Homecare is a good option for a person with dementia who doesn’t need to go into a care home. Christina Macdonald shares her own experiences of finding the right kind of carers and reveals how to find the help you need.
There will come a time when a person with dementia may struggle to cope on their own, and they may not want to go into a care home. In fact, they may just need some additional help at home. Home carers can be a good solution and there’s a vast range of options available, depending on your personal preferences and budget.
My experience with carers
I first realised that my mother could benefit from some help at home when I noticed she was becoming very thin. I looked in her fridge and cupboards and found that food was either sparse or out of date. I wanted her to have nutritious meals. I contacted social services as a neighbour had told me about a Meals On Wheels Service. This was set up by social services quite quickly and she received a hot meal every day, including a pudding, which she paid for.
Mum gained some weight, but there were other problems to deal with. Although physically healthy, mum was neglecting the housework. I called social services who put me onto Age UK who were able to provide a cleaner, which mum had to pay for. However, Age UK informed me that mum could apply for Attendance Allowance, which was around £320 per month.
Finding homecare as mum’s personal care needs increased was more challenging, but the decision was taken out of my hands. After a minor fall, mum ended up in hospital and needed medication. It was apparent to the social worker that visited mum in hospital that she wouldn’t remember to take her medication at home, so social services provided carers who came in twice a day to prompt her to take her medication. I was reassured by this service at first.
However, it turned out to be an additional challenge. As mum was receiving a private pension, social services decided mum should pay for the care but the standard of care was very poor. One day I was visiting mum when the carer came in. I kept mum’s medication in a safe which the care staff had access to, as I didn’t want mum taking tablets on her own and taking the wrong ones, or too many. A very abrupt and unpleasant carer came in and asked mum what the code for the safe was. When I explained that we didn’t want mum to know the code so that she couldn’t take any tablets unsupervised, she shrugged it off as though it was nothing. On other occasions, the homecare agency would call me and say no one was available to visit mum.
Quite often I would go in at the weekend and see that mum had missed several tablets during the week. When I raised this with the manager of the homecare agency, they said they would investigate the matter and report back to me. They never did. There was no real consistency in the staff they supplied – mum seemed to be frequently seeing different carers which was very confusing for her.
In the end I decided to hire the services of a private care agency. Mum was paying for her care anyway and the cost was only a few pounds more per hour. I interviewed a local care agency after extensive Internet research and made sure they would be able to meet mum’s very specific needs. I insisted that, bar holidays or sickness, mum would be visited by the same carer each day. By this stage mum needed assistance with getting out of bed and washing and dressing, so it was important for her to strike up a good relationship with the same person and didn’t feel awkward in their company. When mum had a fall, the carer was quick to respond by calling an ambulance and I felt that mum was in safe and responsible hands. My only regret is not using a private agency sooner.
• Ask the homecare agency if they have experience of looking after someone with dementia.
• Meet the carer first and see how they interact with you. If they are abrupt or unfriendly to you, they will probably talk to your parent in the same manner.
• Once you’ve enlisted their services, it’s worth letting neighbours know and ask them to alert you if they have any concerns.
Employing a carer v using an agency
You could appoint your own carer or personal assistant but you would be classed as an employer and would be responsible for their tax and national insurance, and would need to issue them with an employment contract and payslips. They must be paid the National Minimum Wage of £6.50 per hour (increasing to £6.70 from 1st October). They are also entitled to employment-related benefits like paid holiday and statutory sick pay.
These responsibilities may not be suitable for many people needing homecare, so a better option may be to hire the services of a homecare agency. They would then be responsible for paying the carer and deducting their tax, while you would pay the agency.
Although it’s more expensive as you will pay the agency’s commission as well as the employee’s fee, homecare agencies provide a flexible service. Care can include either a 24-hour live in carer, someone who comes in twice a day to get the person up in the morning and into bed at night, or a carer who comes in for an hour or two each week to do some shopping and general household tasks. You can choose the level of care and add additional hours as needs increase. It also means they would send someone else if your regular carer is taken ill.
Before you appoint a private agency, you may be entitled to financial help from your local council. The first step is to contact your local social services department and ask for an assessment of your care needs and see if they will contribute towards the cost. If the council decides you need help, you may receive a personal budget and can choose to pay a carer directly, which gives you more choice over the care you receive (but remember if it’s a private person you will then become their employer). However, you may not want to manage a direct payment, so the council would then provide the homecare and support you receive.
Another option is to fund your own care. If you want to appoint a private homecare agency, you will need to find the care agency and pay them directly. The agency should try to send the same carer, though this may not always be possible due to holidays or illness.
You can check that the care agency is registered with the United Kingdom Homecare Association, which has a facility to search for a care agency in your area.
However, if it’s a fairly small level of care that is required at this stage, it may be worth speaking to Age UK, who can provide cleaners for a reasonable hourly rate who will usually also do some shopping.
Similarly, if you only need someone to prepare meals, you may be eligible for Meals On Wheels, provided via social services. You would pay for the meals (around £5 per meal) and they can be provided seven days a week.
If you decide to use a homecare agency, The United Kingdom Homecare Association recommends asking the following questions:
• Can they provide the care needed and meet your personal preferences?
• Have they cared for someone in a similar situation or with similar needs to you?
• Do they obtain references from care workers’ previous employers?
• Do all of the carers undergo a criminal record disclosure from the Disclosure and Barring Service (in England and Wales) or Disclosure Scotland (in Scotland) or Access NI (in Northern Ireland)?
• What happens if the regular carer is ill or on holiday?
• Can you contact the agency outside of office hours and in an emergency?