital she was wheelchair dependent. 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.
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. Read more about ‘reablement’ options here. 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 care jargon) of Local Authority (LA) contracted carers was arranged to help Marj get up, prepare breakfast and lunch. My husband or I dashed home to help Marj after work until we’d arranged longer term home care.
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. Some have ‘care broker services’ that can help you find a home care provider, for a fee if your elder is a private payor.
LA contracted and funded care workers (for elders who need LA funding support) have high caseloads 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 will turn up) dropping by at unpredictable times. You never know exactly when you’ll get help getting up, having lunch, tea or going to bed. This is awful for those of us who have a routine and don’t want to go to bed at 6 pm. Carers arrive to dispense what seems like 15-minute chunks of ‘care’.
It’s tough on them too. 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.
The elder crosses their 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 stressful. 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. Understandable.
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 would seem to be the result of outdated national and LA policy, prioritisation and allocation of scarce resources. We’re well overdue for a rethink.]
How do you find private home care?
Fortunately, for the first 8 or 9 years, 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 at all ii) whether they had any carer availability for the shifts we needed (breakfast, lunch and bedtime and likely times) 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 included though, as they pay to be listed. Other websites that rate home care include NHS and Homecare.co.uk.
Marj has employed three domiciliary care companies over the years, with two different business models:
- The care worker is self-employed yet affiliated with 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, the plan and progress since the last inspection.
Only ever consider employing a carer directly if you are prepared to potentially 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, get Government advice here.
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 if you can.
How much can you expect to pay?
Over the years, I’ve noted the following pricing: £14 to £30 per hour depending on the business model. Sometimes there are extra charges for weekends and bank holidays and/or an allowance for fuel if the carer is travelling far. Small gifts and/or bonuses recognise those carers who’ve gone the extra mile at Christmas.
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.
Make sure you are getting all the financial help you’re eligible for.
How many carers do you need?
Always 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 the flexibility for holidays and sickness (theirs and yours). Currently, Marj employs two different care providers and has employed up to three (a nightmare admin load for me, try not to do that if you can).
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 our plan with Marj and asked for her preferences i.e. 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 (if they have mental capacity), 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 weekdays. 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 also settle Marj in bed, last thing. Marj now needs this help at weekends too, not just during the week.
- Prepare your 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? A 100% ‘turn key’ operation is best.
- what extra support you might need if circumstances change eg should needs change, you work away or take a holiday.
- include whether your elder would like accompanying on social or shopping trips.
- 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 carers can enter and leave securely.
- appropriate equipment will help you maintain one carer per shift. If you need to engage two carers per shift the costs shoot up. Make an appointment with an Occupational Therapist asap if your elder finds it hard to move around the home or between furniture. Your experienced care provider will tell you if they need equipment too.
- Responsibility for preparing medicines eg preparing pill dosage dispensers is usually down to the primary carer (ie, you), but you may be able to delegate this or ask your GP to pre-package daily dosages (they won’t be wild about the idea but it is possible).
- 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 regrettably makes a person sound like a piece of luggage)
- screen and recruit carers who genuinely want to do the job
- train their carers and keep them up to date (eg in ‘moving and handling’), dementia care, dental hygiene, basic nutrition and hydration, health care and general comfort
- provide additional services like pre-screened cleaners, handymen or gardeners (not all do this)
- are easy to get hold of, with open communication
What are great carers like?
You’re likely to ‘click’ if they:
- are the right ‘fit’ for the person needing care, kind and patient, gently 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’re 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 timesheets legible and up to date (easier admin for everyone)
- happily collaborate with the primary carer (ie you)
- look after the home as if it were their own (don’t flush wipes down the loo or damage skirting with the hoist)
New tech/platform based home care services
Last but not least, here are some new local companies you may want to contact.
I’ve met Hossein and Emily at Care and Carers, Aylesbury. Their tech platform helps those cared for, their carers and family members communicate with each other ‘real time’. They’ve had great feedback from their clients and I’d love to see more of this.
Alternatively, if you’re Oxford way, I’ve met William from Trust On Tap, an Oxfordshire homecare business expanding into Bucks and beyond. When I searched on the Trust on Tap website, I found carers available near us so I’ll try them in the future too.
I’m very interested in how new tech can improve information sharing between elders and their carers (especially carers living remotely from their elders). I’ll write more extensively on this in the future I’m sure.
In the meantime, if you have any more helpful tips on finding home care, please share them.