There are a number of reasons you may be looking to arrange help at home for the person you care for. Your friend or relative may be returning home from hospital and may need some temporary support whilst they recuperate, or you may need some additional support to fully meet their needs as their carer, due to a progression in your cared for person’s long-term condition or disability, and their care needs having increased and become more difficult to manage.
Some people also find that receiving or providing personal care for a a friend or relative, such as helping with washing, dressing or toileting, is outside of their comfort zone, and so consider arranging help at home for the person they care for.
Help at home is also often described as home help, homecare, domiciliary care, or community care. Help at home can be tailored to meet your cared for person’s needs, ranging from as little as an hour of support a week to having a significant care package or live-in care, where a care worker will stay with you at home to provide support throughout the day and night.
Help at home can sometimes make the crucial difference in enabling the person you care for to keep living in their own home, rather than having to move into supported accommodation or a care home. It can also be the difference in enabling you to have regular short breaks away from your caring role supporting you to stay well.
Before looking at arranging help at home for the person you care for it is important to understand the type of care which may be needed to fulfil your cared for person’s needs, how they are going to get it and how this will be funded. This can be determined through assessments with your local authority responsible for social care services or NHS services responsible for community health and hospital care.
It may be that you or those close to you might notice changes in your ability to manage the day-to-day things you normally cope with easily, like preparing meals or looking after yourself. If this happens, contacting social care is a good first step towards finding the help you and the person you care for need.
If the person you care for is admitted to hospital and it is likely that care will be needed following their return home, either a ‘Care Needs Assessment’ or a ‘Continuing Healthcare Assessment’ will be offered prior to their discharge. Any assessments needed prior to discharge will be discussed during the discharge planning process and sometimes happen prior to the patient being ‘medically fit.’ This can cause worry for carers and family members, but it is important to understand that hospital teams do this to gain a true understanding of your friend or relative's needs.
The person you care for will be expected to be fully involved in looking at what will suit them best and what can also support you as their carer. Carers and family members will also be encouraged to be involved to provide further insight into the cared for’s needs and any support already being provided.
There are several types of assessments to determine what care or support may be needed. Visit our page on 'Assessments for care and support' to find out more about the types of care assessments that can be requested where there is a need for care and support to manage daily living needs.
It can sometimes be tough to know whether you are making the right choice for your friend or relative when deciding to choose to help at home rather than an alternative option such as supported accommodation or a care home.
Here we cover some of the benefits of help at home to help you to decide whether it is the best option for the person you care for.
One of the benefits of help at home is that it can be a much cheaper option than moving into supported accommodation or residential care. Care at home can also be very flexible. You can often quite easily increase or decrease the amount of care as your friend or relative’s needs change, without having to make the long-term commitment that moving them somewhere new can entail.
On top of this, many people would rather have the chance to stay in their own home for as long as possible. Help at home could enable your friend or relative to stay in a place they know and love, for longer, with all their home comforts and with more independence than they may have with other types of care. It is also likely to be much less disruptive and upsetting for them, compared to the significant upheaval of having to move.
You may think that your friend or relative’s needs are too high for help at home, but it is still worth looking into even if you feel it is not an option. It may be that with some home adaptations and the provision of more involved care, for instance a live-in carer; that they can stay in their own home for a while longer. Other services such as companionship care and daycentre support can also help to complement care packages being delivered at home.
It is good to remember, however, that everyone has their own individual wants and needs that should be considered. When supporting someone to make a decision or making a decision in someone’s best interests, speak to the person you care for about what they would like to happen, if possible. Don’t assume you know what they would like, and make sure they are as involved as much as they possibly can be as they may surprise you.
After speaking to your friend or relative, you may decide together that help at home is not quite the right option for them. If so, take a look at our guide ‘Future care planning’ for general advice about planning the next steps for their care.
There are several different types of help at home that could provide you with the support you need.
External Cleaning, Gardening, and DIY services
If you know that you are not able to balance caring with cleaning, gardening, and DIY, you could consider hiring in external help. It is likely to be cheaper to pay for a cleaner, gardener or handyperson, which costs around £10 - £15 per hour, than for a paid carer, generally costing around £20 per hour.
Companionship Services
Some charities and care agencies provide companionship care which in addition to providing companionship; provide a range of other home help support, such as cleaning, laundry, gardening, shopping, collecting prescriptions or meals delivery services. You could try contacting your local branches of the Royal Voluntary Service, the British Red Cross and Age UK, to see if this is something they offer, and what charges their services might entail. Please be aware that if any personal care is needed, then there may be further costs added.
Home Care
You may prefer to hire a professional carer(s) to help with the day-to-day care your friend or family member needs. You might even be surprised with the many different tasks a carer can help with. They can assist your friend or relative with getting in and out of bed, to and from the toilet and up and down stairs. They can support with personal care such as washing, dressing as well as assisting with combing their hair, brushing their teeth, cutting their nails, applying creams and lotions, putting on make-up or shaving. They can prepare nutritionally balanced meals and provide support with eating and drinking, reminding to take their medication, collecting shopping and prescriptions, and looking after family pets. A paid carer can even take the person you care for out and about to local amenities and events including day centres or social clubs. Often, one of the most valuable roles a companion can fulfil is just being there to listen and to chat to your friend or relative, play a board game or sitting down together to do a crossword. On top of all this, paid carers can also do some of the cleaning, laundry, gardening and handyperson jobs that you may have been considering hiring others to help with. It is important to discuss the full extent of the care required prior to confirming your commitment to a carer or care agency as this can be difficult to rectify later if your requirements are unable to be fulfilled.
It may be that your local social care authority will be able to support with arranging and financing help at home, but this will depend on a number of factors including what your friend or relative’s care needs are and their financial circumstances.
Social Care in England can help provide a range of services to support people, such as care in your own home, access to living aids and home adaptations to help you remain independent or care in a residential care home. Social care services are different to healthcare services – whilst healthcare is provided free-of-charge by the NHS, social care is provided by local authorities, who can charge for their services. Whether you qualify for this support depends on your level of need. If you do qualify for support, your local authority will then assess your financial circumstances to identify who will fund the cost of the care. A financial assessment can be completed to determine whether Social Care will fund some or all of the care. Some support, such as living aids and minor home adaptations, is available free of charge for those who have eligible care needs.
People with over £23,250 in capital – both savings and investment – will have to pay the full cost of the residential and nursing care home. This sum is known as the capital limit. The capital limit is decided by Government.
If you would like to access support from the local authority, then the best place to start is to request a ‘care needs assessment.’ This will allow Social Care to assess exactly what care is needed and whether they are eligible for support. Take a look at our guides ‘Getting local council funding for care costs’ and ‘Needs assessments’ for further information.
Following this assessment, if it is decided that your friend or relative can have their needs met by help at home, and that they are eligible for financial support, the local authority will provide them with a care plan in writing. This sets out what they have identified as your friend or relative’s needs, how these will be met and how much funding they have allocated to cover these needs, which is known as their ‘personal budget.’ Once this is in place, if you like, you can choose for the local council to manage this budget on their behalf and make all of the arrangements for your friend or relative’s help at home for them. Alternatively, you can opt to receive what is known as ‘direct payments,’ where you or your friend or relative receive the funding and make all of the arrangements yourselves. For more details about these options, including the pros and cons of both, take a look at our guide ‘Personal budgets and direct payments’. If you do choose to arrange your own help at home, take a look at the section below for further advice.
Even if you do not think it likely that the local council will provide any funding, it is still a good idea to have a needs assessment conducted by them all the same. It can provide a really helpful guide to exactly what care your friend or relative should have to meet their needs. Plus, the local authority will also provide you with free advice about what other support is available for you to access. A needs assessment is free, and your friend or relative is eligible for it whatever their financial situation, so you have nothing to lose.
If your friend or relative is not eligible for financial support from the council, or they are but you have opted to choose direct payments, you will need make your own arrangements for their help at home.
There are two different options for arranging carers to help your friend or relative in their own home:
- Employing your own help at home.
- Arranging help at home through an agency.
There are a number of pros and cons to both options, so it is important to take some time to think through which would work best for you and the person you care for. Below we discuss some of the benefits and costs of each, as well as how to go about making the arrangements.
One of the benefits of employing your own help at home is that it allows you much greater choice and control in who is looking after your friend or relative, meaning you can pick one or two particular people that they are more likely to get on with and trust. You could pick someone who has a similar background to them, someone with experience working with others with the same needs or someone who has come through a personal recommendation.
Employing your own help at home also gives you full control over exactly what you would like their role to include, depending on what your friend or relative needs or wants. This could potentially include a much wider range of activities than an agency carer may be able to take on.
One downside, however, is that if you only have one person hired to help, when they are unwell, want to take holiday or need to take some emergency leave, your friend or relative will not have anyone to care for them, potentially at the last minute. If this happened with an agency carer, the agency would be responsible for finding cover, but in the case of employing your own carer, it would be up to you to find someone to step in and help.
You should also bear in mind that if you do decide to hire your own carer, you could technically become an employer. It is important to determine whether the arrangement you are making means that you are their direct employer or whether they count as self-employed. This is not something you can choose; it depends on the circumstances under which you work with the carer, and they work with you. Use the service provided by the GOV.UK website to determine whether your circumstances mean the carer you are hiring is likely to be counted as self-employed or employed.
If you are their employer, this brings with it a wide range of legal responsibilities. You may need to arrange employer’s liability insurance, Pay As You Earn (PAYE) tax, National Insurance and pension contributions as well as carrying out all the right background checks including ensuring they are legally entitled to work in the UK. You must also be aware of a number of other key areas of employment law such as National Minimum Wage and National Living Wage requirements, Statutory Sick Leave and Statutory Sick Pay, working time directive rules, holiday entitlement and equality legislation protecting against discrimination. You also need to register with HMRC as an employer. Your local authority should have a system in place to support you with all of this and using a third party such as a Payroll and Payment service who understand the nature of your personal budget contract and who can take the pressures of this away from you.
Furthermore, if you use an agency, they will be inspected regularly by the Care Quality Commission (CQC) and have their own staff training and vetting policies and procedures in place so you can feel confident that your friend or relative will receive a reasonable level of care. Care arranged privately, however, is not subject to any inspections or checks by the CQC. If you are employing a private individual, it will be up to you to assess whether they have the right level of training (for example, RQF Adult Care qualifications) and undertake any background checks that you feel necessary to protect your friend or relative, in particular a Disclosure and Barring Service (DBS) check.
In addition, if you have any problems with the care being provided, you do not have the backup of being able to use the agency’s complaints procedure; you will have to deal with the issues yourself through disciplinary procedures, including potentially having to fire someone if they are not doing the job satisfactorily. You will need to be aware of the legal requirements around notice periods and dismissal before beginning any of these procedures; Acas can provide further information.
If you do decide to hire your own help at home, you can find a private carer in a number of ways. One option is to ask friends or relatives for recommendations of people they have used themselves. You could also advertise the position locally, for instance in a newspaper, an online community group such as on Facebook or Nextdoor, a classified ads website such as Gumtree, a supermarket jobs board, or a local shop window. You could also advertise the role for free through your local Jobcentre Plus or using a nearby college or university employment service. When advertising the position, it can help to know that these roles are sometimes known as ‘self-employed carers,’ ‘personal assistants’ or ‘personal care assistants,’ so that you are using the terminology that people looking for these jobs are also searching for.
Another option is to use what is known as an ‘introductory agency.’ They specialise in matching people who need support with carers who are suitable for their needs. Using an introductory agency also means you have the added benefit of them carrying out some of the background recruitment checks and training for you. It is worth bearing in mind that it will still be you who employs the carer though, meaning you will be responsible for everything else related to their employment after the initial stages.
If you find the carer yourself, it is a good idea to interview them before hiring them. Even if this means just meeting them informally, it can make a significant difference to ensuring you have found someone you are happy with and trust to care for your friend or relative. You may be surprised how different people can be in person to how they seem on paper, so it can be worth arranging interviews for at least two or three candidates so that you have some options available if your preferred one doesn’t end up working out.
Once you have decided on someone you would like to hire, then it is wise to request references, ideally in writing, from two previous employers. That way you can be sure that the people they have worked for before were pleased with them. Once you are happy with their references, you should provide them with a basic job description covering exactly what you would like them to do, and an employment contract. The GOV.UK website tells you everything you need to cover in this contract.
If you decide you would like to hire help at home but without becoming an employer, you can use a care agency instead. Although this will be much simpler in many ways, it will likely be more expensive and mean that you will have very little say in who cares for your friend or relative. It is also unlikely that they will have the same carer visiting all the time, so it will be difficult for your friend or relative to have consistency, though the agency will try hard to ensure that the person attending to them is always suitable for their needs.
The best place to start with arranging this type of help is to contact the Homecare Association, formerly known as the UKHCA. They can provide details of help at home providers operating in your area that follow their code of practice, meaning you can feel reassured about the quality of care offered. Another option is to search on the NHS website for ‘Home care’ providers. Alternatively, you could contact your local adult social services department at the council who will be able to provide you with details of all care agencies operating in the area with free advice about what to do next. You may also want to ask friends or relatives who you know have used private care agencies themselves to see whether they have any that they particularly recommend or would advise against using.
It is wise to do your own research into any agencies you are interested in. All private care agencies must be registered with the Care Quality Commission (CQC), so it worth taking a look at their recent inspection reports to make sure they are of the quality you would like for your friend or relative.
It is also a good idea to try and meet with a few care agencies in person where possible. This will give you the opportunity to talk to some of the staff and see whether it feels like the right fit for your friend or family member. This can really help you to decide you feel happy with. When you meet them, it is a good idea to bring along a list of questions you’ve prepared in advance to make sure you cover everything you want to know about. You may also have other questions that occur to you when you are there too. Bring a pen and paper so you can make a note of the answers, as it can be easy to forget the details afterwards, especially if you visit a number of places. Some important things to ask about could include the level of training that their carers have and what experience they have caring for people with needs like those of the person you care for. You may also want to ask how they will select potential carers. Don’t forget to also find out a breakdown of their costs, as these can vary considerably between providers. It is also important to clarify in advance whether their fees include VAT and travel time and any other extras, or whether these will be added on top later. You may also want to ask how you will be charged; most providers will send you a monthly bill.
Online Help and Advice
Visit our online support section where we have provided advice and guidance on a range of relevant topics to help you in your caring role.