How to plan for live in carers?

[JadeVS72]

We're not yet at the 'elderly parent' stage. Dad late 60s, mum early 70s both fit and well- play golf, do yoga, go on walks, various hobbies, provide childcare when we book ahead as long as they're not too busy. They are about an hours drive away (we are in the north) We are very lucky for now I know!
Mum has said when she does get older once they can't cope any more she will never go into a home and wants her money spent on a live in carer. When I have tried to discuss avoiding iht she has made it clear she doesn't want to put anything (e.g. their second property) in her grandchildrens' names and would rather know she has the money for live in carer and doesn't care about tax bill when she dies (this is fine, we don't need to inherit anything anyway we are comfortable)
How do we plan for this and execute the plan? Parents don't have a financial advisor but I do. Do we just find an agency when the time comes and pay with a combination of pension and savings/proceeds from selling second property? How do we make sure we can afford it (some kind of annuity?) Any other advice? Thanks!

She needs to do both POAs stating her wishes. You can discuss with your planner who will be able to advise on financial options.

I suspect you are away ahead of yourselves - unless they are relatively unlucky I can’t imagine them needing a live in carer for at least 15 years. If a live in carer is needed then by that stage the parent will likely need a downstairs bedroom + wet room or a stairlift/internal domestic lift; plus the carers will need their own good sized bedroom and ideally a bathroom too. Can that be accommodated in their current home? If not you may need to plan for building work. You just pay as you go for the live in carers, same as any domilciarly care. Round here they are about £880-£1000/week at the moment. I assume your parents have put good financial plans in place, they sound completely switched on.

Your mum may say she would never voluntarily go into a home, and that’s certainly her right, but does she understand how difficult that could be if she has advanced dementia or some other conditions at an advanced stage? That live in carers would not be able to manage? Is she prepared to accept that she might be condemning you to hard work, stress and worry by insisting on staying at home come what may? They seem pretty open to practical conversations, it’s worth talking though all the worst case scenarios.

If you're planning ahead, a spacious downstairs shower room and a room that can be converted into a bedroom should the need arise. I think live in carers work 2 weeks on 2 weeks off presumably they could go in an upstairs bedroom

Hello, yes POAs (both health/welfare and financial, for both her and your Dad) are a key step and some financial planning/advice are a good idea. You can start to research local domiciliary care agencies and perhaps even have some conversations about cost, I would highly recommend using an agency rather than directly employing as that way the recruitment/vetting/training/support for the carer is taken off your hands and holiday/sickness/other absence cover is provided and if there are any issues with the carer you can take them up through the agency rather than trying to manage yourself from afar, probably this will be more expensive than just employing one person directly but I think safer/more reliable.

It's great that you are able to have this open conversation with your parents, what I would say though is that you might need a bit more of a conversation about when/how the plan for full time care is enacted, you might think it's obvious but actually a lot of older people manage fine with relatively minimal input for a long time, even their whole lives, some do of course end up needing residential/full time care but they rarely go between the two states overnight or in a very sudden/clear way, there's often more of a gradual decline where the person themselves doesn't perceive themselves as struggling/needing as much help as they do (which can be part of emerging dementia but can also be simple unwillingness/inability to accept their increasing age or frailty).

It's fine that your Mum is saying she doesn't want to go into a home and would rather have live-in care, but I think it's more likely they'll end up needing a stepped up/tiered approach over the years, so Tier/Step 1 might be having some domestic assistance, gardeners, cleaners, maybe budgeting a bit more for food so as to have more easy/convenient options, Tier/Step 2 might be visiting carers to help with dressing/medication, meals service, laundry service etc, Tier/Step 3 is a live in carer but who only works normal/daytime hours, sleeps at night and can have weekends/holidays off with family covering other times, Tier/Step 4 is genuine 24/7 cover for which you'll need a team of carers (or consider residential at this point, I know that's not your mum's wish but at that stage where illness is so severe a home can genuinely be the kindest option). I'm not saying you need to get deep down into the detail as obviously you won't know her/their needs yet and of course many people do manage their whole lives without progressing all the way to stage 4 or even past stage 1, what I'm getting at is it would be useful to start preparing and thinking about how will she and you know when their needs are changing and when will extra support be put in place. Do bear in mind your local authority will be able to help to a certain extent with care/social needs, yes it's means tested and your parents will likely have to contribute given their financial situation but still worth exploring using when the need arises as they've done the hard work of sourcing an agency (not always easy) - most local authorities won't offer live-in care but 3-4 visits a day for the more able is possible and you can then supplement with your own private additional care or other support e.g. cleaning. Age Concern provide lots of care services (again you do have to pay) so worth looking at their site...

It is good they are thinking about this, and it sound like they have the money to do this, as a poster above says, carers living in is hugely expensive.
Of course it isn’t ‘one’ carer they would have to have more than one person to cover 7 days / 24 hours if that’s what she is thinking if.

My DM didn’t want to go into a home after her stroke but hadn’t thought it through really as her physical health got worse.( I live 3 hrs away and my brother 2 by train, so we could only help at weekends so family providing care wasn’t feasible).
They didn’t like ‘strangers ‘ in their home, and they didn’t like the fact it wasn’t timed to ‘their timetable’, carers came when they could on their schedule of rounds. So it would be say, a 9 am schedule call to get DMum out of bed for example, but my mum wanted to get up at 8. Many times my dad already got her up when the carers arrived, so their time slot was wasted.
Eventually my DMum had no choice as her health deteriorated she needed a nursing home.
Also if you need ‘nursing care’ that’s on top of the ‘carers’ type care, and so your mum would need to factor that in too.
I think it is possible if you have the cash, but do talk and think it all through and plan for the possibility that at some point she may need nursing care which isn’t possible at home.

When DF moved house last time, before he was eventually diagnosed with dementia, he planned on a bungalow.
we found one, and I insisted that a spare room be ready for guests and/live in care later

It was one bedroom out of four he wasn’t allowed to fill with his stuff.

With hindsight, when he did finally need live in care for the last 2 years until his death, I wish I’d moved him into that room when he moved as it was closer to the walk in shower ( I had added later swapping out a bath) and also has more room in the hallway for ambulance stretcher/wheelchair access than the bedroom he chose. Had I known I would have also added wiring for door alarms, extra phone points for emergency alarms & calls, planned for a ramp, & put in a stand alone tumble drier. All of which was needed towards the end, but by then his dementia and paranoia was so bad he wouldn’t allow workmen in or accept any changes to the house.

what I had managed to plan for correctly was the spare bedroom, x 2 bathrooms so carer had one, upgraded fuse board, tv point in the bedroom (one agency insisted carer had tv in their room) , hardwired smoke alarms. Also POA for finance.

The main carer was amazing, cost just under £800 per week as we found her privately through recommendation. Extras such as extra hours worked usually brought this up to £850/900 per week. He paid out of a combination of pensions and rental income. Continuing health care finally covered 2 live in carers for his last 5 days before death, and several months later they still haven’t reimbursed me.

96% of people's estates never attract inheritance tax.

No RTFT but a few points from “ lived experience “ ( hate that term ).

depends in care needs even if you have the accommodation and money.

to be honest a live in carer is more like a companion / proxy family member to help out. I don’t think they are same as a care home at all I’m afraid.

eg night care needs - pretty much the indicator Soc services will fund a home for as can’t be covered by drop in carer. If you are needing help in the night say for the loo 2-3x or getting up confused / wandering some nights - how does your live in get a decent sleep in order to meet day needs ? You may need a day live in AND a waking night carer to allow the day to sleep.

night care needs are crucial. Relative ended up in care as mental health issues meant he was up pacing / mithering in the night ( and consequently risking falls but also not functioning during the day to make void for self and person they cared for etc )

live in carer even in the day are not there to provide care 100% of the time. They need to go do chores eg that’s being alone for several hours for supermarket shop or what ever. They also need breaks which should be sacrosanct even if they are eating with the person. Mums EOL live in was a lovely Muslim lady who prayed in her own room 5x a day with needed washing before etc. this was entirely in line with contract. Fortunately I sat with mum anyway but that meant I was tied to the house full time pretty much.

if it’s the right thing it can work well. My sis lives in spin and know caters that are English , live there but commute for 4-6 week blocks of live in care for instance.

Finances are a crucial element. MIL was, like most people, always adamant that she would never go into a home, would take her own life first, etc, but as pps have indicated, cognitive decline in particular is rarely a sudden event, and even when it is, the moment for taking drastic measures has usually passed by that point. But in the spirit of her stated wishes, we made enquiries about live-in carers, and it was a non-starter. The cost for the 24 hour cover she requires would be more than a nursing home, without taking into account the adjustments that would have been needed to their house to accommodate carers. I notice that you say 'make sure we can afford it'. Do you mean they can afford it?
My thoughts are that written directives about how your parents might wish to be cared for in the future if needed are really helpful, provided they take account of a range of possibilities. POA is invaluable, of course it is, but you still have to second-guess a great deal, and maybe argue the toss with other family members.

Thanks everyone for your advice! Parents moved about 5 years ago from a tiny village to a market town a few minutes walk from the high street. They got a bungalow with 2 dormers (?) each with an ensuite bedroom - a live in carer would stay in one of these and then downstairs there are 2 bedrooms with a jack and jill bathroom between them although not a walk in shower. But hopefully not too much building work to make it suitable!
I will definitely get POA and plan out their wishes and talk to my financial advisor on how it would be funded.
Hopefully as someone said above this wouldn't happen for 10-15 years if at all! Both my grandmothers spent their last 7+ years in nursing homes although only once it was the only option for them. My mum is trying to mitigate against it being the only option with suitable house and money!

A friend has live-in carers paid for by social services but it's worth bearing in mind:

She doesn't need care overnight but they have to be in the building - the expectation is that the carer sleeps at night so if 24 hour care is required it needs a lot more input.

Hers work solidly for 3 months, then change with another one. Sometimes the same one comes back again. That means she has to train someone new every three months.

Her agency provides cover for 3 hours every morning to get her up as the carer is entitled to breaks. They also have one full day off a week when again cover has to be provided.

She can't be left so has to order food in from supermarket. If she's not well enough to do that someone else has to. The carers are responsible for cooking it but their cooking skills have been very variable and there have been arguments with carers who seem to think one meal a day(!) is acceptable or who want expensive ingredients.

It's been very hard to find carers with a driving licence which then affects ability to get to medical appointments.

She prefers female carers but because of shortages the agency has sometimes had to send male ones.

Carer does things like cleaning and laundry as part of her job. But they don't do more heavy duty maintenance stuff like washing car, gardening, deep cleans. Someone else still has to organise stuff like getting the boiler serviced and gutters cleared.

Packages will vary depending on the requirements and pay but you can't expect a paid carer to do the things family members seem to be expected to take on eg deal with multiple night wakings then carry on as normal the following day with no break at all!