Live in care vs nursing home

[LaBelleSauvage123]

My 87 year old father, who I’ve posted about on here before, has been discharged from hospital to a nursing home. He’s paying around £1600 pw. The home and staff are lovely but he’s just not getting any stimulation apart from when we visit. They are so short staffed that he often has to wait a long time for personal care or to be helped to move from one place to another. I feel that live in care would suit him much better but the one agency that we contacted would have charged £3500 per week for 24 hour live in care with four visits a day from a second carer for personal care. Does anyone know if this is a typical cost? I keep seeing ads which say that live in care is a viable cost alternative to a nursing home but not sure whether my father’s needs price him out of the market. He is unable to walk at the moment and is recovering from spinal surgery ( wearing a collar). He has mild dementia and an unsafe swallow which means he is on puréed food ( much to his disgust!) Would be very grateful for any experiences of live in care. He’s well-off, but not £3K a week well-off.

Hi There. I have an elderly relative with live in care. Financially it's much more manageable if the care needs are just one person at a time. Is it likely that your father will recover to the point that one person could manage his care needs? Or would you be able to assist if an extra pair of hands were needed just 2x daily.
I think the live in carer option is much better if it can be managed.
If you have access to a community OT and social worker they would probaby discuss this option and it's practicalities with you and your father,
Hope it's possible for him

A single person live in through an agency would be between £1090 and £1600 per week depending on where in the uk you are looking and level of care

Hi Everybodystalking. Thanks for your reply. I think it’s possible he could, yes, if he gets the daily physio he’s supposed to have. Unfortunately I wouldn’t be able to commit to every day care as I work and have a disabled son - my siblings also work.

We have live in care for in-laws, I think it costs around £1,300pw? Its gone up a bit recently. Mil died recently but when they were both at home it was much cheaper than a care home for 2. They would have wanted to go together.

It worked great for a couple of years. Live in carer then social care carers 4x a day. Towards the end mil wasn't mobile and the live in carer couldn't get her to the toilet by herself. So that was difficult to manage. But until that point it worked really well.

We've been lucky that we've had great continuity and basic had 2 carers on rotation for a long time. I don't think that's common, we've been lucky.

Now fil is on his own it's working well again. He doesn't get the council-funded carers any more but he gets a contribution towards his care costs instead. It's not much but better than nothing.

Definitely worth exploring. My aunt who is in a care home doesn't get so well looked after for sure. She's clean and safe but the 1:1 aspect of live in care in your own home in our experience has been far better. If you can fund it and are lucky with the carers offered to you.

That would be manageable - it’s about what he’s paying now. The agency we contacted quoted £3k for a day time and a night time carer, with an extra £500 odd for two extra visits a day for personal care needing two of them. This seems a lot to me!

I think though that was because we thought he’d need a waking night - whereas I’m not sure he would now.

Our carers do a 2 week rotation. They will get up in the night if needed but that's not routine. We don't have hard limits as such but I think that of they were having to get up most nights we'd have to change our arrangement with the agency

We had good service from https://www.country-cousins.co.uk

We can paid them an agency fee plus paid the carers direct, plus the usual household costs. They had a ensuite bedroom and private sitting room.

Each worked for a fortnight at a time. We had three carers in rotation so that DM was used to three different people and it was easy to cover holidays etc

Once DM needed 24hr care plus two people to provide personal care, we reluctantly agreed that a care home was a safer place for her.

Live in carer through an agency is about £800-1300/ week or more if specialist needs . Live in carer works generally from 8am to 10pm with 2 hour daily break and sleeps over, but you need waking night care staff if the person regularly needs care interventions through the night of 1 carer.

Expect a waking night carer to be in the region of at least £200 per night £1400 per week (10 hours x £20) or more

So potentially you have a £800-1300 week to a £2700 weekly cost there depending in DFs needs and care agency charges

You would cost it up further by working out what else DF needs and what hourly costs for that are - eg for a 2nd carer for transfers of 2.5 hours a day (4 visits daily of 2x45 mins AM and EVE call transfers and 2 x 30 mins lunch and tea time transfers ) is 17.5 hours week x£20 per hour = £350 /week , higher if hourly dom care charge is more . So if £25 per hour then this would be £425 per week and if he needs longer time for 2nd carer visits so could easily be £500/ week

Does DF need someone with him all the time or can he be left at home alone for the live in carers 2 hour daily break? If not there is an additional 14 hours a week x if £20 hour tuis is further £280 for cover for live in carers break

Remember they may charge double on bank holidays etc and there will be other costs such as carer food as well.

But these are carers not qualified nurses and being in a nursing home DF will also have registered nurses caring for him as well, you would need to check what nursing care he has as if you need to pay a private nurse on an hourly rate in addition ...

Another option might be to look at alternative nursing homes - as they do differ.

Those weee examples of charges

Looking at the fact you asked live in care agency for waking nights and second carer- £3500 / week could easily be the charge. The waking night carer is a big additional cost

I gave some examples so please note that different agencies indifferent areas and for different needs hourly charges vary

Thank you all. I think at the moment he possibly needs more care than he could afford at home. The nursing home he is in is well reviewed - but he hasn’t had a bath or shower since he arrived last Wednesday ( though he gets washed every day) and staff have no time to sit and chat to him, which is what he needs.

Does he need mobility transfers ? You can only do that with two members of staff. Sadly almost all care homes are short staffed its very much task led with not much time for chatting. It depends if he needs a waking night then two members of staff for personal care which can see costs mounting.

Yes I think he does at the moment though I can see him getting strong enough not to. His mobility is the biggest issue as he sometimes forgets he can’t walk, tries to get up and then falls. The home has a pressure mat which sets off an alarm when this happens - but then he needs two people to get him back up again. The trouble is, without mental stimulation I don’t think he’ll summon up the will to get more mobile.

staff have no time to sit and chat to him, which is what he needs.

It's so difficult, isn't it.

Handhold for you.

Just another angle but if he was to remain in care home could he afford for you to employ some companions to go visit him? Maybe two or three people from a companion or volunteer service. Not totally sure how you would recruit the visitors but I’m absolutely positive you could find a couple of people who would visit him for a contribution towards their heating bills or charity or just happy to be employed. That could be a whole new thread. But it would make his care home life more interesting .

Good point @Mum5net

www.homeinstead.co.uk

We heard of home instead who provide carers for a wide range of requirements from my late mother's neighbour, who had arranged to have a visitor who came weekly to play chess through them.

Local carers and befriends may also be available.

Maybe he's not medically fit enough for a bath or shower

Maybe he doesn't want any stimulation

Maybe it's just you that thinks he should have more when actually he's quite content

He's recovering from surgery so is likely more physically and mentally drained than you think

Family members often have unnecessarily high expectations

Plinkton - he is asking for a bath. He says he’s bored and feels as if he’s ‘endlessly waiting’. Trust me, I wouldn’t be imposing my expectations on him if I didnt think he was wanting more.

In that case look elsewhere.

Lots of homes have their activities coordinators working more often now that Covid is a bit more behind us although care homes are getting more and more covid outbreaks now that visiting rules are less strict.

Sometimes you have to demand and request quite firmly that a bath is wanted.

He may want one but it might not be possible due to his injury and cause more damage. Ask for their risk assessment etc when you ask for him.

Care homes may be understaffed but a good one will have the capability of giving a bath / shower at least once a week to residents. Some care homes just have too many residents that they can't cope with and really shouldn't take on.

But there is a severe lack of spaces in care homes so they are often cajoled into taking extra residents.

And when residents get covid then so in turn do staff so just make sure that when you go you're taking an LFT

I'll be honest though if the home itself and staff are as lovely as you say then I'd keep him there and not rush into what could be a huge mistake.

Residents often tell their families completely different things to what is actually going on especially when they have dementia and forget things.

He might be doing all sorts of things but just forgets that he has especially if he's deteriorating rapidly re dementia

@LaBelleSauvage123
Care homes are having a torrid time retaining staff.
However, your DF is paying £1600 a week.
He deserves not to be 'endlessly waiting'.
My DMIL moved homes after seven weeks recently and it has been a much better 'fit'. Her behaviour in the first one was difficult but in the second one
they appear to outflank her difficult behaviour and work at keeping her occupied and more fulfilled.
I'd be tempted to go look at a few other homes and consider moving him. @Plinkton is right that you have to weigh it all up and not just make assumptions. Viewing another one or two homes now that you are no longer a 'newbie' will either make you happy to keep him where he is or will hasten a move.

I have just had a quote for £1600 ish in the south .

£1600 per week quote From one nursing home

I can assure you I live in SE so unless OP is London, there will be private nursing homes that charge £900-1000 per week ( & all NHs claim FNC £209.09 p/week from ccg (nhs) so that isn't the only money they get when you require nursing needs in a NH)
and many that charge £1100-1200 per week, some at £1300 and very few I know charge £1600 per week.

Paying more isn't always a better service, OP would be best to have a look around maybe a few towns over with a 15 mile radius.

All those care homes have activity coordinators and active support for their clients

Thanks everyone for advice. We are in the SW so it’s interesting to know that this is a high price even in the SE. Things have improved since I first posted - Dad is being looked after well though there’s still not much mental stimulation ( though this is partly down to him not wanting to join in with activities). We’ve looked into care at home and it would probably be cheaper if he could manage with one live-in carer and a second coming in 4 times a day. But there’s all sorts of caveats - the effect another move would have on him, the fact his house is very old and unsuitable in some ways for someone with mobility issues, he’d be twice as far from family etc etc. So we’ve decided to leave it for a month and then reassess.