Idiots guide to inhome care please

[tobee]

Please treat me like the idiot I am and tell me how I go about finding how to get carers for my elderly dparents.

I'm just not sure how to go about finding what's on offer. What's available local council or private or whatever. No idea how much things cost either.

They have some mobility issues and df has early stages of dementia. They live in their own home.

Thanks!

Use an agency or look locally. It is expensive. About £30 an hour round us.

Do you have adult SS involved? You need to contact them and arrange an assessment. Maximum number of visits per day they would be entitled to is 4. They will have to pay if they have more than £23,250 in savings in each name so ensure that if money needs to be transferred between them to reach this threshold you do it before the assessment. LA’s will not fund private carers.

Look at your local councils website for adult social care information. They may list local providers.
age uk will have lots of info on their website.
local recommended services are best- ask at doctors, neighbours etc. local Facebook?
also look into attendance allowance and seek help completing the forms- age uk, carers orgn etc can help.
loads of advice here too!

With regards to SS, do not offer to help or volunteer to help but arrange to be there at the assessment. Carers do not:
-cook from scratch
-clean beyond washing up the crockery from the food they have prepped
-help with pets
-do the shopping (they can help put away a delivery tho if you chat to them nicely)
-collect prescriptions
-facilitate medical appointments

If your parents have more than the amount of £23250 each, I’d try and find a private carer - the approved ones from agencies are very hit and miss to say the least.

Sorry you are going through this. I’m out the other side and it is just shit. The dementia is another layer of complexity in an already difficult situation 😩

Thanks for replies.

So who do I email or phone to find out? How do I find an agency? How do I know if they are good? Do I need to contact their local authority?

I really do need an idiots guide.

I don't even know if carers are what they need. They don't really want them but aren't totally unrealistic. Really it would be useful if people could pop in to do a few things for them, check up on them, sort the odd meal at this stage. When my sister and I can't.

I really wish they'd have proper fall alarms etc but they would need to be forced into it.

Try this to start:
https://www.ageuk.org.uk/information-advice/care/arranging-care/homecare/

Oh thanks I think my last post was posted before the others loaded!

Go to your local council website and search adult social care.

Home instead is a private option where you can pay for what you need including companionship.

Ok, so how much do they have in savings? Because if they have no savings you need to ask social services for a care assessment for them. If ss feel they would benefit from care then ss will pay and make all the arrangements.

If they have around £50k or above they will have to contribute to the costs, or pay it all themselves - this is called self-funding. In that case ask around and call three local care agencies who can talk you through how it all works. You will be able to choose what the carers do and how often they come, and just popping in to do lunch and a bit of sorting out is well within scope.

fwiw FIL has middling dementia, he has carers twice a week for an hour to get him showered.

if you decide to take things further then the agencies will want to meet your parents and do a more considered assessment and can make recommendations to you, but if your parents are paying then it’s their choice.

do you have POA in place?

Hi @tobee I was in this stage a while ago, and unfortunately "forced into it" is often what happens eventually, usually after a fall. It would be worth reading this book asap: https://www.amazon.co.uk/gp/product/0091901812/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1

Ideally, you need to ask around your neighbours to find out where the good private care firm is, and then keep that information somewhere safe.

If/when a fall occurs, the NHS / social care machinery clicks into action and there will be a social care assessment:

https://www.nhs.uk/conditions/social-care-and-support-guide/help-from-social-services-and-charities/getting-a-needs-assessment/

This is repeated when there is significant increase in care needs.

The tricky part is that there comes a time when the person/people are not able to manage at home with family help, but might not be willing / ready to move into a home and then things get fiddly.

You can get carers at home, which can be cost effective if there are two people to be cared for, as that would be very expensive in residential care.

There are also assisted living flats, where there are shared carers on site: https://www.ageuk.org.uk/information-advice/care/housing-options/assisted-living-and-extra-care-housing/

You can learn a lot from reading existing threads.

Does your df have a diagnosis? It would be helpful to have that in case he goes into hospital. It would also be helpful to discuss with him what level of medical intervention he wants as his condition deteriorates. He will reach a point where he is unable to make decisions for himself about things like life-saving treatment for pneumonia, and the default response for the hospital is to automatically treat him, even if he is suffering quite badly, even when well.

You may want to find out how long he wants to keep going and what he is willing to put up with to acheive that. I have not in any way ever managed to get a sensible discussion about that in my family. It's the hardest thing on earth to be asked to decide whether your parents should receive life saving treatment when time is tight and outcomes are uncertain.

It's all a bit complicated tbh.

There are lots of other good threads on here that you can read to get a sense of what's going on.

Thanks for all these replies; I'll m reading and taking on board and will share with my dsis.

To answer a few questions

I need to double check with them about savings. I think between 50 and 100 k together.

Yes we have all powers of attorney

Yes my df has dementia diagnosis. He also has attendance allowance.

Now 1 more question from me. How does the value of their house come into the equation please?

The value of the house is not taken into account if your mother still lives there. This is only relevant though after the savings have dwindled to £23250 each. So make sure you pay from both pots and keep tabs on it. Until then, you are self funding. A diagnosis of dementia does mean a reduction in council tax tho. So start there!

@Netaporter a lot of what you say simply isn't correct - coming from a self employed carer of over 15 years

@tobee I'm a self employed carer and hopefully I can answer a few questions.

Firstly you need to establish what type of care or help they need or would like. You certainly can talk to social services but at this stage unless they have little in the way of cash they will probably do little more than signpost you to services.

So as I say start with what they need or would be helpful.
Unlike what a PP stated above those of us who are self employed can pretty much do what we like in terms of what we offer.
Personally I don't do cleaning beyond wiping surfaces down and the odd bit of emergency hoovering. I ask my clients to have a cleaner or someone else to do the cleaning - because I don't enjoy it.
I do shop for clients. I pick up prescriptions. I talk to the doctors and make and take to appointments.
I will cook from scratch if that's what people want. I often do a big batch cooking session for one of my clients where I batch cook 4 or 5 recipes and freeze in portions. I still charge my hourly rate so it's more cost effective if I do multiple recipes in one go.

But I can do all these things because I'm self employed.
Agency carers would be different. They are on much more of a tight schedule and will usually only heat up ready meals or make sandwiches.

The advantage of agency care is that you have a more reliable service in that if one carer is off sick another will be sent. Which isn't always the case with self employed care. On the flip side though you have the same faces coming in each day.

At this stage I'd start by thinking about what you want a carer to do, and how many hours you want them there - then approach a few local agencies to discuss pricing and availability.

Using an agency is more expensive than employing directly but makes life easier.

Simultaneously I would contact Adult Social Services and ask for a Care Needs Assessment to be done. Have this going on and ready in case care needs change considerably or for when the money runs out and you need council to help with funding.

Thank you so much everyone!

@carerneedshelp i was referring to the SS-approved agencies, not private carers if you read. I have experience of both from two of these in very different LA’s. The SS-approved carers did none of these things and were charging at £25-30ph. We had to endure a succession of carers who didn’t enjoy the work/were unreliable/took the piss. The private carers did all of these thugs to a higher standard and were exceptional, but no funding was available for them by the LA because they were not registered as ‘approved’ which at some points to most people makes them unaffordable if required 4 x a day every day.

*things

Best thing to do is to contact your local Adult Social Care team at your council.

They will offer your parents a Care Act Assessment. This is an assessment of all their care and support needs. A social worker will visit to carry out this assessment.

They can then arrange a care package if required, as well as suggest referrals to other organizations who may be able to provide support.

They will also arrange for your parents to have a financial assessment with a Community Finance Officer to determine how much they would need to pay for care. As mentioned above, if they have over approximately £23k in savings they would be expected to pay full cost. Their house doesn't feature in this equation whilst they are living there, but this would be different if they were both going into residential care homes.

Finally, if your local department is anything like mine, don't expect this to be a quick process. We have a huge backlog of referrals to process and not enough staff sadly.

If your parents are full cost, you may want to consider organizing private care yourself as this would be faster but they would miss out on the care act assessment that may identify needs you haven't considered. You can get a list of care agencies in your area from CQC.

You've had some really good advice already.

I would just like to say that when I was trying to find Carers for DFIL we went through the Council's website as advised and didn't get a single offer. In the end I googled what was close by. Found a new agency, rang them, had a meeting with them and DFIL and they e been brilliant.

You've already had the Contented Dementia book recommended upthread, I'd also like to recommend Twilight Shepherd as it gives very practical advice.

If you haven't got health & financial POA first your DM, I'd see if she will agree to them now. Make this your first task.

Have they both had a Care Needs Assessment? if not, I'd request one for each of them and be there when it's carried out. If your DF has Dementia he won't give an accurate account of the support he needs.

If you and your DSis are both currently being their Carers have you asked for a Carer's Assessment?

One thing you should consider with the savings is to prepay their funerals, otherwise it will come out of the £23k that's left at the end. I've heard stories of the time that the funeral and a Solicitor for Probate is paid, there's as little as £2k left. Obviously you can do the Probate yourself but prepaying the funeral should help to get their savings down.

We have found that 1hr early morning to get DF up, washed, meds, teeth, hearing aids and breakfast works well. Carers take a meal out of freezer. They will also keep an eye on washing and load/unload washer.
Then a 30min visit at lunch to prepare ready meal / veg and wash up. They run through physio exercises to get him up for a bit. He enjoys the chat and company.
Siblings and I take turns to do a teatime visit, meds and ensure house is secure for night. DF still capable of undressing for bed.
DF has Parkinson's and some dementia but so far this arrangement is working well. The right carers will be a godsend. You need good communication from them so you know of any concerns. Hope this helps!

Get a social services assessment, also think about what they need help with - for home help type tasks it can be better to find a housekeeper type person, we've had them for various elderly relatives 1-2 days a week for a couple of hours. For personal care you can either hire directly or use an agency, most opt for an agency unless you know of someone locally who can pop in multiple times a day. Many people start with just one morning visit at first to help with washing then add visits for additional care and medication etc if they get increasingly infirm. Even if via social services it is means tested.

Remember anything medical is technically available through the nhs so if that is the case the continuing care team are the ones to ask. This is not means tested

I used to work as a carer and there was a huge spectrum of what we were asked to do for different people. Anything from making beds, ironing, shopping, cooking, getting prescriptions, taking to medical appointments as well as personal care such as bathing, hairwashing, emptying commodes etc. No 2 days were ever the same, so it will massively depend on what your parents need.

From personal experience with my own Dad, we started off gently with a cleaner. This got him used to someone being in the house once a week, then we went onto meals on wheels and then eventually carers coming in x4 a day. For your own sanity (as this will be a marathon and not a sprint), do everything you can to make your own life easier.

@tobee i agree with the advice to start with a cleaner also

in the end what worked for us for both sets of parents;

1. A ring doorbell - this helped with MIL who tended to refuse carers entry so we could phone and reassure her
2. A front door opening alarm which altered the door opening (useful if a dementia sufferer might wander, also useful if your parents are bed bound)
3. a weekly cleaner
4. a dog walker (also added another level of checking per day, interactions, making a quick cup of tea)
5. I bought inexpensive ikea kallax units that contained clearly labelled boxes everything the carers might need to assist each parent - toiletries, meds, bed linen, clean clothes etc.
6. a communication book that each carer left messages in for the next - I.e please hang out the wash/put in the tumble dryer, please order more shower gel
7. a tumble dryer and heated airer
8. delivery service from the pharmacy
9. a weekly Ocado shop (longest dates on the food) unpacked at an agreed time a menu planner set up with parents so that everyone knew what was being served when and avoided waste.
10. a falls alarm
11. a newspaper/magazine service
12. one of those FB screens next to the bed which made comms easier for someone with dementia.
13. a visiting chiropodist and hairdresser
14. installation of a stairlift

We did end up with one household having two bed-bound parents so the furniture had to be removed to accommodate medical beds, recliner chairs, joists and other medical aids. If funds allow, a downstairs bathroom is really helpful.

Agree that the assessment is the first step to ensuring you anticipate the changing needs.

@Netaporter was talking about Social Services carers and she is correct.

What a private carer does is between her and her employer.