The Financial Case for Live in Care for Couples: A Breakdown

When considering care options for elderly couples, it’s important to take a step back and evaluate the financial, emotional, and practical implications of each route. Whether it’s keeping both at home with live-in care, placing one partner in a care home while the other remains at home, or moving both into a care home, the differences in cost are staggering and often misunderstood.

Here, I’ll delve into the numbers and explore why live-in care for couples could be the most cost-effective and compassionate solution for many families.

The Three Care Scenarios: A Quick Overview

Before jumping into the financials, let’s break down the three scenarios:

1. Live-in Care for a Couple: A live-in carer supports both individuals in their own home, providing personalised care around the clock.
2. One at Home, One in a Care Home: One partner remains at home with support, while the other moves into a residential care home.
3. Both in a Care Home: Both individuals move into a care home, receiving shared or individual care within the facility.

Now, let’s look at the costs for these scenarios (this is a rough estimate, assuming the mortgage is fully paid-off. You must also take into account costs may differ from region to region):

• Live-in care for a couple: £6,190 per month
• One at home and one in a care home: £7,580 per month
• Both in a care home: £13,000 per month

Below is a table summarising the detail behind these numbers. Each is a rough estimate and will vey from family to family and place to place:

Whilst Live-in care for a couple and One at home and one in a care home cost a similar amount, especially if the lower-need persons needs little to no help at home, the numbers paint a clear picture: live-in care for a couple is usually the most economical option. But let’s break this down further.

Scenario 1: Live-in Care for a Couple (£6,190 per month)

This option provides a dedicated carer living with the couple, offering:

• Personalised care: The carer focuses exclusively on the couple’s needs, from mobility assistance to meal preparation.
• Continuity: The couple remains in their home, surrounded by familiar comforts and memories.
• Cost-effectiveness: At £6,190 per month, this option is substantially cheaper than the alternatives.

Hidden Benefits and Savings

Beyond the obvious cost, live-in care avoids other expenses, whilst delivering significant benefits:

• Property retention: The family home can often be retained rather than sold to fund care. Remaining in the property prevents it from being seem as a liquid asset meaning that you may be able to qualify for additional government support.
• Health benefits: Staying in a familiar environment can reduce the risk of hospitalisations, which often occur due to falls or confusion in unfamiliar surroundings. In addition, people remain psychologically, and emotionally healthier in their own homes, surrounded by objects, atmospheres and routines that keep them being themselves.
• Shared care costs: Unlike care homes, where costs are typically charged per person, live-in care for couples leverages one carer for both individuals leading to a small 10%-20% premium.
• Better carers: Higher pay will attract more skilled and competent carers who are capable of managing the often complex dynamics of a couple living together, where one partner has greater care needs while the other may wish to oversee and influence the care provided. These carers are likely to be more experienced, engaging, and better compensated, which, perhaps counterintuitively, will result in higher-quality care that your loved ones will appreciate and enjoy.

Scenario 2: One at Home, One in a Care Home (£7,580 per month)

This arrangement splits the couple’s care needs, with one partner receiving professional care at home and the other moving into a care home.

While it may seem like a practical compromise, it comes with hidden challenges:

Financial and Other Downsides

• Increased costs: At £7,580 per month, this scenario is nearly £1,400 more expensive than live-in care for a couple.
• Double the logistics: Coordinating care between two locations can be stressful and time-consuming.
• Loss of home environment: Not only does losing the home environment often lead to a rapid decline in health, especially for dementia patients, but the less-dependent partner may also find their world falling apart as they not only miss their spouse but realise how much of their life and identity revolved around them.

Emotional Impact

• Separation: Splitting up a couple who may have been together for decades can lead to emotional distress and loneliness, often exacerbating health issues for both parties.

Scenario 3: Both in a Care Home (£13,000 per month)

The most expensive option by far, moving both individuals into a care home costs a staggering £13,000 per month.

Why So Expensive?

Care homes charge per individual, with fees covering accommodation, food, and care. While the level of care may be appropriate, this comes at a steep price:

• Double occupancy doesn’t mean a discount: Couples rarely receive any cost reduction, and certainly nothing close to the 80%-90% discount fro receive from a single live-in carer.
• Hidden extras: Fees for outings, specialist treatments, or even basic amenities can inflate the bill further. In addition, costs may balloon as needs increase, whereas many private live in carers would absorb these increases or apply only modest price adjustments to accommodate them.

Emotional and Practical Considerations

• Loss of home: Couples often have to sell their property to afford care home fees, potentially eroding their children’s inheritance as 2nd homes become part of an asset pool against which council may leverage fees (at this time, in early 2025, they cannot do this against primary residences).
• Institutional environment: While care homes strive to provide a homely feel, it’s hard to replicate the familiarity and autonomy of one’s own home.

The Importance and Value of Remaining at Home

When discussing care options, the overwhelming preference for many people is to remain at home. Statistics back this up: a 2021 survey by the Live-in Care Hub revealed that 97% of people would rather stay in their own homes than move into a care facility. Similarly, Age UK found that staying at home is strongly linked to better mental and emotional well-being for older adults.

The Emotional and Psychological Benefits of Home

Home is more than just a physical space; it’s an extension of who we are. For many, it’s filled with objects, scents, sights, and routines that embody decades of memories and experiences. When people are uprooted from this environment, particularly those with dementia, the effects can be devastating:

• Loss of identity: Familiar surroundings help individuals with dementia navigate their day and retain a sense of self. Removing this framework can accelerate cognitive decline.
• Connection to the past: Photographs, furniture, and even the smell of a favourite room can act as anchors, helping individuals recall cherished moments and relationships.

The Risk of Rapid Decline in Care Homes

Studies have shown that individuals, especially those with dementia, often deteriorate faster in care homes. Research published in the Journal of Alzheimer’s Disease found that relocation stress can significantly exacerbate dementia symptoms. Furthermore, a 2018 report by Alzheimer’s Society highlighted that moving to a care home can lead to increased confusion, agitation, and even depression.

A Case for Staying Home

Let’s consider my interview with Louise (not her real name), a woman with early-stage dementia who remains in her family home with live-in care, whose testament I recount while exercising my poetic licence. She begins each day with the smell of her favourite lavender soap, eats breakfast at her kitchen table where she has done so for decades, and spends afternoons in her garden. The soap, bought for her by her daughter each year, reminds her of the first time she received that gift on a sunny day in Hope Cove, her granddaughter nestling into her daughter. The table, lovingly mended by her husband with the help of her son, brings back the memory of the splinter her son received that day and how she carefully removed it with the tip of her sewing needle. That same needle she used to mend her best friend’s blouse when it hilariously and embarrassingly burst apart at her own 40th wedding anniversary, held in the very garden she looks out on every day. These sensory experiences reinforce her identity, connect her to her past, and remind her of who she is, the people she identifies with, and those she holds dear.

Contrast this with a care home, where routines, smells, and even meal choices are dictated by the institution. The lack of personalisation can leave individuals feeling lost, confused, and disconnected. Removed from her familiar surroundings and without the constant daily reminders that ground her in her memories, objects, sounds, and rituals that make up the fabric of her life, she struggles to find a sense of self. The absence of her treasured possessions, the loss of her daily rituals, and the unfamiliarity of the new environment create a sense of detachment. Without the home she built over decades, filled with memories and the presence of loved ones, she feels unanchored, as though part of herself has been lost.

When Live-in Care Might Not Be the Best Option

Having said all that, while live-in care can provide tremendous benefits for many couples, there are situations where it may not be the most practical or effective choice. One of the key challenges arises when the behaviours or needs of one or both partners become overwhelming, particularly during the night.

For instance, if one partner requires constant care and is frequently awake throughout the night, due to conditions such as dementia, chronic pain, or other health issues, while the other partner is also in poor health, live-in care might not suffice. The strain on the carer to manage these nocturnal disruptions alongside daily care can become unsustainable. This is especially true if the healthier partner is unable to assist during the day, leaving the carer without any opportunity for rest or reprieve.

That said, live-in care can still be manageable if the healthier partner is in good enough condition to contribute. For example, the healthier partner could assist during certain hours of the day while the carer covers the nights, or vice versa. This shared approach can ensure the burden is balanced and the couple’s needs are met without compromising the quality of care.

However, when neither partner is able to support the carer, or when the demands of care are excessively high, such as constant agitation, wandering, or severe behavioural challenges, it may be time to consider alternative arrangements. In these cases, a care home with specialised facilities and 24/7 staff may provide a safer and more supportive environment for everyone involved.

Ultimately, the decision should be guided by the couple’s health, the complexity of their care needs, and the sustainability of the support structure at home. Care is about finding the best fit for the individual situation, and while live-in care is an excellent option for many, there are times when alternative solutions are necessary to ensure both partners receive the care and support they deserve.

Why Live-in Care is usually the Winner

The financial numbers don’t lie: at £6,190 per month, live-in care offers a more affordable alternative to the other scenarios. But beyond the pounds and pence, live-in care provides significant intangible benefits:

1. Preserving Independence: Staying at home allows couples to maintain their routines, privacy, and autonomy.
2. Continuity of Care: One dedicated carer builds a strong relationship with the couple, understanding their unique needs and preferences.
3. Flexibility: Live-in care can be tailored as needs evolve, offering more adaptable solutions than care homes.

Real-Life Example

Take Jack and Mary (names have been changed to protect the identities of the individuals involved) who have been married for over 50 years. Jack has mobility issues, while Mary has early-stage dementia. With live-in care, they can stay in their family home. Jack can sit in his favourite chair, while Mary potters in the garden under the carer’s supervision. Compare this to being separated or uprooted to a care home, where routines are dictated by institutional schedules. The difference is night and day.

The Bigger Picture

Choosing care is never just about money, but the financial element cannot be ignored. For couples with moderate to high care needs, live-in care offers an affordable, compassionate, and personalised solution.

Key Takeaways:

• Live-in care for couples is nearly 50% cheaper than placing both in a care home.
• It’s about more than savings: live-in care preserves independence, reduces emotional strain, and offers a tailored approach to care.
• Families can retain the family home, potentially preserving inheritance and avoiding unnecessary upheaval.
• People who remain living together, at home, live longer and heathier lives.

Final Thoughts

As someone who’s spent years helping people save money and make smarter financial choices, specifically around care, I know that every situation is unique. But when it comes to elderly care, the figures and benefits of live-in care are hard to ignore.

It’s a choice that not only makes financial sense but also prioritises the dignity and well-being of our loved ones. So, before jumping to conclusions about care homes, take a moment to consider live-in care, because sometimes, the best solution is closer to home than you think.