Preparing for live-in care – what you need to know
If you are in the position of having to arrange care for an older relative who can no longer look after themselves, it can be an emotional and stressful time. You’ll want to ensure that they can continue to live independently for as long as possible rather than going into a home, which 97%1 of people say they don’t want to do. That may mean organising live-in care, where a carer lives in your relative’s home 24/7, and subsequently reorganising their home to empower the carer do the best job possible. Every situation is different, but here experts from The Live-in Homecare Information Hub, outline the most important factors to consider – and equipment that may be needed – when a carer comes to live with your relative.
What will I need on a daily basis?
If your relative is bedridden – then it will be preferable to have a hospital bed that has features for enhancing comfort, such as variable height for the bed, the ability to raise the head or feet using electronic buttons and adjustable side rails. It also means that carers don’t need to bend at a difficult angle and risk back injury. You are most likely to need a mattress to relieve and reduce pressure and prevent ulcers. Pillow or bed raisers can also be useful aids. If the person is totally bedridden they may need incontinence aids and a hoist to be able to move onto a commode. This equipment is mostly organised through an occupational therapist or district nurse via the local surgery and is supplied on the NHS, although in some circumstances families will purchase the bed.
If the older person requires walking aids or is prone to falls, there are many great mobility aids to help someone who struggles to move around easily. Zimmer frames or a tripod with wheels and brakes can also improve manoeuvrability considerably. A wheelie commode (concealed portable toilet) is advantageous to have so that movement in and out of a shower room is with ease. And a wheelchair can be used for distances when out and about. Stairs can be a major hazard and you could consider the advice of experts such as thyssenkrupp home solutions to see what might work in your parent’s home.
Some live-in care companies will support you in identifying your loved one’s needs or in supplying mobility aids or they may provide input for the occupational therapist assessment based on the knowledge they have of the client. It’s a good idea to make sure you check with the agency to find out how involved they usually get should this be something you require.
A stair lift will obviously make life a lot easier for the carer and client alike if the older person lives in a house and has frail mobility.
Getting in and out of an armchair or sofa can be problematic if someone is weak because this type of seating tends to be lower to the ground than an ordinary chair. Elephant feet, which raise the sofa to a more comfortable level, are beneficial in that case. Similarly, alarmed pressure mats can be used under a cushion so that the carer is alerted when the client is moving from the chair and provide assistance accordingly. This is valuable for preventing falls and given that a third of all people aged over 65 fall each year (equivalent to over 3 million2) and falls account for 10 – 25% of ambulance call-outs for people aged 65+ (at a cost of £115 per call-out to the NHS), anything that can reduce the incidence will mean a real cost saving in both human and financial terms3.
If the person is prone to falls then it’s important to make sure they take a walking aid when they get up from sitting. A lot of falls happen at night when people may be a little disoriented. A monitor or a bell (if they have the mental capacity) can be really handy.
You can also support a live-in carer by making sure there are no unsecured mats, rugs or any other trip hazards. Many people accumulate a lot of furniture over the years and it might not all be necessary, so it’s a good idea to make sure furniture doesn’t block common routes throughout the house. The same goes for clutter and loose wires.
People living with dementia will require a carer with a great deal of specialist knowledge and patience. Some people living with dementia can be prone to wandering. For peace of mind families often invest in an alarmed pressure mat to go under the front door mat, which will alert the carer that they are near the doorway.
If the dementia is severe then simple signs on the bathroom door such as “this is the toilet” help to retain a sense of dignity. In the kitchen similar signs such as “this is the biscuit tin” or “here are the mug”’ are also important.
A wipe-able white board or easy-to-read diary is an effective reminder as to what’s happening that week; for example if their friend is coming to visit or if there is an appointment to attend. Or they might have a daily calendar to tell them: “Today is Thursday and it’s going to be sunny”.
There are many potential hazards associated with bathing, especially when there is limited mobility or strength. With a hard-tiled floor and slippery surfaces, safety when bathing is paramount. If there is no shower then your occupational therapist may recommend a bath seat. Strategically placed grab rails, toilet frames and perch stools are great for support and semi-standing while washing too. A wet room with a seated shower is safer than a bath and enables the carer to assist with washing.
Many other aids are available to enable people to continue daily tasks for as long as possible, such as tools to make food preparation easier, jar or bottle openers, easy-to-use tin openers, kitchen items for blind or partially sighted users and pill dispensers.
What will the carer need?
Carers will needtheirown bedroom with a comfortable bed and bedside table. Pleasant surroundings really help because the carer will be happy to return and that supports consistency of care.
They’ll also need suitable areas to hang and store clothing.
It’s good if you can supply a TV and comfortable chair so the carer has a separate area to relax. They will be with your mother or father virtually all the time, so having some private space for their break is essential. This is also good if the live-in carer is looking after a couple as it allows them to have time together.
Internet access is also essential for carers to keep in touch with family, friends and their care company.
Unless your older relative lives near a really good bus route, it’s practical to provide a car, which is insured, for the carer to use. Very few carers have their own car and many will be working in rural locations.
How does the relationship work on a daily basis?
One of the many benefits of live-in care is the advantage of having someone around to alleviate loneliness, chat and share activities like gardening, music, pets, watching films or reading books.
Matching the right carer to each client is essential; all of The Live-in Homecare Information Hub members, for example, have their own thorough in-depth matching procedure to ensure both parties are sensitively paired and compatible. Alongside an individual’s medical needs, likes and dislikes, hobbies and personalities are also taken into account. Indeed many enduring friendships have been forged.
If there’s an accident or incident, the carer will tell the family and agency immediately. They also may monitor any trends, for example, to see if there are any specific reasons for repeat falls.
Carers keep regular report sheets on what they’ve done and to report potential risks/hazards, deterioration or improvements, changes to the care plan, untoward events, any fault with equipment the carer is using – particularly with regards to “manual handling”, or a visit by an outside professional or a friend – especially if it made them very happy. Also they need to be vigilant about scams or being duped.
Good carers will always ask close family members if they can do something different or special for the relative, but don’t be afraid to let them know, or to introduce them to the extended family.
Carers will also need to know the names of doctors, dentists, eye care professionals and favourite hairdresser.
Celia, who lives in Kent and arranged live-in homecare for her mother says: “All of the carers were wonderful, courteous and respectful. They really got to know my mother and her love of horses.” Each family is very different and the amount of contact required will differ; Celia used to call around three or four times per week and regularly read the daily diary that each carer kept. “The relationships formed were brilliant – one day when my daughter was visiting my mother, I arrived to see the carer taking my granddaughter to get fish and chips for the family, it was really special!”
The Live-in Homecare Information Hub is a non-profit coalition of the UK’s leading live-in care at home companies, all of whom are experts in this specialist field. For further information, please visit http://stayinmyhome.co.uk/home/
1 A nationally representative sample of 2,000 adults (aged 18-75) was surveyed by One Poll in July 2014 commissioned by Consultus Care and Nursing Ltd, a founder member of The Live-in Homecare Information Hub. 2 Epidemiology of falls. Masud T, Morris RO., Age and Ageing, 30-S4:3-7, 2001. 3 Fall prevention: New approaches to integrated falls prevention services. NHS Confederation, Briefing, April 2012 Issue 234.
If you found this article useful you may also like to take a look at our other articles on choosing the right care.
Why not sign up for our regular newsletter offering advice and tips on care, finance, health and quality of life for older friends and relatives? Just click the box below.