Live-in care for someone who is bedbound, hoisted, or needs two people to move

The Health and Safety Executive sets out what that plan must contain. In its information sheet Getting to grips with hoisting people it says the plan should clearly state the control measures for moving and handling the individual, including the specific equipment needed, the techniques to be used, the number of handlers required and the sling attachment loops. If the plan says two handlers, it says two handlers whether the care is bought by the hour, delivered by an agency or provided by somebody living in the spare room.

So live-in care covers a great deal for somebody who is bedbound, including the part visiting care is worst at: the long stretches when nobody is due and the person is lying there waiting. What it does not do is turn one person into two. Transfers, hoists and when a visit needs two carers sets out the five ways a transfer is done and how the number of handlers is decided. It is worth reading first. Where a nurse has been asked to delegate a clinical task, delegated healthcare tasks explains who trains whom.

There is one thing live-in care does change. NICE's guideline on home care for older people asks services to prioritise continuity of care by ensuring the person is supported by the same care worker, so they become familiar with them. For somebody lifted in a sling twice a day, being handled by a person who knows their pain and their bad shoulder is not a small thing, and it is the strongest argument for live-in care here.

Two things in that grid catch families out. The first is that the second carer's visits are visits: a one-hour minimum on PrimeCarers, a rate set by that carer, and a slot to fill seven days a week. Somebody covers Sunday morning as reliably as Tuesday.

The second is the afternoon. Under the client contract a live-in carer manages their own rest, and the expectation for live-in care is that they will have opportunities for rest which the parties agree between themselves. If your relative cannot be left alone, somebody has to cover that time, and settling it before the placement begins is far easier than discovering it in week two. The live-in carer's daily break goes through the options.

If a second carer cannot be found for every slot, two alternatives are worth naming rather than working around: live-in care versus 24-hour care, which is two carers on shifts rather than one living in, and a nursing home, where two staff on a transfer is part of how the building is staffed. The difference between live-in care and a nursing home compares the two.

Put the two lines together and a week with a live-in carer and two daily double-up visits comes to about £1,620 at typical rates. That is more than a nursing home place, and any page that tells you otherwise is comparing the wrong things. What the money buys is your relative in their own bed, one familiar carer rather than a rota, and a household that still looks like theirs.

The cost of live-in care has the full picture, including the extras outside the rate.

Almost all of the equipment comes through the council rather than out of your own pocket. The NHS guide to care and support you can get for free says you may be entitled to free home adaptations and equipment provided they cost less than £1,000 each, after a home visit from a council worker or an occupational therapist, and hoists and profiling beds are loaned and fitted rather than bought. Local authority funding explains the means test that follows. If your relative is still on a ward, what to arrange before discharge day is the checklist to work through now, because a bed that has to come downstairs takes longer to organise than a carer does. For the spare room, where live-in carers sleep is the page to read.

NICE's guideline on pressure ulcers asks, at recommendations 1.1.8 and 1.1.9, that an adult at risk changes position at least every six hours, and an adult at high risk at least every four hours, with help if they cannot manage alone. For somebody who is bedbound, four hours means two or three times between bedtime and breakfast. A carer who is up three times a night, every night, is not sleeping, and within a fortnight that shows in the daytime care.

Pressure sores: preventing them at home covers what to look for on the skin, which mattress NICE asks for and the point at which a red mark becomes a district nurse's job. On the night itself, waking night or sleeping night explains where the line falls. A waking night carer alongside a live-in carer costs £148 a night, which is one of the reasons families look at two carers on shifts instead. Ask any carer you speak to how many times a night they can get up and still do a good day; one who says it sounds like too much is giving you the answer you needed.

The wording above comes from the NHS guide to continuing healthcare. Our own page on NHS continuing healthcare explains the checklist and the twelve care domains, and direct payments sets out how to take a funded budget as money you arrange the care with, which is how families choose their own carer instead of taking an agency rota.

1. 1

   Get the moving and handling plan in your hands

   Before you look at anybody

   Ask community occupational therapy, the district nurse or the ward for the current plan, and read the number of handlers, the equipment and the sling loops. If it predates a hospital stay, ask for it to be reviewed. HSE guidance says a plan is revised when the needs of the individual change.
2. 2

   Search live-in carers and read what they list

   Free

   Profiles carry the weekly rate, availability, reviews and the carer’s own account of the moving and handling they have done. Shortlist the ones whose experience matches the equipment in the house rather than the diagnosis.
3. 3

   Ask each carer what they have been trained on

   This week

   Ask which hoists and slings they have used and when they last trained on them. Under the client contract a carer agrees not to undertake work they feel unqualified to perform, so a straight answer here is the carer doing their job.
4. 4

   Book the second carer before the live-in carer starts

   Week one

   Finding somebody for seven mornings takes longer than finding one live-in carer. Agree those visits in writing first, then set the start date.

Two things about the contract are worth knowing before you agree anything. Notice for live-in care is seven days once the carer has worked a full week, meaning 168 hours in total, and 48 hours before that. A placement you cancel is still payable in full, with the exceptions of unplanned hospitalisation, illness, or another reason you and the carer agree; the carer can waive some or all of it, and PrimeCarers charges nothing of its own for a cancellation. Ending live-in care covers what happens when an arrangement stops.

You also agree to provide a safe working environment, and the carer decides whether it is safe for them to work in and may stop if they reasonably believe it is not. A carer who uses that clause is protecting your relative as much as themselves. When you are ready, search for live-in carers near you, and how every carer is checked sets out what we verify before a profile appears.