A 24-hour care team at home: how many people it takes, and what it costs

The first two shapes put one carer in the house at a time. Two carers alternating does not mean two people living with your relative. It means one at a time, with a handover day when they swap, and the weekly figure stays the same because you are paying for a week of care rather than for a head count. Live-in care rotas sets out the cycles families use.

The last two shapes are what people usually mean by a care team. Somebody is awake through the night, either alongside a live-in carer or on a rota where nobody lives in. They buy more cover, cost more, and put more people through the front door in a week. What complex care means explains how a need comes to be called complex, and complex care at home lists twelve of the tasks that bring families to this pillar. Where the hours have been growing month by month, staying ahead of motor neurone disease at home covers how a package reaches this point.

The legal part applies to carers who are employed. A worker employed as a domestic servant in a private household is taken out of some of those rules by regulation 19 of the Working Time Regulations, which removes the average 48-hour week and the night-work limits but leaves the daily rest, the weekly rest and the break in place. Carers you find through PrimeCarers are self-employed, so the regulations do not govern them as employees. What governs them is the agreement you make, under which the carer manages their own rest periods and agrees suitable times with you.

The human part is the same whoever employs whom. Somebody woken three times a night cannot give good care the next day, and somebody on duty seven days a week for a month stops noticing changes in the person they are caring for, which in complex care is most of the job. The daily break is where this shows up first. If nobody has agreed who is in the house for those two hours, the break either does not happen or your relative is left alone. The live-in carer's daily break goes through the ways families cover it, and what live-in carers are entitled to sets out the rest of the week.

Where your relative cannot be left for two hours, the break needs a named person: a family member at the same time each day, a second carer booked by the hour, or a day service. Settle it before the first week starts.

The national guiding principles for delegated healthcare activities, published by Skills for Care with the Department of Health and Social Care and updated in November 2024, set out four things that have to be true: the person consents and understands why, accountability is clear, the care worker has the learning and support to carry out the activity safely, and the delegating professional keeps monitoring and reviewing it. They are on the Skills for Care delegated healthcare activities pages, and delegated healthcare tasks goes through a single sign-off step by step.

Two things follow. Keep the rota as small as the cover allows, because each extra person is another assessment and another set of habits in the house. And start the conversation with the community nursing team before discharge, naming the carers if you have them. If part of the day needs a registered nurse rather than a trained carer, nurse-led or carer-led complex care sets out where that line falls.

A handover is a conversation with the folder open rather than a text message. When a live-in pair swaps, a day when both carers are there is worth paying for, because the carer leaving can show the carer arriving how the hoist is set and what has changed in three weeks. Where a night carer arrives each evening, fifteen minutes with the day's record is enough, as long as it happens every night.

Be at the first few handovers, because you are the only person who sees the whole week. After that the value is in the folder rather than in your attendance. Writing a care plan with your carer covers the household part.

Nobody on that list appears automatically. A managed agency covers a shift by sending one of its own employees, which is part of what the higher rate pays for, and a family arranging care directly holds that risk themselves. That is the reason to build a second trained carer into the rota from the start. When your carer is ill or on holiday goes through the first morning in order, and how many carers a rota needs has the arithmetic for a rota that is not round the clock.

For a complex package running twenty-four hours a day, some families use a managed provider rather than arranging it themselves, and that is a reasonable decision rather than a failure of nerve. The four ways to arrange care, compared sets an introductory agency, a managed agency, a franchise and a platform against the same eight questions, including who covers a dropped shift. Our managed service sets out what the two levels add.

Whichever route you take, clinical oversight sits with the nursing team. No agency and no platform can delegate a healthcare task or sign a carer off.

Read the table from the bottom up and the arithmetic is uncomfortable. One live-in carer with complex experience costs about the same across a year as a nursing home place, sometimes less. Add a waking night carer for seven nights and you are paying roughly £2,376 a week against about £1,410. A shift rota costs close to twice a nursing home place, and the nursing home has a registered nurse on site around the clock without anybody in your family holding a rota.

Families choose home anyway, for reasons the arithmetic does not hold. Your relative stays in their own bed, with the same one or two faces instead of a building's worth of staff on rotation. A husband or wife stays in the same house rather than visiting. Somebody with advanced dementia keeps the surroundings that still make sense to them. Those reasons are allowed to outweigh a spreadsheet, as long as you have seen the spreadsheet first. Care at home or a care home compares the two properly, and live-in care against a nursing home takes the nursing comparison on its own.

1. 1

   Get the tasks in writing from the ward

   This week

   Ask for the care plan, the healthcare tasks, how often each happens, and which the nursing team thinks could be delegated to a trained carer. Ask who the community team will be once your relative is home, and get a name.
2. 2

   Decide the shape from the nights

   This week

   Use the week of night notes and the four shapes above. If somebody has to be awake, say so now, because a live-in carer and a night carer are two separate searches. With no spare room, a shift rota is the shape you are working with.
3. 3

   Look for one more carer than the week needs

   Two to three weeks out

   Search live-in or overnight carers near the house and speak to more than you need. The rate, the availability and the reviews are on the profile. Experience and training are the carer’s own account, so ask about it and ask the nursing team to assess it.
4. 4

   Agree the rota, the break and the dates in writing

   Before the first shift

   Who is on which weeks, when the daily break falls and who covers it, when each carer plans to take time off, and what happens if somebody is ill.
5. 5

   Book the sign-offs before discharge

   Before the first shift

   Give the community nursing team the carers’ names and ask for training and competency assessments for all of them, not only the first. This is the step that delays a discharge, so it is the one to chase.
6. 6

   Put the folder in the house before anybody starts

   Day one

   The care plan, the delegation records, the medication chart, the numbers and the daily record, in one place. Show it to every carer on their first shift.

The sign-offs are the slow part, because they depend on a community nursing team fitting your relative in, so start them before the discharge date is set. If the date is already set and nothing is in place, what to arrange before discharge day is the shorter list to work through first.