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Home care is a necessary evil, with the emphasis on evil.

POLITICIANS seem to think that older people are all desperate to get free home care, courtesy of the tax payer. But most would rather stick pins in their eyes than allow domiciliary carers over the doorstep. And who can blame them?


Who wants some complete stranger breezing into their home for 15 minutes, becoming very intimate with them, creating an awful mess and then leaving? I can think of a few men, actually, but that is another story.

  Given the constant stream of stories about  abusive and lazy domiciliary carers - and the in-built time shortage most have - it is hardly any wonder that many older people are unhappy at the very idea of the euphemistically-named home care.


Home care staff may only have time to rush in and out before they are onto their next job.

Home care companies can charge as much as £25 for half an hour, while the carer will receive a fraction of that. It is not surprising, therefore, most older people will only allow this to happen when they have no choice – even if they are in dire need. 


Home care can make a real difference to an older person’s life. 

Once carers have been appointed, people can often wonder how they managed

without them.  From struggling to get washed and dressed and put food on the table,

a person’s life can be transformed by home care.

The trick is to make sure you get the care you want and that you pay for


Finding decent home care is a real challenge

Certainly up there with finding a good care home or the Holy Grail.

We hope it exists, it certainly did at some point, but it hasn’t been seen for millennia.

Most older people only come into contact

with the care industry after a crisis

Perhaps a hospital stay or a collapse in health?

At this point they will be vulnerable and find themselves getting a poor quality care provider or putting up with slap dash care. An older person might not feel able to complain or to point out

any problems.

It is annoying because, home care can be a lifeline for an older person.

Care Agencies - the reality.


Care at home is big business. 

Private agencies dominate the field. 

Agencies employ dozens of ‘carers’ who may visit 20 homes a day

and do not have time, or sometimes the inclination, to give a decent service.

The carers may not have any experience, qualifications or aptitude.

Many are only doing it because they cannot get anything else

or because the hours fit in with their family.

Firms get paid by the minute and so time is money

– their money that is.

Agencies can charge £25 or more for half an hour

– more at weekends and public holidays.

The carers may receive just £5 an hour in real terms.

An older person may see a different carer

every morning and evening and yet never ‘speak’ to anyone. 

The half hour visit may actually be just seven minutes.

A carer may dash in, rush them off to bed and dash out again

because they have to get on to the next person. 

Finding a Care Agency.


  1. Research your local area, if you are thinking about getting carers in to help an older relative for the long term. 

  2. Ask at your local carers’ group or day centre.  Be careful, people will recommend an agency, even when they are not particularly happy with

  3. Interview local agencies individually. You cannot tell much from websites. It is time consuming and awkward. But if you set it up well to begin with then it can save an awful lot of time later, checking and complaining about standards of service.

Services Provided by Carers.

  • Washing,/bathing,

  • Dressing,

  • Meal preparation,



  If you pay they can also help with

  • Shopping,

  • Housework.


If an older person is struggling with these basics of everyday life, then it is time to get help.

You may be in touch with social services who will recommend that home care is needed.

Social services can become involved following a doctor’s recommendation

or you can request that they attend. See here for information on funding.

Personal Assistants.


You can employ a carer, or personal assistant, directly.

This guarantees continuity of care.

But you effectively become an employer and have to pay tax and NI contributions,

perhaps pension contributions, and give holiday pay etc.

This may not sound appealing. It is an area, though, which is ripe for development.


In future, we will think beyond the stark alternatives of home care or going into a residential home. 

  • Perhaps ‘Granny Minding’ services, along the lines of baby minders, may emerge?

  • Maybe ‘Granny share’ arrangements, along the lines of nanny sharing could split the cost of a full time carer between families.

  • Obviously, there would be issues to do with both safeguarding and locations, but we need to think beyond the current options, if families are to be able to cope both financially and socially.


Live-in Care

As described on the housing overview page here,

this is becoming an increasingly popular type of care – both for older people and the carers.

Stories abound of ex-pats coming over for six weeks every few months

to stay with an older person and then being able to fund their lifestyle on the Costas.

And for the older person, they get a single person, main carer and helper.

This can allow them to stay at home, even if they are living alone,

and means they receive individual care. 

When the carer takes a break, agencies can send a stand-in

or sometimes relatives can take over, if the person cannot be left at all.

That's the theory anyway. It may be necessary, though, to suck it and see. 

While this may appear costly, live-in care can be less expensive or no more expensive than a care home and more appealing to families because it offers their relative a continued normal existence. Some agencies sort out the carer’s tax and national insurance on behalf of the client and this means that they are more expensive than others, which simply introduce you to a carer. But it removes any hassle for the family.


  • Charges for such live-in care in southern England can be £1,000+ per week, depending on needs. Costs are less elsewhere.

        It sounds a lot but when you think about the cost of residential homes, live-in care can offer a real alternative.

  • There are more than 70 live-in agencies throughout the country, many operate on a local basis others are nationwide. You obviously will want to take a close interest in any live-in carer’s background but reputable agencies will carry out rigorous tests and will be happy to explain these.





Interviewing a home care agency is little different to interviewing a care home manager and you need to ask many of the same questions.

In fact, because they will be sending people into an older person’s home and caring for them out of sight, this IS even more important.

Check the CQC website here, the regulator also inspects agencies. And run any agency through Google. Unhappy customers take to the internet to vent fury and there are always stories about pilfering carers, whose agencies you will want to avoid.

Once you have established that they are not the 'notorious' local agency, you need to meet the agency owner or manager. They probably won’t want to meet you and may appear shifty, but that’s the industry.  You need to be able to gauge, if these people are going to run a tight ship and have a positive work ethic. Anyone who acts as though they are doing you a favour, avoid.



Key questions for Home Care Agencies:

  • What qualifications or experience do your carers have? There are recognised care qualifications – not that these are necessarily hallmarks of good practice.  Most agencies will say their staff are very experienced and well qualified. Ask how many carers they have and about staff turnover. If staff are under too much pressure, they will not stick around for long and are unlikely to offer a good service.

  • How many carers will my relative see? If an agency burbles about time pressure and fitting people in, or even claims that it is good to see a range of people, then don’t consider them. An agency will not appoint only one carer. But you would want to see the same few carers over a week. If you see more, things get slap dash. Ask if you can request particular carers, if your relative gets on well with someone.

  • What time will the carers come? If they say they cannot give a time or they will try to come between 8 and 10, strike them from the list. It is only reasonable to be able to ask that they come within a given time period. Everyone wants the same times, they will say. But it can be very distressing if an older person is left waiting until 11am to get out of bed or hasn’t had lunch by 3pm. So stick to your guns and insist on particular time periods.

  • What will be covered by the carers? Will they just help an older person to get dressed and then leave them to try to change the bed on their own? Will they keep an eye on the client’s health?  Some untrained carers seem not to know what to do if an older person is ill. In there is an emergency, will they wait until an ambulance comes? Can you provide a check list of all the things that you want done. If the agency won’t accept one, why not?

  • How are the carers supervised?  Does the agency check to make sure clients are satisfied and carers are doing their job well? Or do they leave it to the clients to complain? You want to be confident that they will be doing their job without you having constantly to check on them.

  • If you are not satisfied, how do you complain and what does the agency do?  You don’t want to start off on the wrong foot but you need to know that someone will listen if you have a problem and that you don't just get given a number to call...and call.

It is in everyone’s interests, even the agency’s, for the care package to work - although they won't act like it. So it is advisable to get all the awkwardness over at the beginning. And, if you are not satisfied, then step in quickly.


Do not allow poor care to pass without comment. If you don’t say anything, you will become the client who puts up with anything and things will only get worse.

Behind closed doors, out of sight, such abuses are all too common

– worse can and does happen.

Man in wheelchair
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