Live-in homecare: what options are available?

As clients and/or their parents age and become less able to look after themselves, minds naturally turn to arranging the right kind of care to suit their needs, and the needs of the immediate family. Live-in homecare is a little-known but long-established alternative to residential care, enabling people to stay in their own home and community by having a carer who lives in their home, and provides round the clock support.

Carers provide essential assistance with washing, dressing, preparing meals, medication and housekeeping, as well as providing vital companionship; having someone to talk to and laugh with can make a world of difference. Some carers or nurses are also trained to cope with particular conditions such as dementia, Parkinson's, stroke, MS or palliative care.

These are often delicate and worrying situations and what works best depends on the individual circumstances. There are two models of live-in homecare: full management and introductory - and some Hub members offer both. All members have very stringent recruitment, matching, and training processes.

Choosing one service over the other is a matter of personal choice; one may be more appropriate than the other for an individual's personal circumstances, and those of their family. So what are the differences?

Full management

With full management, the company providing the care employs and trains its carers directly. This is ideal for clients who live far away from a parent, or have significant other demands on their time and need someone else to oversee and organise all aspects of care arrangements day-to-day and long-term. This includes initial expert client and risk assessment, client-carer matching, through to comprehensive care plans, staffing rotas and HR requirements.

With this type of live-in homecare, your client will be assigned a dedicated manager for ongoing oversight, reviews and support. The provider will also offer 24 hours a day support for both carers and clients. Clients can ask managed service providers to oversee as much or as little as they would like.

Introductory care service

Introductory agencies don't employ their carers directly; they are self-employed contractors and are responsible for paying their own tax and NI contributions, and are paid directly by clients or their families. This type of care service is more suited to families who are keen to be more closely involved and 'hands-on' with the administration and day-to-day arrangements.

Regular, close, and continuing liaison with the client is necessarily maintained to ensure the client receives the right level of care. Agencies also pro-actively manage rotas, so that handovers between carers are seamless. The client or family also pays the care agency a fee for the introduction, placement and booking of carers.

How are the two types regulated?

All of the Live-in Homecare Information Hub members are committed to providing care that is responsive, effective, well led, loving, and safe.

Companies offering full management are all regulated in England by the Care Quality Commission (CQC), the independent body that inspects and maintains standards within the industry. There are equivalent bodies responsible for service regulation in Wales, Scotland and Northern Ireland.

Introductory agencies are no longer under the remit of the CQC. It ceased inspection of this sector a few years ago and can now only inspect organisations that directly employ their care staff. However within the Hub members, introductory carer providers' selection, training and management procedures often exceed CQC standards as full management providers often do. The introductory agencies which also offer live-in nursing are regulated in that area by the CQC.

Supporting clients in making informed choices

Many private client advisers are still unaware of the option of live-in homecare and assume that residential care or a nursing home is the only choice. Where power of attorney exists, the carer can be the eyes and ears for the solicitors and families alike.

It's important to raise awareness of live-in homecare and inform people about the two different options available, as well as the different methods of financing later life care and the support that can be provided on legal matters to ease the process, and provide peace of mind for families and their loved ones.

Mike Smith is managing director of Trinity Homecare; a member of The Live-in Homecare Information Hub

If you would like to find out more about live-in homecare, www.stayinmyhome.co.uk is a valuable information resource developed by The Live-in Homecare Information Hub