Full time live in care - how expensive is this?

[Jancis]

Hi, just wondered if anyone who is posting on TP knows anything about 24/7 live-in care as I am trying to help a colleague who is considering this for her relative? I know it can be an expensive option but the biggest problem must be finding an agency who can provide carers prepared to do this rather isolated work? From what I have read it all sounds good on paper but in reality there might be a high turnover of carers - every 8 weeks or so has been quoted?
Is it possible to buy consistent care at a realistic level - comparable to care home fees - say £750 - £1000 per week, or are we talking about much much more?

[jenniferpa]

I'm assuming you meant per week Jancis?

I think there are several ways to do this with the "cheaper" (cheaper being relative in this situation) options being perhaps more prone to breakdown than others.

I think such options are more reliable when the people who are employed are treated as properly as employees with regular time off, decent pay etc. I suspect that part of the problem with such arrangements is that sometimes people are expected to work much like a family carer - on call 24/7 with not much support. Even the frequently suggested 3 week live in, 1 week off arrangement means that the person has to have somewhere to go for that one week.

I do know someone who did this (not for someone with dementia but a quadraplegic) and she managed with 5 rotating carers but it was almost a full time job. And this, while being a 24/7 position was more physically draining than emotionally so (a lot of lifting, repositioning etc but not much in the way of verbal abuse that can come from dementia). Also, with that number of people they had their own homes to retreat to. That worked because the person being looked after was well able to point out shortcomings on the part of the carers and that's a biggie with people with dementia - they may not be able to this.


I think you would need to look at whatever the realistic hourly rate would be and take it from there. So if you averaged it out at £10 a hour that's £1680 a week (and that doesn't include other payment might have to be insurance, holiday pay, and the like).

[Katrine]

I have over 3 years experience of employing live-in carers for my mother through a national agency. I would recommend them.

Although some of the carers have proved unsuitable, most are excellent. Those who have been unsuitable have been people who have a personal agenda along the lines of:
a) just in it for the money
b) arrogantly thinking they can make 'improvements' instead of following a carefully developed routine
c) people who are on a power trip and like to make the person dependent on them emotionally
d) people with insufficient experience of dementia care.

I visit for every handover visit, which happens between 2 and 6 weeks, but usually 3-4 weeks. Visiting for handovers is unusual. Most carers hand over to each other without a family member present and rely on a carers notes file to maintain the care regime. Some clients do not have family and are monitored via a solicitor or other guardian.

New carers don't come for more than 2-3 weeks so that we can see if they suit us and we suit them. I provide detailed feedback to the agency when carers are not suitable, and always try to be fair to the carer even when I am stating why I don't want them to return. With good carers I provide very positive feedback which the agency is happy to share with them.

Very good carers are welcome back and we have now got several who are regulars. One in particular is a person who is happy to be with us for between 5-8 weeks. I would not normally allow such long bookings for the carer's sake as it is boring and isolating living with a person with a very narrow field of interests. However, those people who are able to maintain their own interests and social contacts while still showing my mother that she is very important have the right personal resilience to take on longer bookings.

The cost for us is £70-75 per day in their wages, plus £5 per night call if needed. The carers are self-employed and responsible for paying their own taxes. The agency fees are around £90 per week for which they provide us with carers who are CRB vetted and matched to our requirements (not always the case, it depends on whether they are short of carers). In the winter it is always more difficult to find carers as many are South Africans who go home for the winter so there are more carers available in summer than in winter.

The fees depend on the needs of the client. If the client has nursing needs the rates are higher. If the client is incontinent the fees can increase, and this will probably happen to us soon as my mother is becoming incontinent when in bed. Wet bed and wet person happens about 5 times a week at present and this creates a lot of extra work for the carer.

Some clients require two carers at once because they have high care needs 24-7 e.g. hoisting, or dealing with night-time wandering and anxiety. In our case this isn't necessary but I did have to go back for an extra fortnight recently when my mother was ill and it was too much for the carer by herself. The night call bill was huge on that occasion, but fortunately that health crisis has abated.

We get help with care costs via direct payments from the local authority but it does not cover the full bill for care. I would say that given that the carer also gets free bed and board and travel expenses the cost can be higher than CH fees but not necessarily excessively so. In my mother's case she has been assessed by SS as having nursing needs because of psychiatric issues so if she was in a nursing home her fees would be considerably higher than what we pay for home care. We are also very fortunate in having 5 hours a week of respite care paid for by the local authority (in Scotland) to give the live-in carer an afternoon off.

This is just my personal experience and, as my post title indicates, it all depends on the circumstances of the client and the funding that they can access. In my MIL's case she could not afford this type of care and as she lives in a very small house would not be able to accommodate the carer anyway. They require, ideally, their own bathroom and certainly need a bedroom and some sort of private space with a TV etc. so that they can have time off during the day and evening. Some of our carers are very insistent that they must have 2 hours free time a day. This can be provided by friends, relatives, outside carers. In our case my mother sleeps in the afternoon and most carers are OK with that, but some are annoyed that they are still effectively on duty because they can't leave her alone in the house for very long.

It is a matter of negotiation with the agency when you set up the contract. You submit a short written brief that is given to carers and then that person decides whether they want to take the booking.

It can be a very satisfactory arrangement and means the person being cared for is in a safe and familiar environment. They get to wear the clothes they like, have a daily routine tailored to their personal needs, and to eat the food they like. Most carers are keen cooks and this is an added bonus!

Anyone who would like to know more please PM me. Katrine x

[jenniferpa]

Katrine - i'm interested that you said many of the carers are South African. I wonder why? Wouldn't they need a work permit?

[Katrine]

Most of the South Africans are either British subjects who have lived there for a long time or are people who until recently were entitled to work in the UK with an 'ancestral visa' i.e. they could prove that their parents or grandparents were British born.

However, the rules on ancestral visas have recently changed. This means that SA workers have to apply for shorter duration work permits and pay extra for these. This is having a serious impact on the cost-effectiveness of them coming to the UK to work. Many really need the money as the cost of living in SA is high and it can be very hard for white people to find work there due to ethnic employment quotas. Some women find that their husbands can't get work due to these quotas so they need to come to the UK to work as they can't earn enough in SA. It is a complex situation.

I would stress that not all agency carers are from SA, just a significant number of them. I was very worried at first they might be arrogant ex-colonialists with unacceptable views on race. This has not proved to be the case.

[Jancis]

Thank you so much Jennifer and Katrine.

Katrine, your detailed and really helpful reporting of your first hand experience with your mum's agency will I'm sure be helpful to members on TP. The friend who got in touch with me was aware of my own problems with deciding what was best for my Uncle. I had related to her how we wanted him to be able to live in his own home and that it might be an option for him to have live-in carers. His home wasn't suitable for this, however - too remote and dangerous due to lack of infrastructure/amenities and lots of other reasons.

It's interesting that significant number of your mother's carers come from South Africa - is this because of terms offered or is it because of your location?

[Pacucho]

Just like Katrine I employed live-in carers to help care for my mother at home for a number of years.

On average I paid in the region of around £750 per week, and like Katrine we had both good and bad carers, but mostly good.

Like Katrine's experience most of the live-in carers were from South Africa, Australia or New Zealand, and depending on your requirements they could be either young or older carers. National agencies have long established links with these countries.

If you require details of the agency I used send me a private message.
Regards

Paco

[Jane3006]

Gosh I am amazed at the care costs, the reason being that we paid for 24 hour care for a short period of time but that cost us £1500 per week. I wish I could of found it for the £750 per week as think mum would still be at home now. Good luck with this and hope you are successful

[Katrine]

Just before Christmas I had to pay for 2 days live-in care via a local agency because the live-in carer had to get home and weather did not allow someone else to travel up from England. This 48 hours of care cost me £500! That is because the new agency charges much higher rates than the one we normally use.

I asked them to email me their fees and a contract in advance, which they didn't do, so it was a horrible shock to get the bill. I certainly won't use them again. I think they charged me full nursing rates. I don't know because they still haven't given me any more information and I've written it off to experience. It was an emergency situation and the local agency we normally use could not supply anyone because it was such short notice.

Our normal weekly fees are around £625, including agency costs, plus the costs of travel and bed and board for the carer. My own travel costs are also not included in this figure although they are part of my mother's care arrangements. We also do a 24-hour handover between carers so that we have that extra day's pay to cater for. Bank holidays are paid at double time.

And obviously my mother's home has to be maintained, with utility bills, insurance, gardening, replacement of household items etc. So there are lots of hidden costs compared to living in a CH, but for us it is far preferable.

[sistermillicent]

I think the reason it is so much cheaper than some agencies is because the carers are registered self employed, this is a clever way of avoiding national insurance and other things that an employer would normally be obliged to do.

My husband worked for an agency, not a nursing one, for a while and let's say for example he was being paid £15. per hour, the agency would have charged the firm he was with £30 per hour.

The agency that looks after my mum reckons it would cost the family under £1000 a week to have a live in carer.

P

[Nitec]

Hi, just wondered if anyone who is posting on TP knows anything about 24/7 live-in care as I am trying to help a colleague who is considering this for her relative? I know it can be an expensive option but the biggest problem must be finding an agency who can provide carers prepared to do this rather isolated work? From what I have read it all sounds good on paper but in reality there might be a high turnover of carers - every 8 weeks or so has been quoted?
Is it possible to buy consistent care at a realistic level - comparable to care home fees - say £750 - £1000 per week, or are we talking about much much more?

Hi Jancis, as a live in carer, i might give you idea that how much might cost..
First of all i have been working as live in carer since 2004 and i had a lot of experience with my client, clients family and carers,
most of the aggencys charge you registration fees, plus daily charges for carer they send to you something between £15-£20 per day, the carer gets about £450 -£680 per week, the price would be changable, the level of care you want them to provied.
Most important thing and sadly most of the aggency dont care who is the carer, most of the carers do this for money and a few is really trying to help. As i said agency doesnt really check the carers if they do their job proper, or if they understand what their clients needs, or they might not be good with observation about changes their client daily life.
It's very hard to work with who suffers with Dematia or Alzheimer, you need a lot of understanding, passion and need to know how their mind is work. i would sucest search very carefuly when you employ carer or agency to find carer for you.

[Eikenella]

Hi Janis,

I too am amazed at the care costs for live in carers. My mum is in a wonderfull nursing home, in North London, and the fees are £586 per week. Your Colleague should maybe look at care homes as an option. Mum's day to day and medical care and, 'social' life' are very much better than when she was cared for at home.