Hourly care for someone who lives alone

The reason to think in layers rather than in solutions is that no single layer covers a whole day. A pendant alarm covers every hour of the day, but it does nothing until it is pressed. A carer can do almost anything, but is only in the house for an hour. A daughter forty miles away can do a great deal, though not at seven in the morning. Put the layers together and the gaps between them become small, and if you rely on only one of them the gap is as big as the other three.

The layers also have very different prices, which is worth knowing before you spend. Making the house safer is the cheapest thing on the list and it never stops working: rails, lights, clear floors and a key safe cost a few hundred pounds once. Technology is next, at a few pounds a week. Carer visits are the expensive layer, and the only one that gives help rather than summoning it, which is why the sensible order is to do the cheap layers first and then buy exactly the hours you still need.

There is a pattern running through all six. None of them is an emergency on the day it starts. Each of them is a small change that becomes serious over weeks, and each of them is visible to somebody who sees the person regularly and is not related to them. Family miss these things for two reasons: they visit at the same time and see the same performance, and they are looking at their mother rather than at a situation.

If several of these are already true, read how many visits a week does my parent need next. It builds the week from the tasks rather than from the worry, and it will tell you whether one visit a day is enough.

Very little of that hour is what most people picture when they hear the word care. There is no personal care in it at all. A check-in visit suits the very common situation where somebody is managing perfectly well on their own but nobody would know for a day and a half if they stopped. It is also the visit families are most likely to be told they do not need yet, usually by the person who lives alone.

Which time of day you choose matters more than the number of visits. Mornings suit anyone who struggles to get going, and they catch a bad night early. Middays suit anyone whose problem is eating, which is most people living alone. Evenings suit anyone who is frightened after dark, or who leaves doors unlocked, or who has stopped bothering with tea. If you can only afford one visit a day, put it where the risk is rather than where it is convenient for you to picture.

Seven days a week is worth arguing for over five. Weekends are when family assume somebody else is visiting, when the GP surgery is shut and when a small problem has two days to become a big one. It is also the loneliest stretch of the week for a person on their own. If money is tight, a shorter visit every day beats a long one on weekdays only.

Welfare calls are worth more than people expect, as long as everyone is clear about what they are. A daily call at an agreed time gives the person something in the diary, gives the family a fixed check, and picks up the obvious things: a chest infection you can hear, confusion you can hear, a person who does not answer. What a call cannot do is see anything. Somebody can sound perfectly well on the phone while standing in a freezing kitchen with an empty fridge, and older people are practised at sounding fine to their children.

The other thing to be careful of is the call that replaces the visit. If your daily phone call has become the only human contact in the day, there is not much of a safety net left. That is the point at which one hour a day from a carer changes the whole week, and it costs £140 at the typical rate. Sitting services and companionship care both cover the longer, less task-driven version of the same visit.

Two guides on this site go further: home technology for the elderly covers the whole market, and using Alexa to make everyone's life easier is the practical setup guide for the one piece of kit most families end up glad they bought. If you want the argument about where technology does reduce the number of visits you need, how technology can reduce your need for private carers makes it properly.

None of this works with a different carer every day. Somebody new sees a frail old lady in a cardigan and has nothing to compare it with, while the carer who was there on Monday notices that it is the same cardigan. That is why the same carer every visit is the thing worth insisting on, and it is the main practical difference between choosing your own carer and taking whoever a rota sends.

Ask your carer to keep short daily notes and to send you anything that changed. Six weeks of notes turns a vague worry into something a GP can act on, and it is the strongest evidence you can take into a care needs assessment.

1. 1

   Fit a key safe and get the alarm worn

   This week, under £100

   Do this before anything else. It costs very little, it takes an afternoon, and it is what makes every later layer work. Give the code to the carer, one neighbour and one family member.
2. 2

   Pick the one hour of the day you worry about

   Free

   Mornings if getting up is the struggle, midday if it is meals, evenings if it is locking up and the long night. Book one visit a day at that time, seven days a week, and give it a purpose you could write on a card.
3. 3

   Choose one carer and meet them

   This week

   Search by postcode, look at two or three profiles, and talk on the phone before you book. Every carer on PrimeCarers has interviewed online, and their identity, right to work and enhanced DBS are checked before they appear, and they are insured while they work. Ask them what they would want to check on a first visit; a good carer will have an answer.
4. 4

   Review after a fortnight, then add

   Week 3

   The carer will tell you what the visit missed. That is when families add the evening call, the shopping visit or the two-hour companionship visit. If the answer turns out to be the night, look at overnight care rather than more daytime hours.

There is one warning about pace. The most common mistake is arranging everything at once after a fall, in a fortnight when everybody is frightened, and finding a month later that half of it was not needed and your relative resents all of it. The second most common is waiting for a crisis to force the decision. Somewhere between the two is a single visit a day, arranged calmly, at £126 to £175 a week, that can grow when it needs to. Getting someone to accept care is the guide for the conversation itself, which is usually the hardest part.