Live-in carer - am I expecting too much?

[NetZeroZealot]

Elderly DPs (87 & 90), one recently diagnosed mild Alzheimer's, the other very frail & also prone to confusion / extreme forgetfulness.

They are lucky enough to have savings and a large house with a separate annex and as my sister & I live 1 & 2 hours away respectively & their needs have increased we decided a live-in carer was the best option starting in January. It was a job persuading them but after Mum had a couple of falls & a hospital admission they agreed ...

What the agencies promised and what has been delivered are miles apart!

As continuity is very important, we asked for a long-term carer to work a 5-day week - family can cover the other 2 days. Carer is free to do what they want at weekends and has the privacy of their own self-contained accommodation with TV, kitchen etc. I spoke to a few agencies and settled on a well-known, long-established company who promised (as they all do!) to carefully match the carer to DP's needs and offer us a choice of people, and importantly, came to meet my DP rather than relying on form filling.

In reality we were not offered any choice & had to accept the carers offered as the agency only found someone 2 days before the start dates. Only 3 months in we are now on carer number 3. The first did not drive which was a pre-requisite of the job; the second clearly did not like living far from home / in a semi-rural area and left of her own accord; and we now have number 3 who is OK. But not great.

Although the agency says they have checked references, they do not share the references with clients, but cherry pick quotes from them. DBS checks are a given.

All the carers have been competent and likeable and my DP have adjusted, but they found the unanticipated changeover between them very stressful, as I knew they would.

Meal planning is part of the care plan but the current carer seems to struggle with this - on my visits I still have to throw out bad food, or chuck stuff in the freezer which is on its last day when it should have been frozen the day the food delivery arrived, etc. This was a major problem with my Mum before & I feel the carer should be managing this better.

She also keeps asking me to buy stuff for them / the house which I don't think is needed or she could easily pop out & buy for them. And many other minor niggles - now I write it down it all seems a bit trivial.

They are paying a lot of money for this, and although it is reassuring to know there is someone there to deal with issues when they occur (which they do) I expected more. But perhaps I was being naive?

Sorry this is so long, anyone else got useful insights to share?

Can I ask how much you are paying? I will be doing something similar soon I think. Your story sounds familiar re lack of continuity from my research. Would be interested to hear possible solutions.

I think your mistake is going through an agency. I think you have a better chance of getting the right person if you recruit yourself.

To be honest, it sounds like you were looking for a housekeeper rather than a carer.

What are you expecting?

Managing food is a really sensitive topic and different to meal planning to many.

It’s a difficult balance for a carer, as a quick way to cause upset is to throw out something that someone wanted / still thought was ok.

That kind of thing may well be solvable by all sitting down together and talking about the approach. Eg. Meal plan for the week and shopping done to match that. Fridge clear out once /twice a week or daily. Everything out of date binned even if still looks ok (does that apply to seasoning / flour / pickle?), or just stuff that’s gone off. Freeze on day of purchase only or when running out of time in the fridge. They’re all topics where individual views range massively.

Buying stuff is similar. Who’s in charge of the budget. You’ve said both that you think some things aren’t needed and also that you’d prefer they just bought things. What happens when they buy something you don’t think is needed? Again, it’s something you can probably work out through a plannong discussion.

The number of people working in live in care is small. The number who are good at it is even smaller - and they are generally in longterm jobs and find their next job by word of mouth.

Having been a live in carer, I would say that looking after 2 people with dementia (because honestly that's what this is) is a lot of work, not all carers are cooks/meal planners as well, and being semi-rural can be very isolating and make the job miserable.

No they need a carer to
manage medication, help with showering/ bathing etc as well as eating properly.

£1400 per week

How many hours is the carer supposed to be working?

Preparing, serving, supporting eating and clearing up after three meals a day is a decent chunk of time. Same for medication for two people. Same for bathing for two people.

You multi task far more as an individual than you can as a carer, so you might be misjudging how much time they actually have available each day.

I agree with you but some things are obvious surely - eggs 3 weeks past their use by dates, mouldy food?

DP get their own breakfast. Medication is in blister packs & takes 30 seconds. Only one needs help washing. Agency produced a detailed care plan based on their assessment of needs & how much time it should take.

Have they actually agreed to be in charge of all the meal prep and food, or have you been assuming it and they haven't liked to challenge you? Ditto with bits of shopping.caring for 2 dementia patients one of them physically frail is a big job.

Not necessarily.

eg. Many will happily use eggs while theyre still fresh regardless of dates on the box. Many will happily cut mould off hard cheese and use the rest of the block. Others would say that both should have gone in the bin well before that point.

This is the problem with managing food when you don’t have sole accountability for buying / using and disposing. You’ve got a range of views that are blending together.

You'll also need to adjust your expectations on timing. Most agencies are pretty tight on record keeping requirements, particularly around medication. Popping a pill out of a blister pack is a ten minute task not a 30 second one.

If you’re keen to make things work with the current carer then a planned review meeting might be the way to go. Get their input on how things are going, any questions or suggestions theyve got, anything that would behelpfil
to clarify, any adjustments Youre looking for. Can include food management, shopping arrangements in that.

The one that I came across works 3 weeks on and 1 week off. She is an ex social worker and loves her job, which she does because she needs the money. The way she described it, it doesn’t seem an unusual arrangement. She’d definitely be doing the things these carers aren’t doing. She has only worked for one client at a time, as far as I recall, never for two clients with another carer alongside.

But none of her placements has been for more than a year, because of the frailty of her clients. She works for an agency and I wonder if it might be worth having another look around for alternatives?

I am the carer for DH with LB dementia. Round the clock care can be difficult to find, remember with dementia carers have to be awake at night as well as dementia sufferers often do not sleep well, so in terms of costs, the costs for live in care will often be higher than for a care home. However, there are clear advantages to people remaining in their own homes during this really difficult period. I use carers for respite during the day and occasionally at night. On the advice of my LA I used a site called UKCIL to set up adverts to employ directly. This worked well and I have maintained continuity of staff for very long periods. It costs £95 to join and overall costs will be lower as you are cutting out a middle person. Turnover for agency staff is higher and in some cases I am aware that they do not always treat staff well.

No you’re not. The things you’ve mentioned are pretty basic.

we were with a company that was taken over by a large well established company and had similar issues. The managers changed frequently with no notice and were frankly pretty disorganised. Does your company begin with B by chance?

we ended up changing companies. Some issues linger, but on the whole much better experience now.

its part of the care plan written by the agency.

Your expectations are completely reasonable.

Keep on at them about the food. If english isn't her first language she might be having difficulty grasping what you say about them but put all your expectations in writing both to her and the agency and then keep checking and keep telling her if she's not doing what she's supposed to be. I'd be all over this for about a month to do everything i could and then, if no progress had been made, i'd ask for another carer.

Going forward, coud you employ your own carer?

Also, is having a driver really necessary? You'll exclude a lot of good carers that way.

Do you mind me asking why they need to be able to drive? I might be able to come up with some alternatives.

That’s for both of your parents? Up in Scotland you’d be about £3k I think for a live in carer to the agency. Is it waking nights?

Who looks after your parents in the evenings and overnight, how many hours a week does the carer work or be on call. Are they trained in food prep and hold a certificate in food hygiene. Does anyone have poa for your parents, do they both have capacity to make financial and care decisions. Live in care can work but would they be safer in a carehome or extra living with 24hr oncall support,

They're only pay £11.66 per hour for care for two people, based on 24 hours per day, 5 days per week. Even if active care isn't expected 24 hours, the carer is living in.

DD1 gets agency provided care and Social Services budget £29 per hour.

How much does the carer actually get paid ?
I assume the £1400 a week is for the agency. Which is a lot ! It should get you a very good person.
I can only assume the carer is paid a minimum wage and the agency collects the bulk of that.
If you are caring for two people all day you can and should expect the contents of the fridge to be managed. It is part of the caring function to manage food, quality and intake.
Do they need caring or nursing care is another consideration.
My own experience of agencies is that you have to bottom down every aspect as to what they will be doing. Else they won’t include it. They will present themselves as ‘caring, worry free’ the reality, as you now realise, is they are in business for profit. Hard cash. Which often doesn’t reach the people actually doing the job but the owners. Who do no caring whatsoever.
They will, if they can get you to do more and more. Mum did not have live in but had many carers visiting throughout the day. I suspected that the carers were not there as long as they claimed to be. And probably had other clients they had to see. I found myself asked by the agency to do things which they should have done. I felt like a member of staff. Except mum was paying them.
Worth looking around for other agencies if you are unhappy.
The main issues here are around food. I hope you know precisely what is spent on what food ? And food shops for her and your parents are separated. Do you know what is purchased ? Your parents should not be given leftover, cheap or out of date food while the carer is eating quite differently.
It would be very worthwhile doing sudden unannounced visits. At different times. To see what in reality is going on. I would nip in the bud any additional things that are asked but not appropriate for you to do.
They are being paid to do a job. You are the employer via the agency.
I trust you have an inventory of all your parents items too ? Valuables I would lock away.
I would definitely look at different options. Multiple visits by carers with occasionally overnight stays. But ideally a much more trustworthy and competent agency who pay their staff better.

That is what you are paying the agency. The carer will be receiving a lot less. Personally I would advertise and interview locally myself.

That's very cheap. Two elderly relatives of mine were £2400 a week for a similar service in their home, live in care, and 2000 each a week in a nursing home to start with... It went up to 2200, 2300 a week each quickly. Worked out about £19,000 per month for a good while until 1 died after about 2yrs.

Id say the money received by the carer isn't enticing enough... After agency fees, tax, ni, etc, they are probably taking home 700 a week. It's not enough to be lonely

Most likely a minimum wage. Tbh not a job a lot of people would line up for.

When we had live in carers for MIL they were organised as 2 or 3 week engagements with a small pool of carers. The transition days were hard as MIL became unsettled but the agency told us no carer would commit for longer stays. And as the carers returned she did get more used to them. I think your expectations of a single carer may be unrealistic.