Let’s say you’re starting to think about home care for your mother-in-law after she wrote off her car recently. You knew she had been declining, but that was your wake-up call that she needed more help. This is a common scenario; many families realise their loved one needs in-home care, but it can be confusing about what options are available and how to pay for their care.
As soon as you start thinking about getting help, you should gather your family members together and write down all the tasks you believe your elderly relative needs assistance with before you start your search, so you can find the right fit. It’s also a great idea to get an independent evaluation from a social worker. They can pick up on cognitive or physical decline that the family members may not notice and can guide you through the different levels of care.
Home-care agencies can send someone to do an in-home evaluation of your loved one’s personal situation. They might recommend having an aide two afternoons a week to help with driving and shopping, and to provide conversation and companionship, for instance. Many people prefer to stay at home as a long as possible, so having in-home care is a great alternative to the likes of nursing homes.
Not to mention, hiring through an agency has many advantages. They will do all the background vetting of the candidate for you, make sure the worker is licensed (if necessary) and trained, and will handle tax filing and other paperwork. Hiring an aide directly is also a good option, particularly for non-medical help. That way you can find someone who can grow with your family member’s needs. The aide may start as a companion, and then take some training course as the needs expand, so you can have continuity of care.
Here are your options for home care—from the least intensive to the most skilled levels of in-home care. Keep in mind that training and licensing requirements, as well as costs, may vary.
Non-medical care
Companion care
What they do: Companion caregivers provide friendship, conversation and mental stimulation for their ageing clients. This can literally be a lifesaver for elderly people who live on their own. Loneliness in the elderly is a major underlying cause of poor health and even death. Human interaction and socialising is incredibly important, especially if family members don’t live nearby. The companion may also help with shopping, driving, light housework, watering plants and cooking, but will not do any hands-on care or grooming.
Training: No special schooling or licensing is required, though some companion-care agencies may have their own training programme. Agencies have a lot of really good workers who are often actors, artists or writers, and who are used to working their schedule around the needs of the client—but most importantly, they enjoy working with older adults. You could also find a university student, a neighbour, a member of your loved one’s religious community or a local community group who is a good fit for the job.
Cost: According to uk.talent.com, the national average wage in 2023 for companion care in the UK is £13.80 per hour (295 salaries reported).
Home health aide
What they do: A step up from simply being a companion, a home health aide also assists with the activities of daily living, including dressing, bathing/showering, feeding and going to the toilet. While a home health aide can help remind the client to take their medication—putting all the pills out with breakfast, for example—they usually do not have formal medical training and cannot administer mediation. Home health aides may work part- or full-time or can live with a patient who requires around-the-clock care.
Training: If you hire an aide through an agency, they will likely have been trained in a certificate programme. If you hire home care privately, you can ask for proof of training and the Care Certificate. A home health aide who comes through an agency will have a stricter schedule and a plan-of-care, which lays out all of the duties and activities throughout the day.
Cost: According to uk.indeed.com, the average rate for a home health aide in 2022 is £28.21 per hour (10 salaries reported).
Medical care
Registered nurse
What they do: There are very few instances when a family needs a registered nurse in the home. In fact, skilled nursing is usually only necessary after the patient has been discharged from hospital and is recovering from an illness or injury. In this case, the doctor will have determined that the patient is stable enough to go home but requires care for very specific medical tasks, such as wound care, tracheotomy, PICC lines, IV medications or infusions or colostomy care.
Skilled nursing care is ordered by a doctor, with a plan of care and with specific goals, usually for a 60-day time frame. Unless the patient needs constant infusions, for example, the nurse will usually visit for a few hours at a time, a few days a week. It is important to note that the nurse does not replace a companion or home aide, but will work with the aide (or family caregiver) on a plan of how to best care for the patient when the nurse isn’t there. Skilled nurses do not provide services such as housekeeping, food preparation or shopping, though they may help bathe and dress patients and assist with other activities of daily life.
Training: Most skilled nurses are registered nurses, which requires a degree in nursing and registration with the Nursing and Midwifery Council (NMC).
Cost: According to uk.indeed.com, a home care nurse in the UK costs £16.76 an hour on average. It’s worth checking if you are eligible for NHS continuing healthcare.
Hospice care
What they do: Hospice care, also known as palliative care or end-of-life care, is specifically for patients who are terminally ill. To qualify for hospice care, you will usually have to provide a referral from your doctor or nurse. Once a patient is under hospice care, they agree to forego curative, or life-saving, therapies, and the focus shifts to making the patient as comfortable as possible in their final days. Hospice care covers medical and nursing care, such as managing pain and other symptoms. Some hospice care providers may also offer additional services, such as massage, respite care, or spiritual and psychological help.
Training: Hospice nurses, also known as palliative care nurses, are registered nurses with NMC registration.
Cost: If you are eligible for NHS continuing healthcare, your hospice care is fully funded by the NHS.