The short answer
- The weeks after discharge need the most coverA ward sends somebody home when they are medically ready to be there, not when they can manage alone. That gap is at its widest in the first weeks.
- One carer holds the routine between therapy visitsNICE sets stroke rehabilitation at three hours a day or more, on at least five days a week. That leaves 153 hours of the week at home.
- Communication may be the hardest part to live withStroke is the most common cause of aphasia, which makes speaking, reading, writing and understanding others difficult. It is not a change in intelligence.
- Set a review date before you set a start dateRecovery after a stroke is uneven, and an arrangement made for the first fortnight can run for months unless somebody puts a date in the diary.
Figures here are what carers on PrimeCarers charge for a live-in week, £1,050 to £1,400, with our fee included. The carer sets their own rate.
The first weeks
Why the weeks straight after discharge take the most cover
A stroke unit discharges somebody when they are medically ready to be at home, which is not the same as being able to manage there. The distance between the two is what the household holds, and six things account for most of it.
Getting about the house
Transfers and stairs
Meals at the texture that was agreed
Swallowing
Medication on time, every day
Preventing another stroke
Tiredness that is not ordinary tiredness
Pacing the day
Low mood and the adjustment to it
Mood
The nights
Getting up in the dark
The condition itself is covered elsewhere here. Read stroke recovery care at home for the recovery phases and preventing a second stroke, and hospital discharge explained for the pathways a ward can send somebody home on. If the council or the NHS offers reablement, that is free short-term help to regain independence, usually for a maximum of six weeks according to the NHS, and it can run alongside a live-in carer.
Between therapy visits
What one carer carries between the therapy visits
NICE sets stroke rehabilitation at three hours a day or more, on at least five days a week, covering physiotherapy, occupational therapy and speech and language therapy. Drawn across a whole week, the therapy is the dark band and the rest is what somebody at home holds.
Each row is one day and each block is one hour. On weekdays, 3 hours are marked as rehabilitation and the other 21 are not. Saturday and Sunday carry no rehabilitation block.
- 15 hours a week: Rehabilitation at the intensity the guideline setsPhysiotherapy, occupational therapy and speech and language therapy, at least three hours a day on at least five days a week.
- 90 hours a week: The rest of the day at homeGetting up, washing, meals at the right texture, medication, walking practice, the exercise sheet, and rest between all of it.
- 63 hours a week: NightsGetting to the toilet, turning over, and being heard when something goes wrong. A live-in carer sleeps in the house and is there for these hours.
Therapy intensity from NICE guideline NG236, recommendation 1.2.16, and quality statement 2 of NICE quality standard QS2. The remaining hours are arithmetic on a 168-hour week.
At the intensity the guideline sets, that is 15 hours of the week with a therapist and 153 without one. Some are ordinary life and need nothing. The rest is where the rehabilitation happens or does not: the exercise sheet on the days in between, walking practice with somebody alongside, and meals at the texture the therapist set.
Your relative may come home through an early supported discharge team. NICE describes that as offered where the stroke team assesses it is suitable, with therapy continued at home at the same intensity as in hospital. It ends after a matter of weeks, when a community stroke team picks up what is left. NICE also asks that training in care, in things like moving somebody and helping them dress, is offered to family members and carers willing and able to be involved. Ask for it by name while your relative is on the ward.
Communication
Talking to someone whose speech has changed
The NHS describes aphasia as a condition that makes it difficult to speak, read, write and understand others, and names stroke as its most common cause. It is not a change in intelligence, and it is one of the hardest parts of a stroke to live with day to day.
What helps
- Saying one thing at a time, then leaving a long pause for the answer
- Asking questions that can be answered with yes, no or a point
- Using gesture, drawing and facial expression, which the NHS suggests alongside speech
- Turning the television and radio off before you talk
- Keeping a page of the words and phrases that work, so a new carer is not starting blind
What makes it harder
- Finishing sentences, which removes the practice they need
- Raising your voice, since hearing is usually not what has changed
- Talking about the person to somebody else while they are in the room
- Treating a good hour as the new baseline, since speech slips when somebody is tired
Speech and language therapy is the treatment, and the NHS says most people improve with it, particularly in the first few months, with improvement still possible years later. NICE asks that it is led by a specialist therapist working with the people around the person, carers among them, and that somebody with aphasia is given chances to talk with people who know how to support them.
That is the argument for one carer rather than a changing rota: somebody in the house all day learns which words your relative reaches for and what helps a conversation along, and which times of day are better. How to establish a routine with a live-in carer covers writing that down. The Stroke Association is the UK charity for stroke survivors and their families, with a support helpline, a forum and information about the effects of a stroke.
Round the clock
When care after a stroke needs to be round the clock
A live-in carer is in the house day and night, but the weekly rate assumes they sleep at night and have a break each day. When your relative needs somebody awake through the night as well, 24-hour care after a stroke has to be built from two carers rather than one.
| When it fits | A week on PrimeCarers | |
|---|---|---|
| One live-in carer | Your relative settles at night and needs help once or twice at most. | £1,050 to £1,400, typically £1,120 |
| A live-in carer, with a waking night carer on the hard nights | Two or three nights a week are broken and the rest are settled. | A live-in week plus £148 for each waking night |
| A live-in carer, with a waking night carer every night | Your relative needs help getting up, turning or settling several times a night, most nights. | About £2,156, from £2,086 |
One live-in carer
- When it fits
- Your relative settles at night and needs help once or twice at most.
- A week on PrimeCarers
- £1,050 to £1,400, typically £1,120
A live-in carer, with a waking night carer on the hard nights
- When it fits
- Two or three nights a week are broken and the rest are settled.
- A week on PrimeCarers
- A live-in week plus £148 for each waking night
A live-in carer, with a waking night carer every night
- When it fits
- Your relative needs help getting up, turning or settling several times a night, most nights.
- A week on PrimeCarers
- About £2,156, from £2,086
Figures are what carers on PrimeCarers charge, with our fee included. Carers set their own rates. Somebody still needs to be with your relative during the live-in carer's daily break.
After a stroke, the nights are the part of the day that can become too much for one carer. If your relative cannot get to the toilet safely alone and needs to go several times on most nights, the live-in carer ends up working the night as well as the day, and that is not safe for either of them for more than a short while. The same is true if the stroke team has asked for your relative to be turned to a timetable to protect their skin, because somebody has to be awake to do it. A transfer that the physiotherapist or occupational therapist has assessed as needing two people is different again: one carer cannot do it alone at any hour.
Ask the stroke team which of these applies before you book seven nights. If only some nights are hard, a waking night carer on those nights costs much less than a full week of them, and the review date you set is the time to look at it again. Waking night carers are a separate search from live-in carers, so look at overnight carers as well, and introduce the two carers to each other before the first night.
24-hour care at home sets out every way to cover the day and the night and what each one costs, and live-in care or 24-hour care goes through the signs that one carer is no longer enough. Waking night or sleeping night explains where the line between the two kinds of night falls.
What it costs
What a live-in week costs, and what it sits against
Live-in care is priced by the week. Carers on PrimeCarers set their own rates, and our fee is inside the figure you see, so it is the amount that leaves the account.
| What it covers | What it costs | |
|---|---|---|
| Live-in care on PrimeCarers | One carer living in the house, day and night, seven days a week. | £1,050 to £1,400 a week, typically £1,120 |
| Live-in care where needs are complex | Where hoisting, or tube feeding a nurse has trained the carer for, is part of the day. Tube feeding is outside the insurance we arrange. | £1,260 to £1,750 a week |
| A waking night on top of a live-in week | Where somebody is up repeatedly and a sleeping carer is not enough. | £148 a night on top |
| Hourly visits instead | Visits at the hardest times. The hours between are uncovered. | £18 to £25 an hour |
| A live-in care agency | The agency employs the carer and sends whoever is available. | about £1,120 to £1,750 a week |
| A care home place | A room in a home, with staff shared between residents. | about £1,160 a week, or £1,410 with nursing |
Live-in care on PrimeCarers
- What it covers
- One carer living in the house, day and night, seven days a week.
- What it costs
- £1,050 to £1,400 a week, typically £1,120
Live-in care where needs are complex
- What it covers
- Where hoisting, or tube feeding a nurse has trained the carer for, is part of the day. Tube feeding is outside the insurance we arrange.
- What it costs
- £1,260 to £1,750 a week
A waking night on top of a live-in week
- What it covers
- Where somebody is up repeatedly and a sleeping carer is not enough.
- What it costs
- £148 a night on top
Hourly visits instead
- What it covers
- Visits at the hardest times. The hours between are uncovered.
- What it costs
- £18 to £25 an hour
A live-in care agency
- What it covers
- The agency employs the carer and sends whoever is available.
- What it costs
- about £1,120 to £1,750 a week
A care home place
- What it covers
- A room in a home, with staff shared between residents.
- What it costs
- about £1,160 a week, or £1,410 with nursing
PrimeCarers figures are what carers charge with our fee included. Agency and care home figures are typical UK ranges quoted for comparison, not our prices.
The cost of live-in care breaks the weekly figure down, and when live-in care becomes cheaper than hourly visits compares the two with the hours written out.
As recovery moves
Changing the cover as your relative does more
Recovery after a stroke is uneven. The NHS says it can take days or weeks for some people and months or years for others, with a review of progress at about six months. An arrangement set up in the week of a discharge can still be running unchanged months later, because nobody looked at it.
Go through this at the review date you set
0 of 8 ticked
Signs the cover is doing more than it needs to
Signs it should stay as it is, or grow
If help is needed at particular times of day rather than continuously, hourly visits cover those times for less than a week of somebody living in, and hourly care after a hospital stay sets out what a visit covers. Going the other way is also normal: a second stroke or a fall puts the need back up, and can I hire a live-in carer temporarily? covers a fixed number of weeks.
Arranging it
How to set live-in care up from a hospital ward
Most of this can be done while your relative is still on the ward. The parts that take longest are the hospital paperwork and the conversations with carers.
- 1
Ask the ward for three pieces of paper
Before dischargeThe rehabilitation plan and its goals, the result of the swallowing assessment with any diet the therapist has set, and the exercise sheet. NICE asks for a health and social care plan to be agreed with you before a transfer home, so the ward expects the request. Almost everything a carer does at first comes out of those three documents. - 2
Check the room and what is being delivered
The same weekA live-in carer needs a bedroom of their own. Ask the occupational therapist what equipment is coming and whether a bed is going downstairs, because that changes which room is free. - 3
Look at carers near the house
FreeSearch live-in carers by the postcode where the care will happen. Each profile carries the weekly rate, availability, reviews from families, and what the carer says about their own experience. - 4
Ask about this stroke, not strokes in general
Before you decideAsk how they would manage the transfers the physiotherapist has shown, what they would do about a meal at a modified texture, how they would handle a night when your relative cannot settle, and what training they have had. - 5
Put the rate, the start and the review date in writing
Before day oneAgree the weekly rate, the start date, what happens on a day the carer is away, and a date to review the arrangement, then confirm it by message or email. A date in the diary is the simplest protection against care carrying on past the point it is needed.
How do I hire a live-in carer? covers the practical steps, and how should I interview live-in carers? has the questions worth asking on the call. When you are ready, search for a carer near your relative.
Questions
Questions families ask about live-in care after a stroke
It can start on the day of discharge if a carer is available and the room is ready, so it helps to talk to carers while your relative is still on the ward. What holds a start date up is usually practical: a bedroom for the carer, equipment being delivered, a bed moving downstairs. What to arrange before discharge day is the list to work through.
That is something to agree with the carer rather than something we can promise on their behalf. NICE asks for training in care to be offered to family members and carers willing and able to be involved, and for speech and language therapy to be led by a specialist therapist working alongside the people around the person. Ask the therapist to show the carer what they want done. PrimeCarers does not record or check training or qualifications.
The speech and language therapist assesses swallowing and sets what is safe, which the NHS describes as changes such as softer food and thickener in drinks. Whoever is at home follows that at every meal and watches for coughing. The NHS lists repeated chest infections, weight loss and dehydration among what dysphagia can lead to. Where feeding is through a tube, that is a nursing task a nurse may delegate to a trained carer in writing, which PrimeCarers does not check; it falls under complex care and costs more.
For one person the two are close. A live-in week on PrimeCarers runs from £1,050 to £1,400, typically £1,120, and a care home place is about £1,160 a week, or £1,410 with nursing. What differs is that live-in care is one carer for one person, and your relative stays in the house they know. Is live-in care cheaper than a care home? sets the two side by side.
Set a review date when you set the start date, and use it. Look at transfers, meals, medication and nights separately, and ask the stroke team what is safe without help. Either side can end a live-in arrangement on 7 days' notice once 168 hours have been worked, and on 48 hours before that. Ending live-in care covers doing it without leaving a gap.
Possibly, and it is worth asking before you commit to paying for all of it yourselves. A council care needs assessment is free and does not depend on savings, Attendance Allowance is for the help somebody needs rather than their diagnosis, and NHS Continuing Healthcare can fund care in full where needs are mainly health needs. The different types of care funding explains which route applies.
Some do and say so on their profile, with reviews from families they have worked for. We do not check or record qualifications, training or references, so what a carer writes about strokes, transfers or swallowing is their own account for you to ask about. Before a profile appears, every carer has had an ID check, a right to work check and an enhanced DBS check issued within the last two years (PVG in Scotland, Access NI in Northern Ireland), and has been interviewed by us online. Reviews and any references on a profile are not verified by us. Visits booked through PrimeCarers are covered by the carer insurance policy we arrange, within its terms (no clinical procedures). How should I interview live-in carers? has the questions to ask.