Share
[easy-total-shares url="https://www.agespace.org/care/elderly-care-at-home/home-care-options" fullnumber="yes" align="left" networks="facebook,twitter"]
Home Elderly Care Home Care Elderly Home Care services: choosing the best option

Elderly Home Care services: choosing the best option

Care at home provided by professional carers and companies may be called home care, visiting care, domiciliary care or live-in care.  Each type of care is slightly different, from the level of care provided, the cost, and who might give it.

The range of care options could be a few hours each week of general support, to daily medical support and care, or 24/7 round the clock live-in care.  Different companies may also inter-change some of the definitions aswell, all of which can make decisions about the right care very confusing. 

The right support and care will help elderly relatives remain in their own homes for longer, living as independently as possible. In this guide we explain all the home care definitions and options available and the likely costs.

How do you know elderly parents need more help at home?

You may be able to see that they are no longer coping as well as they used to, or the GP has suggested more help at home. A care assessment from the Local Authority will establish what care is needed. 

How to choose home care for the elderly

Alongside a care assessment a financial assessment will determine whether or not the Local Authority will contribute to or pay for the care (in general terms anyone with more than £23,250 in assets and savings will pay for their own care). 

Care companies will also carry out their own assessment to match carers with the right skills and experience to give the best care for their clients.   

What level of care do your elderly parents or relatives need?

The level – amount and type of care – will be determined by what needs to be given.  Under national guidelines the minimum time block for a home care visit is 30 minutes. The maximum is someone living in the home and on call 24/7 often for a certain amount of weeks/months, with breaks during that period.

These are the different types of home care you may be considering:

Type of support/care

Description

UK Average cost (2024)

Home care/domiciliary care

General name for all care at home options

 

Visiting Care

Care and support provided by carers who visit the home (rather than living in)

£18.75 per hour 

Live-in Care

Care and support provided by carers who move into the home. Live-in carers work on average 8 hours in any 24 period.

£139.50 per day 

Companion care

Support at home that doesn’t include medical/health care;  may include shopping, meal preparation, tasks around the house.  This sort of support might also be provided by “home help” organisations.

£18.75 per hour 

Personal care

Help to get up in the morning, washed, dressed, and going to be bed at night; might also involve help going to the loo.  Might be provided by one or more carers at the same time -particularly if lifting someone is required

£18.75 per hour 

Overnight care/sleeping care

A carer who stays overnight (but doesn’t live in) to provide care – ensuring someone is safe overnight, or medical intervention, personal care;

£17.46 per night 

24 hour care

Provision of 24 hour care by carers who don’t live in the house; rotas of day/night carers; often provided by organisations that generally offer day care services (not live in care)

From £18.75 – £17.46 per hour x 24 

Live-in care

Carers who move in to the home to provide round the clock 24/7 care and support;  often live in for weeks/months at a time.

£140.35 per day 

Respite Care

This may be needed in a range of different situations: following discharge from hospital when a period of recuperation is needed;  after a period of illness at home;  or to relieve a family member who needs a break.

Depending on the requirements

How different care needs are met

The home care that is needed may be given in many different combinations: 

  • Hourly care/care by the hour: there may be a minimum number of hours per week that a carer can be contracted;
  • Care given through multiple visits per day – such as morning, lunchtime and night time: this is likely to be carried out by more than one carer 

The amount of care and daily visits will depend on what is needed – from just a bit of help and companionship to complex medical care provided by more than one carer, round-the-clock, or carers taking over from others in order to give them a break.

Who funds the care may also determine what combination of care may be given: it is likely that the Local Authority’s default will be Visiting Care or Hourly Care, whereas if your parents or relatives are funding their own care, they have more flexibility depending on their budget to select the type of care given. 

How is home care paid for/funded?

Currently in England and Wales anyone with more than £23,250 in savings and cash will be paying for their own care. Those with funds between £14,000 – £23,250 will be eligible for some funding support for their care, and those with less than £14,000 will receive fully funded care by the Local Authority.  

The NHS will fund some elements of care which is not means tested, but based on health and medical needs. This may include 6 weeks of nursing care following a hospital discharge, or in some circumstances all care needs will be funded whether at home in a care home.  This is called NHS Continuing Care. 

Who recruits, trains, employs and manages carers?

This is where things get a little complicated…..

Local Authority Funded Care

Local Authority funded care will be arranged with care companies in the area.  Particularly with the current budget constraints, care companies will have agreed a set rate from the local authority, negotiated in “bulk”  to fulfil the care needs in the area.  These will most likely be private companies (or charities), although some LA employed carers and organisations may still work in your area. 

The individual carers may be employed directly by the care company who will be responsible for their recruitment, training, payment and management. Or they could be self employed and be contracted and managed by the care company.

Self-funded Care

These same companies will also provide carers for self-funders, and those in receipt of direct payments from the Local Authority to pay for their own care.  This is more likely at higher ££ rate/charge than the rate paid by the Local Authority to the same care company.  

Self-funders have a wider choice of care companies, and different ways of working with carers including deciding whether or not to employ the carer themselves. 

How are carers employed, managed and paid?

Traditionally, day care/domiciliary care was offered and provided by companies different to those providing live-in care.  However, many organisations are now offering the full range of care solutions – from hourly care to full-time live in care. 

Introductory Care Agencies

Predominantly for live-in carers, but increasingly for day care services, companies will either provide “introductory” services or managed care.  Introductory services are essentially recruitment services – for clients to find self-employed carers vetted and checked by the introductory company.  The client will pay a recruitment fee and will then become the employer of the carer, responsible for their salary, NI and pension contributions, sick pay and holiday cover.

Increasingly it is also possible now for clients to pay an additional fee to the introducing agency to not only vet and train the carer, but also to assume responsibilty for the carers contract, payroll etc.

Managed Care Agencies

Managed care is when a care company (or charity) employs, trains and manages its own carers, and is fully responsible for the scope of all the care provided (rotas, holiday cover, sick pay and cover etc). 

You will enter into a contract with the company to provide the agreed level of care and support. 

What are the differences between introductory care and managed care?

Introductory Live-in Care 

Managed Live-In Care 

The customer is in full control of the Carer directly and decides what and how needs to be done

Live-in Care Provider employs, trains and manages the carer.  They can move the carer around or not offer you choices.  They can be slower to change how care is delivered.

Not regulated by the Care Quality Commission (CQC)

Regulated by the Care Quality Commission – as so incur greater costs that are passed to you

Customer manages the care – including holiday cover, sick cover – which may involve more than one carer

The care has to be delivered in a framework that might not please you

Pay for the services you use

Paying for the central costs of more complex organisational needs

The role of the Care Quality Commission in monitoring care

The Care Quality Commission (CQC) regulates all care in England (there are equivalent bodies in the nations).  They do not regulate introductory care agencies – ie recruitment companies – because the company itself does not actually provide care.  

Before entering into a contract with a Care company you should review their CQC report as part of your due diligence. 

What is the best solution for your elderly parents or relatives?

If the Local Authority is funding the care your parents and relatives will have little choice as to the carers they provide and the combination of the care given.  The local Authority and the care agency selected will carry out their own assessments, and endeavour to match carers with customers, but with limited resources and ever-increasing need, it may not always be a perfect fit. 

Arguably the local authority will also manage the amount of care and time associated closely.  For care companies  there is increasing pressure to provide a level of service within significant budget constraints agreed with the Local Authority. 

Self-funders have more choice.  However some of the same constraints may apply – lack of carers, squeezed resources etc., so it is a good idea to consider all the options and shop around as much as possible. Questions to consider as you navigate through this include:

  • What level of care are we looking for? (companionship/support or medical care)
  • What kind of care are we looking for? (hourly visits, live-in fulltime care)
  • What skills and qualities does the carer need to care for my relative? (specialist dementia experience, lifting, ability to play scrabble)
  • How much care are we looking for (full-time/hourly/other)
  • Do we want to employ an agency or to recruit and employ a carer directly?
  • If we recruit a carer do we want to be responsible for payroll, holiday cover, sick pay etc?

An example of a situation you might need to consider could be: 

Mum needs someone for a couple of hours in the morning to help her get up, washed, dressed.  To give her breakfast and to see she’s ok for the day. She needs the same in the evening, cook her a meal and help her go to bed.  We don’t want to be responsible for the payroll.  Mum wants a consistent carer, the same face every day.  We can cover the weekends. 

Selecting the right care can seem a daunting task.  The best companies make it their business to make it as straightforward as possible, with a commitment to providing the best fit in terms of skills and personality for the client.  It may well be that the arrival of a carer – even for an hour a few times a week – has a hugely positive impact on your parent and relative. 

Things do go wrong.  It is also important to know your rights, so that should you feel the care is not right, sub-standard, that you can either complain, or work with the provider to improve the situation.  It can feel hard to complain amid the fear that the care given declines further – but equally – an elderly relative suffering in silence is not a solution either.  

FAQs on Home care options

What is the difference between Day Care and Domiciliary Care?

Domiciliary care and day care are one and the same thing - care provided in the home. 

What is the hourly rate for domiciliary care?

The cost per hour will vary depending upon the type of care given and the location.  There is often a minimum weekly amount that a care company will be prepared to contract for.  The average cost is in the region of £18 per hour. 

Is live-in care as expensive as moving into a care home?

Live-in care can be less expensive than moving to a care home.  It comes with the additional benefits of being able to stay in your own home surrounded by all that is familiar. 

What is managed live-in care?

Managed live-in care is where you/your parents and relatives have a contract with a care company who recruits, trains and employs the live-in carers.  They are responsible for employment, payment, holiday and sick cover. 

What is introductory live-in care?

Introductory live-in care is where you employ the carers directly, hired through an introductory agency.  The carers are self-employed so you are responsible for pay, NI contributions etc.  

What is the difference between care agencies and care providers?

Care agencies predominantly broker between self-employed carers and customers - you will pay a recruitment fee to a carer hired from them.

Care providers will recruit carers, employed by them, to deliver a live-in carer package as agreed with you. 

Does a live-in carer need their own bedroom, bathroom and living area?

A live-in carer must have their own bedroom.  They do not require their own bathroom although that would be a bonus;  nor do they need their own living area.  They do need access of course to the kitchen and living areas. 

Will the NHS pay for live-in care?

The NHS will only pay for live-in care if it is agreed by them as part of a NHS Continuing Care package.  This is care provided "free" by the NHS.  Based on an underlying health need, NHS Continuing Care is very hard to be eligible for, but worth looking into.