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?

The problem is that virtually no-one wants to be a carer, so most people will only do that job if they have no choice.

You wouldn't want to be a carer and neither would I nor would most people reading this thread.

People would rather be on benefits than be a carer.

I 100% agree with this comment. I looked at doing care work when I was desperate for a job and needed a few weeks of money to just literally get me out of a hole.
I couldn’t believe the number of agencies that were prepared to sign me up with zero experience and with me actively stating that I would not do half the job that they were describing to me
It was almost as if they thought I might change my mind when I got there
I most certainly would not have
But they were happy to sign me up anyway and palm me off onto their customer

I think perhaps your expectations are a little high, you may indeed find someone better direct but they will still need regular breaks covered - my aunt's live in carer had 1-2 weeks off every six weeks. Caring is a tough, poorly paid job and that is often reflected in the quality of staff, but I also think you are overly focused on some minor points - ie eggs - three weeks past best before is fine and in fact government guidance I think. And why do you need to freeze things on the day of purchase? Guidance is as soon as possible after buying but always by the use by date. Most things I freeze are on the use by date and it's never been an issue whatsoever.

I'm not saying don't try for a better carer, but with whoever you have the general standard of care is the most important thing rather than unimportant details like this, I think.

Bottom line is you’re paying relatively little for the amount of care and getting comparatively poor care as a result. Similar to another poster we are paying an £2500 per week for my parents. Standard rate in London for overnight care for example is around £200 per night for sleeping and £250 for awake care. That alone would be £1000 pw for 5 nights.

With my parents I went through a couple of agencies before finding a really good one. So I suggest you keep looking and find one that will provide a care team.

However some issues are just inherent to the issues of having in home care and that’s why past a certain point care homes are worth considering. In any case, it’s really worth looking round the care homes in the area because what tends to happen is that one or other may have a sudden escalation - fall, fractured hip, stroke etc and you suddenly need higher level care - and you don’t want to be scrambling to do that on the hop.

There speaks someone who has not looked after elderly people, particularly with dementia.

I managed care services for years and if I personally needed to put something in place for loved ones I would pay for blocks for 10am to 6ish months to Fri cash in hand to 2 or 3 local mothers and granny's at an inflated rate beyond what they'll get anywhere else so they want to do a really good job and stay. And tell them all you want is to make sure your parents are content and happy and the house is looked after. To use their initiative and then stay out of it beyond that. Anyone not reaching the mark, out they go.

If your parents are needing overnight care, care at home by non family members isn't a good option. Getting consistent staff will be an expensive nightmare that you're continually let down about. The ideal set up people have in mind just isn't available for people that aren't billionaires.

I think your expectations are high, particularly if they are caring for two people. We used an agency for my dad and there’s always change as carers come and go. They also work shifts, such as one week on, one week off. I think it’s unlikely you’ll get one person working a 5 day on/2 day off pattern, and they have to have a break in the day as their hours are too long otherwise. Also, £1400 is low for caring for two people. We paid that for one.

Such a good post. Agree with every word. I think it's so hard filling these kind of live-in posts successfully even if you pay top dollar (and agree that what the OP is paying is not that) - there really aren't that many people out there who are, to put it perhaps too simplistically, caring enough to provide kind, gentle emotionally atuned but assertive enough care, monitoring of medical needs etc while efficiently running a household without daily guidance or supervision AND being a good personality match for the clients AND fitting in with/managing client's family expectations AND giving up most of their own life to live in someone else's house, unless there is a really big financial benefit to them from the job (and noting that sadly elder care jobs do tend to be in more or less temporary by in nature so not like the carer can count on the job being forever if they love it and do an excellent job) - even when on paper the duties/requirements aren't that heavy it's the mental/emotional load of being in sole responsibility all the time that can make people find it hard and become sloppy or lazy. TBH if your parents are happy, well looked after and can tolerate the carer and your biggest complaints are out of date food you've done quite well! I'd much rather that the house immaculate and fridge sparkling and organized but parents miserable or hating her.

I'm not saying you're a bad person OP or your expectations are wildly out of line or parents are particularly difficult or anything like that, you sound very typical of a live-in job. It's just I think it's much easier to provide consistently good quality care in an institutional type setting with a big team of people, shared loads for the carers, better supervision, more variation in tasks and duties, if they don't get on with one client they can mainly work with another or vice versa - but of course institutions are usually not the best for the client so it's a hard one.

I'd be wary of employing your own carer directly though, it's great if you find that rare unicorn of the perfect carer but much more difficult if you get another mismatch, lack of the support and supervision of the agency, having to make your own payroll etc arrangements, cover for holiday/ sickness, lots more issues. Maybe switch agencies, or consider changing the model slightly if you can find an agency which does a week on/week off model or 3/4 days in 3/4 days off - I know this means not being able to build a relationship with one consistent carer but personally I've seen great results with more like a small team of 3-4 consistent people who rotate in and out, this way you can get more of a mix of different skills/preferences, if you get one carer who's a great cook they may then take more ownership of meal planning/cooking while maybe someone else's who's more into the social/engaging side would like to them out more and so on? Just a thought anyway.

We had a similar situation with providing care for my MiL who had vascular dementia. We didn't want a live-in carer as she was living with us and we could provide the evening care, but as we both worked full-time, we needed daily full time care. We started out with agency workers, but they kept being swapped around, which wasn't what we needed. And some days they would arrive late because the agency had over-scheduled the carers they had on duty that day, which needless to say didn't work for us.

We ended up putting in our own ad in the local job centre. And, apart from the issue of having to interview each one and check references, we got exactly what we needed. We ended up with two carers who were able to work out schedules that worked for them between the two of them and they remained constant until my MiL's death. We did have a hiccup with one we had employed at the start, but we always did a trial period before giving them a contract. We felt that this gave us much more control over the care and consistency for my MiL. Towards the end, she required two carers to move her, so we employed a third carer from an agency to come in three times a day and help. But the primary carers knew the routine and we felt satisfied with the care my MiL received.

I know you are looking for someone to live-in and will require a greater degree of trust in who you employ, but it may be a more satisfactory arrangement for you to employ someone directly rather than going through an agency. We were able to get someone who had been working with adults in a residential complex as a live-in carer and someone else with nursing experience. I don't know if there might be other places, like temping agencies or nursing agencies or even the local church, where you could advertise for such help, but it might be worth checking out. Good luck.

I have not been rude to you, unlike you. Nor have I assumed anything, I simply said I don’t want to manage care myself. It’s not a single experience as I’ve been responsible for various elderly relatives. I don’t know why you can’t let this go.

It's not 120 hours? It's 40 hours a week.

Sounds odd, but have you looked at Lady magazine? They have ads for live in carers and also you can put an ad in for a full time live in carer

They do get a break in the day. We are paying the rate the agency sets for the hours worked, which was consistent with other similar agencies when I was researching this.

I have a lot of experience in finding caring support for my daughter and both my parents and I would make the following observations:

Clients like myself often have complex, multiple requirements and expectations which frankly no one can fulfil so it is best to be realistic about what matters and not fret about the small stuff, or you will constantly chasing that elusive perfect employee.

You are often better off finding someone yourself. You can advertise locally, use your own connections - agencies are not as local as you are, and often arrangements break down due to location, which is less likely if you are dealing with locals to start with. Try Next-door app for example. You can use a payroll company to handle all the admin.

Always think about your parents' needs and wishes over your own.

Good luck

I manage a care home, so the situation is slightly different, but most problems like this are caused by differing expectations. You need to meet the care workers and have a good discussion regarding what you expect, and listen to what they can actually provide.

Care plans are great, but a good discussion between relatives, the service users and the care givers regarding care going forward is invaluable when working on a one to one basis ( or two in this case).

I’m in Scotland, so the regulatory bodies may be different from where you are, but care workers have to adhere to certain standards which include the promotion of independence and personal choice for individuals. They cannot force or trick people into having showers they do not want, wear certain clothes, go places they don’t want to go, take medication they don’t want etc. They also have to offer choice regarding food, even if it means another food will go off due to this.

It is often amazing the amount of relatives who think we can just conceal medication in food, hide clothing, dispose of belongings, or even sedate people to carry out personal care without medical assessment.

I know some of this not relevant to you, but it’s just to illustrate difficulties which can arise from differing expectations. Communication is essential.

Care workers have a difficult job, and are often not viewed by society with the respect they deserve (arse wipers etc). Many leave because of the constant changing demands coupled with the low wages and status. Good carers are treasures. Although you are paying through the nose to the agency, the care worker will likely see a fraction of that.

I really hope you get something sorted for your parents ❤️

🙄🤦🏻‍♀️😂😂😂

I went through all this with my late OH.
Effectively there is no choice of carer. They only stay for a block of so many weeks and in the preceeding couple of weeks to a new person you are frantic to get someone before the deadline and have to take what you are given.
Most were from overseas and their language skills were a problem for someone who was muddled abd sometimes paranoid. He thought one was a Russian spy ...
Food was a problem as special diets had to be accommodated.
And you can bet your life that the moment the carer went on her (deserved) break my OH would need the toilet and I was unable to lift him.
They could not deal.with his catheter so I had to do all that.
This unsatisfactory service cost an arm and a leg.
Sadly he had to go.into a nursing home for the last few weeks but it was a good one and there was always someone around to help him.
Also it is worth remembering that however nice the carer it is a stranger in your home 24 hours a day with all the stresses that brings. One of the carers insisted on having a shower 3 times every day!

We’ve been through this. We’ve spent years trying to find someone decent and got nowhere. Paying that kind of money is ridiculous, and expecting someone to throw away old food shouldn’t even be a discussion—feeding is literally part of the job.

I ended up cutting my hours because it made far more financial sense, and at least I could make sure things were actually done properly. From my experience, agency workers are completely useless.

I don't think your expectations are too high. But it is very very hard to find a great live in carer who is also a really good fit.
So I just used to try really hard to not sweat the small stuff. As long as they were basically kind and caring, and tried their best, I tried to ignore the broken stuff, the wasting of money, the various oddities. I would have long rants on the Elderly Parents thread though!
It's a tough situation to be in, and I wish you well.

Can I ask what the carer actually gets paid?

My son is considering care work, and a live-in job would be perfect. (He's just returned from living abroad after a divorce. He's in his 30s, not qualified, but has looked after his son, and me when I was recovering from an operation!).

Where would private hire jobs be advertised?

You talk about the carer having a 3 hour "break" during the day - but honestly the split shifts put a lot of people off because the "break" often ends up being effectively trapped time that they can't do a lot with but drags out the working day.

One of my DD's friends quit a home-care job that she was doing to save for Uni because of split shifts. Her hours were 8.30-12.30 and then 3.30-7.30 but there was very little she could do with 3 hours off in the middle of the day and it just felt like an 11 hour working day that she didn't get paid for. She actually earned more in a hospital cleaning job where she only did an 8 hour shift.

Care work is difficult and it is not well paid. Where I am, there doesn't seem to be enough people willing to do it.

Not saying this is the case with the OP's parents, but my own older relatives have been known to resist the carers' attempts to do the actual care that is needed.

So is life. For people who have worked as lived in nannies in the past and so on that’s how life is. I would happily do this job in my 50s. You get free accommodation and enough money to save up for the next chapter in your life.

It didn’t sound like your parents are at this stage yet, but for context we pay £1300 per week for my mum’s excellent care home. That’s for everything.

We were paying over £1600 every 4 weeks for 4x care visits a day. If you take into account all the overheads for living in her own house (utilities, maintenance, insurance etc) as well as food and my time and care costs then my mum was fast approaching the point where it was more cost effective for her to be in residential care. She actually moved because she wasn’t safe at home any more, but financially it isn’t a big stretch once the house is sold.

Managing carers is a thankless task - there was one absolute star, a couple of reliable ones that mum liked and the rest were well meaning box tickers with common sense deficits. You really do have to drop your standards to “is the elderly person safe, clean, warm and fed?” and anything else is a bonus. Whereas mum actually receives “care” in her home - eg they noticed she was coughing when she drank so they got her assessed by the speech therapist who recommended she moved to thickened drinks, and they rang me to tell me - all done within 48 hours of her moving in.

This is all a long winded way of saying that your parents care needs are only going to increase. One poster on this board has noted that with parents with dementia you find yourself constantly solving yesterday’s problems. I’d recommend starting to think longer term and identifying care facilities you like and maybe using them for day care with a view to seeing if your parents take to it and whether they would move in when it is appropriate for them.

One of my former neighbours used to employ live in carers from Country Cousins. I think they used to work two weeks on and two weeks off and alternate. He didn’t have dementia, just frail with mobility issues and could tell them what he wanted done, what he wanted to eat, where he wanted to go etc. Obviously only one person to care for. She had her own annex.

Do they take instruction from your parents, e.g. if your mum decided she wanted new shoes or slippers, could your mum or the carer order a selection to try online, or could she leave your dad at home to take your mum shopping? On medical appointments, can one parent be left at home safely?

Are there commodes to clean or continence issues? Does the cleaner change the beds or is that for the carer? What type of food is expected, a home cooked meal daily from scratch or a Cook meal heated up?

We employed daily care for late MIL and that was circa 30.00 ph. The advantage was that each carer had their strengths and preferences, one was great at bathing and hair care, one was particularly good a washing cashmere jumpers (not to be underestimated - when MIL went into a home and they said they wouldn’t wash her cashmere she was really upset), some ex nurses were particularly good at advocating on medical matters, one was a really good organiser and left notes in the book for the others, but most of all they were a great team, worked well together and were all really kind and caring.