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?

I've also stated that there are excellent food shops in walking distance ... but the carer can also drive.

The care plan states that DP can be left alone for short periods of time if they are wearing their fall alarms - after all they have each other!

The carer gets a cash float for buying things they need during the week. Which we top up regularly.

I'd assumed these are fairly basic duties of a live-in carer. I can't do it so who's going to buy a pint of milk or loaf of bread if they run out? What is your experience of employing carers GinaandGin?

I'd also assumed that by going through a reputable private care agency the carers would be looked after reasonably well (in comparison to, say, NHS carers).

DP already have a cleaner so the carer does not have to do any cleaning.

I think the money is the real problem. Good carers with experience, qualifications etc, make a Lot more than 1400/wk for 2 people. If you are paying this to an agency and the carer gets half, they are feectively getting 700 when others in the care industry are making 2000/week looking after 1 person and at least 2400/wk looking after two.

Demand for care is crazy and people pay these sums because house prices are massive and they often have a v valuable asset that can be leveraged.

No night duties required. They both sleep late and a lot. DM is very early stages of dementia, it's just a poor memory and some confusion at the moment. Of course that may change in the future and then we will need to adapt.

You are paying for a live in carer when your parents don’t need overnight care - and I assume the carer is retiring to the annexe anyway so would be unaware if they did need anything in the night.

You are paying a lot but the carer won’t be getting much more than minimum wage.

You could advertise locally the hours you want e.g. 8-2, 6-9 Mon-Fri or whatever, advertise a good hourly rate. At the moment 40hours a week is costing you £1500 or £37.50 an hour (the agency must love you)- I doubt the carer sees more than the £17.50 so you could easily advertise over £20hourly. Live in accommodation available if required/open to applicants that would like to share the job.

References dont include information about the persons personal life .
I agree if I was employing someone to live with and care for my very old and vulnerable parents i would like to see full references.
I agree with @Winter2020 I think you could get much better and more appropriate care for your parents if you advertised your self and interviewed.

I’ll try a different angle.

You’re probably not expecting too much for the tasks themselves, but you’re expecting mind reading for the carer knowing where you draw your lines on these topics. They’re particularly sensitive ones where different people can have very strong and differing views and get strangely emotional reactions.

If someone came into my house and binned a dozen eggs that were ten days past best before but still fine I’d be pretty pissed off. There was an all out screaming match when my brother being helpful threw out a jar of Branston pickle at my parents that was past its best before. I silently rage at my husband when he leaves out of date milk in the fridge.

Your lines will be different. Your mums lines are probably different to your dads and all three of those different to what the career does at home. They might be asking your mum and dad and respecting their responses. It’s probably solveable through conversations.

I agree. You say that they work 8 hours per day with a 3 hour break in the afternoon, but also that they're very rural. That means the 3 hours is dead time. It really means that they spend 11 hours on duty, with 3 hours hanging around in the middle.

OP frankly for what you're paying i think you're expecting an awful lot

OP - as a veteran of elderly relatives - once your parents are at the stage they are now - this is just what agency care work is like.

Some people manage to find a non-agency carer themselves who happens to be amazing, but this is much easier in big cities, due to greater choice. And they come with their own problems. You still have to manage the carer.

My question is where the carer in the annex hear if one of them had a fall and couldn’t press their alarm?

All in all, this is the point at good care home would be better.

Is it 1.4k a week for both of them or each, is the carers accommodation, bills, food all included in the fee. What are the hours if they are having a 3 hour break.

Semi- rural. On the edge of a lovely market town with plenty of activities going on. Great walks. All fully communicated before the job starts. The long afternoon break seems to be standard for care agencies & I’ve just gone along with it.

For both. Includes accommodation in a separate annexe with own kitchen & bathroom. All food & bills paid by us.

People this age absolutely need someone in the house overnight. Taking into consideration the detail of their conditions - either of them could have a fall at any point and the other one may not be able to cope with it.

What do your parents do during that 3hr break, hat if they need help, can the carer go out for 3 hours, is it a paid break. Is there a falls alarm system in place, keysafe etc.

Do they not cover with another carer while the carer has their break?

The general policy is that the carer needs 2 hours break per day, but not necessarily taken all at the same time.

How long would it take to change, drive some where, park and walk to palce they wanted to go, walk back and drive back to the house?

OP,
I used to work as home carer. I used to look after for an elderly couple.
Wife had very advanced Alzheimers, and the husband just had a stroke, so he was unable to do much caring duties, and after he passed I cared for her for another 2years.
I helped with medication, cleaning, hospital visits all shopping etc.
As carers we couldnt cook, so the were ready meals that we microwaved.

it was 24hour care i was on day duty, and another carer was coming for sleepover.
I had 1hour lunch break (for that hour another carer was coming as the wife couldn't be left alone)

so who is looking after your parents when the carer is on break? what happens when the carer is on a break and they have a fall etc?

Do these activities happen in the carer's alloted break time? Have you actually had a carer that wants to do 'great walks'

It's a town the carer isn't from and probably has no links to. The break really is just dead time for them to read a book, watch TV or doomscroll in.

Also you may think that's a lot of money but the really good live in carers are all working for high net worth families and have much higher expectations, especially if they are looking after 2 people and providing meals as well.

I would make the role as appealing as you can - for example, if your parents still have a car, you could give the carer the use of it. Maybe give them a credit card so that they can sort household purchases online - you can review this at the end of each month obviously, and speak to them if you think the purchases are excessive.

And the most important thing has to be to attract a nice, caring person you parents get on with. So try not to sweat the small stuff, like precise details of housekeeping. Try not to micromanage.

The more appealing a prospect you can make the job, the better quality of candidate you can hope to attract and retain.....

Do not give the carer a credit card, use of s car would need insurance etc.

You would be surprised how long some task take when there are two people to be helped. And part of the carer’s role will involve simply monitoring how your parents are over the course of the day. And when you get a carer in primarily for one adult, it’s surprising how much they find that the second adult needs support with. There will be a difference between what is seen as acceptable when a couple are managing by themselves that shouldn’t be seen as acceptable to a professional carer, although out of date food being one of them - so in that respect I wouldn’t be happy with the service you are receiving.

The carer won’t be paid anything like the amount you are paying to the agency. They do have a bonus in not being expected to work the weekend (most live in carers are on full weeks) but one carer for two adults in that position is probably going to be knackered, especially if there is night time waking.

It’s certainly true that there is a shortage of people working as live-in carers and this means that agencies will take on people without appropriate experience or understanding of the job. We used a LIC for my parents for a while - the best ones came from eastern / Central Europe and are probably no longer able to work in the way that they did. A friend of mine does this role (very experienced) and she is always very scathing of the standards of the staff who cover her breaks.

Carer already has been given use of parents car.
My point in the OP was that the agency has not sent people appropriate for the role who appreciate the benefits of being in the countryside.
the money we are paying is the rate for the job according to all the care agencies I spoke to.
we are not a HNW family.
There is no night time waking.

They are either asleep or watching TV.
All these things are in place.
The carer is free to do what they want during their break.

Nowhere near enough! Thats not even minimum wage for those hours!
3k per week is more what I would be expecting to pay for that level of care.

You need to be really clear about what you want and also be realistic. Meal planning whilst it seems like a good idea in principle, gives little flexibility. Adults with dementia deserve choice as much as anyone else. So there should be 2-3 options available for them to pick from. Expecting them to pick at the beginning of the week for the entire week and then both remember and be happy to eat the choices they picked is unrealistic.
Far better to have a good stock of freezer meals portioned out and easy to defrost and heat up. Put the carer responsible for batch cooking meals to freeze and then reheat.
In terms of buying things for the house - to be honest I would expect them to run most things past you either for you to get or for them to organise. By doing so no accusations can be made.

In my experience (16 years in dementia care now) it’s far better to have a small team of people covering the week rather than one person. This allows several faces to quickly become familiar and reduces the changeover stress. Continuity is important so it should where possible be the same small group. But you get far more consistency when you have several people coming in. It also reduces burnout and fatigue in carers. Don’t underestimate how draining it can be to be with two adults with dementia 5 days a week. I’d suggest having 3 people to cover all 7 days. Ideally the same people the same days each week to create a routine.

Id also directly employ them / engage their services directly rather than through an agency. That way you have more control over who is providing the care and who fits well with your parents. You can also check references and DBS.

This sort of care you need to hire directly for. My friend has 2 carers who work 2 weeks on 2 weeks off, paid directly complete with appropriate pension etc (it’s easy to do yourself or you can use a payroll agency). Works really well but took a few attempts to hire the right people - one has been with her since pre covid and the other 3-4 years.