My parents both have dementia now, but Mum's only became obvious recently, Dad has been declining since 2004. Mum looked after him until 2015 until her own health broke down. They have a care team who come in, officially, to look after my dad, although they do help Mum too from time to time. The team comprises four local ladies who come in on an hourly rate, and two live-in ladies.
To do it comfortably, I think a lot of it is about connections.
If you are well connected and well established in your local community I think employing your own carers can work really well. The ones Mum and Dad use are all self employed so we simply pay them and they take care of their own holiday pay, etc. That said one is a mother and daughter team and when the husband/dad died suddenly I gave them time off and paid them their usual rate. But usually it's OK. There is now a team of four 'local' carers and they work with two live in carers who come in turn and turn about. For the live-in carers, we started with a care agency but then we discovered the contact details of a lady Mum and Dad already knew who'd looked after Mum's aunt so we stopped the agency and went with her, instead.
We went through a host of different ladies, with the lady who'd cared for Mum's aunt, until another finally popped up who my parents got on with.
Now we have a live in care team of two and the day care ladies also do some nights and do relief care during the day.
My parents live 140 miles away and I drive down every Wednesday and have lunch with them. We have a filing box and the carers put notes, queries, letters that need sorted etc in there for me to pick up. We also have a watsapp group which is brilliant for keeping in touch.
You need to trust your carers. Mum and Dad's carers deal with a lot of the admin or I would do nothing else. They also get cash out for Mum to spend and look after her bank card. She's not really up to doing her own finances anymore but if I activate LPA over her side of the account she will have no access to cash, a checkbook or any way to pay for anything outside electronic transfer or direct debit and worse, neither will I because even as the person with Power of Attorney, neither my brother, nor I are allowed a card or chequebook, either. I have been added to my parents bank account for ebanking and I pay the entire team by BACS.
Where we fall down is finding anyone to help with the nights on weekends, when the live-ins struggle doing two nights in a row - Dad doesn't sleep much, if at all and he is very difficult these days - he can be shouty, intransigent, a bit violent and he has very limited mobility. Think Father Jack out of Father Ted with slippers and a zimmer.
So yes it can be done but, caveats to take away:
I'd recommend using an agency for live in: the first one was lovely, although we only needed them a week. We also had another bunch when I was looking for help for the current team at weekends. They came recommended by a local lady who used them.
Neither agency could do bits. Live-in usually works by self employed carers on contract doing two week stints at four or five clients in rotation. That's why it's usually the whole package or none - I found this out when I was consulting Helping Hands about relief nights/care at the weekends.
A day of live-in is more competitively priced than a day at hourly rates. Sometimes, even if you start live-in care a bit before you're ready, you will find it's not much more expensive than having carers in at an hourly rate. Plus you get to know the carers well and they get to know you before the hard stuff starts.
Bolted on top of the live-in, you can use yourself or local carers to cover breaks. They'll need 2hrs minimum a day possibly more if the loved one being cared for is active at night.
Some care agencies will count the number of times the person wakes up each night and if it's more than a certain number will charge hourly rates rather than a flat night rate. That said, when they start work, there is often some flexibility with that.
It helps, going local, if you, or the person you are seeking care for, are well connected and active in their local community you will have more of a feel for who to employ. One agency we used briefly was run by someone who's father lived near my folks and had picked up Dad when he'd had a fall in the garden. It all helps. That said ...
Seek recommendations from people you know who are, or have been, in the same boat. This will help you to find some quality carers. For live-in, local doesn't matter so much if they are people friends or family have used and got on well with. Some knowledge of each other will help you to get to know and trust them, which has been a godsend for me as these people have to be trusted to get cash out of the bank for Mum, help her get shopping, attend her and Dad's medical appointments with her because someone has to remember what's been said in there, etc.
Make sure they are all self-employed so you are not paying NI etc.
Make sure someone on the team can cook and drive.
They should all have public liability insurance themselves, it's not your job to do that, but it's worth making sure they have before you employ them.
Think hard about what it entails. Could you tell someone who you like, and think is competent, but who just isn't getting on quite well enough with the person being cared for, that it isn't working out and you are terminating their employment?
It's a LOT of admin and I mean a LOT. You are running the house and sometimes the social lives of the loved ones in need of care as well as your own. Plus you are paying the care team, ordering supplies, etc.
If you get the right care team, they are amazing. The people who look after Mum and Dad love them as much as my brother and I do. They are incredibly loyal and protective, even now when Dad is not always very pleasant to be around. Mum and Dad want to stay in their own home and I am trying to fix that for them, for as long as is possible. I can thoroughly recommend it but I would say that you need to get the right people and being able to find people we trusted recommended by friends whose judgement we trusted implicitly helped a huge amount. The right team, if you can find them, will be amazing. But yes, it takes application and some trial and error to find the right ones!
I hope this is handy,
Best of luck
MTM