Live in care vs care home

[IllhaveaPpleaseBob]

My >90 yr old dad, with recently diagnosed Alzheimer's, lives alone 70 miles from us. He currently has carers 3 times a week, who take him shopping, do his laundry and provide company. He has a fall alarm, which came into its own this week when he fell over in the night. He's lonely and bored. I still work full time, my sibling who lives closer doesn't but has a less good relationship with dad. We've only just got him to accept care 3 times a week but it's clear he needs more. We're discussing live-in care vs care home and just wondered what other's experience is. If we went down the care home route, we'd bring him v close to us, so that I could pop in often. Care home would obviously have company and activities on tap. But he's understandably keen to stay in his own home (a large bungalow) though he hardly accesses any community activities these days - lunch club once a month. I have some worries about live in carers- how do you know if they're going to be kind, might they rip him off?, no one else will be observing them, it feels like there are less assurances than in a home with multiple staff- but I might be wrong. It feels like a v tricky decision.

I have experience with both

in your situation if you can persuade him I would go for moving him to a care home nearer you. It will take a weight off you, you’ll be able to see him more often, there will be people on site to deal with emergencies, and you won’t be driving 70 miles every time there is a crisis.

we had fantastic live in carers who I trusted completely. Initially for my Dad and then for Mum. But there were still things they couldn’t take care of. Like talking to doctors, more complicated life admin etc… Some live in carers can help with that but you shouldn’t expect it.

if this was just physical help I’d consider it. with Alzheimer’s even with a low maintenance bungalow you are looking at needing to take care of the house and deal with things which from 70 miles away is going to be a burden. For me that was what made keeping Mum at home impossible.

I also think without being close by yourself and able to check in you’ll not be sure how well they are taking care of him.

costs are likely to be similar too. The only “advantage” there with live-in is that the value of his house won’t be used to evaluate financial support.

look around some homes near you and trust your instincts . The website carehome.co.uk is good for reviews.

good luck
getting him to agree to it will probably be the hard part

in my experience live in care is a rotation of staff as it would not be just one person. In fact it is likely to be lots of different people.

as Alzheimer’s progresses he will find it frightening and confusing.

To add on top of this he will not recognise his own home at some point anyway.

just my personal opinion, he will be much happier in a care home with people of the same age and activities to help him stay engaged.

my mil is now in a care home with Alzheimer’s, and whilst settling in took a while she is so much more content now.

You need to consider that live in carers aren't working 24 hours a day. You would need 4 or 5 working full time and that's before you think about covering holidays, maternity leave, sick leave etc.

As he declines, some care may be a 2 person job etc.

Much better to move him into a decent care home when the time comes.

Thanks all, that's really helpful, and definitely makes sense. We will start bigging up the idea of a care home. Luckily there are loads to choose from near me.

The other posters have covered it, but my elderly relative had a live in carer briefly last year and she and the carer were ... very different people , and it highlighted that being stuck in your own home with somebody in that way isn't ideal.
Nor is anything of course.
The unexpected upside of a care home not being your home, is I suspect you don't get that feeling of invasion.
And as PPs say, there's multiple staff, so one person being out or away isn't so much of an issue.

My partner was a live in carer but also had support from the person's family but obviously he was on site for emergencies. His friend is also a live in carer but the gentleman's family take over when he needs breaks and holidays. If you are with an agency they can arrange this cover but there are self employed carers.

However I've seen both of them in their work environment and it's just like how a family member would be in their home, doing the housework, pootling around, cooking, companionship and other things but with someone there doing the caring, ensuring safety and a piece of mind. It might be preferable to have the calm and familiarity of his own home instead of the busyness of a nursing home.

See if you can book your dad into the most promising of the homes near you for a week and see how he gets on with daily visits from you.

In the short term I would get more carers in. Twice or three times a day every day. Then I would consider a care home.

I have experience of both, with three sets of relatives. Live in care can work fine but it is considerably more expensive than a care home. You have to factor in that at home you are still paying all your utility and food bills, as well as the carer fees. So his money would run out far quicker with live-in care.

But why do you think your dad needs to jump from carers 3 times a week straight to live in care? Why not get longer daytime hours first?

My mother had Alzheimers and she had a carer in all morning, then another for an hour in the evening. That worked for about 18 months and when that was not enough, she moved to a care home near me.

Yes we are building up care visits at home first. I think the fall in the night scared us all, so we want to be as prepared as we can be for when he needs a higher level of care.
We're also sorting out a lot more aids, rails etc to reduce the chance of falling in the meantime.

In my experience the desire to "stay in their own home" is understandable but ends up with them feeling lonely and isolated.

That sounds a good idea OP. It will get him used to the idea of having carers around. It is sometimes easier for them to accept carers in the new setting of a care home, rather than 'intruding' in their home situation.

The fall might be a one off, or it could be the start of a pattern, so it's good to be prepared. I looked on here and then visited a few.

https://www.carehome.co.uk/

Your dad if only recently diagnosed is just at the start of his decline. Sorry to be harsh, but it will get worse.

You will either end up dashing up and down the motorway every other day to deal with some crisis, or spending a fortune on 24-hour live-in care. And what happens when his money runs out?

Agree with pps that it's not necessarily more cost effective to stay at home, because not only do you need to pay for adequate help (govt package is pathetic), the bills and maintenance also need to be taken into account.

It may not be what he 'wants' but for the sake of your future sanity I think you need to look at care homes.

Have experience of both and currently dealing with dementia relative using home care.

Agree care home is best option. Try respite for a week. He will enjoy the company and you can observe how things are run. Fancy places do not always offer the best care so use you gut feelings.

That's a good idea

@Diningtableornot I agree about this - I would book a 10 day 'stay' if you are going away and say it's for safety/security and see what they think -

@AInightingale you also need a lot of spare cash on tap without selling a home.

Live-in carers can be great or awful, depending on who you get (and they'll need cover for breaks so it will vary). You're right, there is very little oversight and the agencies we dealt with were appalling.

It really is swings and roundabouts.

For my late OH I tried both, the difference being of course that I was also in the house with the live-in carer.

Live-in carers change every few weeks as they work in blocks of time. They are also entitled to several hours off during the daytime - 2 hours usually. Changing carers is a problem for people with a dementia illness. I know my OH found it hard. Finding the next carer was also hard - all the agencies tell you that there will be a seamless handover, but it was never like that in practice, mainly because, as the deadline loomed, you found yourself having to accept a carer who you did not see as ideal simply because there was no-one else.

What he also found difficult was that we had only one carer for whom English was their first language and communication was difficult for him, and also the cultural differences he found hard - he thought that one was a Russian spy! And food was a problem - some carers had very detailed diets and restricted cooking skills. The advantage of live-ins was of course that the person was still living in familiar surroundings.

Eventually he was settled in an excellent state-of-the-art and eye-wateringly expensive nursing home where the carers were consistent, there were activities to enjoy and also company. It suited him better, but of course it broke my heart.