Anyone employed a live in carer?

[DrBlackbird]

Has anyone had experience of hiring a live in carer for themselves or an elderly relative?

We are wondering about hiring a live in carer to look after my MiL with dementia i.e. paying an annual salary of £xx. We understand this includes being responsible for NI, pension contributions, holiday pay etc.

It’s difficult, however, to understand the legal ramifications of employing a live in carer. For example, my DH thinks you’d have to hire two people to accommodate their need for time off each day/night ie paying £xx to two people. Surely this puts live in care beyond the grasp of any ordinary family?

From what I’ve read, it seems that a live in carer would be classified as a domestic servant and therefore not subject to working hour directive, but it’s hard to find complete information.

Can anyone direct me to further resources on hiring a live in carer or have personal experience of doing so themselves?

A family member does these live in carers roles occasionally, the family pay her directly and it's through an agency who I believe takes care of the tax and NI.
She is entitled to a few hours off each day and the agency sends someone in to cover her.

I know of lots of people who've done this (in a professional capacity) and they all use an agency rather than directly employ the carer. The agency can then organise sickness/holiday cover as well as cover for break times (1 person can't work 24/7 without a break).

A friend of ours was considering this for a parent. Sadly it wasn't needed in the end. At the time, he was initially looking at engaging a private carer- but as already mentioned this causes issues with time off/night time cover/holidays/ emergency cover for sickness etc. He decided if he was going for care at home, he would go through a care company who would manage the schedule/cover etc Whilst he was very keen to keep his parent in their own home, he was persuaded by other friends who have been this to considercare homes with specialist dementia care units - it was pointed out that particularly in the later stages of dementia, having one person solely responsible for the majority their care is extremely stressful, whereas care is shared in a home so carers have more breaks from it. To his own surprise, he found himself leaning to that solution but then events took a turn and it wasn't needed. He's a good friend so we spent a lot of time listening to him trying to process everything so know how difficult it is for you x

The question should be what is the carer there for? Is it as a companion, to cook meals, to private medical support in taking pills, personal care like washing/dressing, taking them shopping or something else? Why live in?

We might be able to suggest other options, depending on what the need for a carer is?

I wouldn’t want 1 person living in as a carer. Too many potential safeguarding issues. A team of people who don’t live in is safer. Or a nice care home

Whilst it's true that we don't have all the info, many people with dementia get to a point where they just aren't safe on their own. You can have carers coming in several times a day for all the things you mention, but once they get to a stage where they might go wandering, forget where they live, might leave a tap running, scald themselves trying to fill a hot water bottle etc then round the clock care can be required.

It's depends if the person needs 24/7 waking care, sleeping nights or 'just' several periods of care during the day.

For 24/7 care you need a minimum of 3 full time workers and will need to factor in extra for holidays/sick days/maternity/training.

If this is needed a nursing home is more appropriate.

A live in carer is best for companionship and regular assistance with toileting/dressing/going out/taking meds but not for someone who can wander or is dangerous to be left unsupervised.

Agree with others that going through an agency would be better. They will complete eg DBS checks, deal with payroll, cover sickness and holidays, support with any issues on either side.

Many thanks for everyone’s replies. It’s this toss up between a live in carer vs home that we’re currently grappling with. Using an agency is more expensive than care homes going by my research. She was in a care home post op recently and went considerably down hill because of so little meaningful interaction with either staff or residents. She likes / craves attention.

She’s in her own home ‘alone’ but going to day care Mon to Friday during the days and receiving visits both mornings and evenings from an agency plus we give her dinners 3-4x a week. However, it’s the nights we’re worried about.

So the carer would live in to help her get dressed, get washed, cook dinner a few times a week and keep her company. She doesn’t need much physical help really, but someone to read to her, do puzzles, or go for short walks etc. Probably a ‘companion’ in the old fashioned sense of the word.

I’ve got a friend whose firm would do all the checks and payroll etc. We’d probably use respite care for holidays.

What I’m trying to figure out is how many hours off do they need each day or each week etc? Does the working time directive apply or not? I can’t find any absolutely clear definition on this.

Yes I have. The question about working hours is very dependent on needs of your relative. If they need help with washing, dressing and meal prep then a single person could be employed as they can have time off the rest of the day (you would need to cover weekends though) if you need 24 hour a day coverage you would need at least 2 (usually working 2 weeks on 2 weeks off) and more if the work level is very intense and they can't sleep properly.

The paperwork isn't difficult.

If it's really just companionship you need, consider whether you can find someone who can live rent free in return for a few hours a week help, you may still need carers from outside but having someone sleep in can be a good thing - there's specialist orgs that set these arrangements up

While I am sure private live in carers are available, there's a reason why people - both carers and the cared for - go through agencies. It give security on both sides - being a live-in carer is really intense and people do need breaks (days and weeks as well as hours), sometimes people don't suit, insurance, finding replacements, DBS, etc etc etc. Your choice obviously but I'd definitely do a lot of due diligence before making a decision.

We had a very good experience though the https://www.country-cousins.co.uk

Each came for a fortnight at a time, meaning there was natural cover for illness and holidays , and not too much irritation from living in such close quarters.

I did this for my terminally ill OH.

I have to say that there were difficulties. I used agencies, as I could not see how else I would find someone and not have all the hassle of employer's responsibilities.

The difficulties were:

1. Finding someone in the first place - some of the people who we vetted (online) were beyond unsuitable and some my OH refused - he was becoming paranoid and thought one of them was a Russian spy.
2. Accommodating the carer in our home. It demanded a lot of adapting to someone else being there - often they were from another culture and I had to work around that (diet etc.) on top of the emotional load of watching OH getting sicker. One carer had very weird traits and hid in her room, just coming out to do care tasks like an automaton then hiding away again.
3. Loss of privacy - that was a huge one.
4. Covering their "off" times. You could bet your life that the minute they set off on their (much deserved) rest time, my OH would need transferring to the toilet etc.
5. Preventing gaps in care - the carers swapped around every 4 or 5 weeks and it proved very hard to dovetail someone suitable and often we would be up against the wall struggling to find someone/anyone in time.
6. Having to help the carer to get to know the routines and foibles of the "patient" - sometimes it would take them till the end of their 4 week stint to get into the swing of it.
7. Listening to their grumbles about the agency, their pay etc. - they nearly all did this.

A person who has early dementia will find adapting to someone living in very hard.

My OH went into a nursing home in the end. It was an excellent one - I searched very hard to find it - but because it was so good I had to sell my home to afford it.

Frankly the whole thing was a living nightmare and haunts me still 3 years later. It all sounds great on paper, but in practice it can be very challenging.

@gogomoto can I ask if they only worked 5 days a week?

Thanks @FinallyHere I’ll have a look. The agencies seemed to charge more than a care home going by one I contacted circa £68k p/a.

I have experience of using live in care for my parents - via an agency . I also know a bit about this as my friend works as a live in carer, again via an agency.

The carer gets two hours per day as their down time and is also meant to not be working during the hours they would be sleeping eg no night waking . If the person being cared for is either not safe to be left for the two hours of the carer's break, or they wake at night, then the family has to fund respite care to cover the breaks and also to allow the nominated carer to sleep. The agency will arrange for another carer off their books to do this . Mostly live in carers will work for a few weeks on full time, then take a week or two off. Again, cover is provided by the agency with the family (elderly person) paying for this .

I think it would be very costly and complicated to employ someone directly - unless the elderly person had quite a low level of needs, in which case fewer breaks/respite would be needed .

Some councils are doing schemes now where they buddy up someone in need of accommodation (often students) in exchange for free rent and companionship. My understanding is these are for people who don't need any personal care however. Private agencies will often have people working on a 2 weeks on 2 weeks off rota. The staff here tend to be very skilled and experienced. These are great but very expensive. I believe one such agency is called 'helping hands'.

Had this. The agencies we dealt with were horrific, zero safeguarding. I had to ask two carers to leave immediately due to putting my dad at risk. Finally sent a good carer, we paid agency £1200 pw, she got approx £500. The standard working hours requirement was that they got 2 hours off in the day and only involved at night if one off need. They did 4 or 6 weeks on and then 1 or 2 weeks break.

There are Facebook groups to directly engage self-employed carers.

There's another

You may not need live in. We got a good daily carer/personal assistant from a newsagent window ad. She had insurance, DBT and was working in local care home. She then got a colleague to cover if she was off. You could also look on Nextdoor.

Be very wary with agencies. Read their reviews. Even the most expensive one I could find had lots of very unhappy clients.

Thanks @ShinyAppleDreamingOfTheSea thats useful. Was your carer considered a domestic servant do you know?

If the live in carer gets to sleep through every night (MiL currently doesn’t wake in the night) and get daily breaks, weekly days off like regular employment, then why would they work for a few weeks and then take a week or two off?

All of this is quite a different experience to my DM in Canada where she employed a live in carer, the salary was reduced because it included room and board so was far more economical than a care home. They had time off during the day and the whole day at the weekend but still lived there ie was sleeping there every night of the week.

We had live in carers for MiL for many years before her dementia got so bad she needed a home. We got them through an agency and they did 2 or 3 week stints. We moved her to a home in the end when her needs became such that one carer was not enough, even with respite breaks.

I think you need to be realistic about what your MiL needs - it’s not just the legal employment position but what is practically possible. Looking after someone with too little sleep is difficult as every mother of a newborn will attest. A dementia patient can be as demanding and as tiring.

And bear in mind that dementia is a deteriorating condition so your MIL’s care needs will probably change over time and you need to keep an open mind as to how best to meet them.

Interesting perspective @SparklingLime Astounding that an agency gets £700 out of the weekly cost of £1200 pw. That seems outrageous. I’d rather pay the carer a higher salary.

It’s specifically feeling that someone sleeping there is the right thing is what’s prompting our investigations.

She’s been managing with daily care and us up until now but it’s wearing looking after her 4/5 evenings a week, we pick her up after work, bring her to ours for dinner and take her home at 9/10pm to help her get ready for bed etc.

The carer won’t be working 9-5 though, they will be working from the moment the person gets up and until they go to bed. They will be preparing all meals and looking after them apart from a two hour break. This is why they need a couple of weeks off after a stint of several weeks. It’s exhausting looking after someone and living in their home.