Live-in care or 24-hour care: when one carer is not enough

Live-in care is one self-employed carer who moves into your relative's home for a placement. They have a bedroom of their own, they are there through the day, and at night they go to bed like anybody else in the house. If your relative calls out, needs the bathroom or wakes confused, the carer gets up, sorts it out and goes back to bed. That is included in the weekly rate.

What is not included is a night the carer spends awake. A live-in week is priced on the assumption that the carer sleeps in the house most nights, and once that stops being true the arrangement has to change.

The line between a sleeping night and a waking one is a convention among carers rather than a rule anybody wrote down, and it is worth understanding before you negotiate anything. Waking night or sleeping night explains where carers draw it. For what a live-in carer's night looks like from the inside, do live-in carers stay overnight? walks through one.

Two or three ticks in the first group is a practical answer on its own. Before acting on it, keep a short note of the nights for a fortnight: when your relative woke, what they needed, and how long it took to settle them. Two weeks of real nights settles the argument better than anyone's memory, and a night carer will ask you for it.

If most of the ticks are about confusion rather than physical need, the answer may be a change in the evening routine rather than a second carer. What is sundowning? covers why late afternoons and evenings unravel for some people with dementia, and night care for dementia covers what an overnight carer does about it.

The first arrangement is ordinary live-in care, and for a great many households it is enough. One carer knows your relative and knows the house, and is there for the evening and the early morning as well as the middle of the day. The nights are covered in the sense that somebody is there and will get up. What it does not give you is somebody awake.

The second keeps that continuity and adds a waking night carer alongside it. The live-in carer holds the days and gets a proper night's sleep, and a second carer comes in for the nights that need somebody up. This is usually the better route when the days are going well and only the nights have changed, and it does not have to be every night. Three nights a week, the hardest ones, is a normal way to start.

The third drops the live-in carer altogether. Two carers work 12-hour shifts and hand over twice a day, so somebody is awake and working at every hour. It suits a household with no spare bedroom, or one where the help needed is heavy enough that nobody could do it across a whole week alone. It is the most expensive of the three and it means two faces rather than one, which matters if your relative finds new people unsettling.

What makes round-the-clock cover expensive is the requirement that somebody be awake, rather than the number of hours. Buying the same 168 hours as ordinary hourly visits at £20 an hour would come to £3,360 a week, which is why nobody buys it that way. The cost of live-in care breaks the weekly figure down, what 24-hour care costs prices each route over a month and a year, and how our pricing works explains what sits inside the rate.

If round-the-clock care at home is beyond what you can fund, that is an answer rather than a failure, and a nursing home is the comparison to make next. Is live-in care cheaper than a care home? sets the two side by side.

1. 1

   Write down a fortnight of nights first

   Two weeks

   Note the time of each waking, what your relative needed and how long it took to settle them. This decides whether you are asking for a sleeping night or a waking one, and a night carer will want to see it.
2. 2

   Search for night cover as its own booking

   Free

   Overnight carers and live-in carers are searched for separately, and they are often different people. Every carer on PrimeCarers has had their identity and right to work checked and an enhanced DBS on the Update Service, and each has had an online interview before their profile appears. Qualifications, training and references are for you to go through with the carer. Carers are insured while they work.
3. 3

   Agree the handover and the rates in writing

   Before the first night

   Settle what time the night carer arrives and leaves, what the live-in carer hands over, and where the night carer will sit. Confirm the rate in writing too: bank holidays are charged at one and a half times the carer's normal rate and Christmas Day at twice, and travel costs are only payable if you and the carer agree them in advance in writing.
4. 4

   Review it after a month

   Week 4

   Nights change in both directions. Somebody settling after a hospital stay may need fewer of them; somebody declining will need more. Ending a live-in arrangement takes 48 hours' notice in the first week, and once 168 hours have been worked it takes a week's notice on either side.

If you have not hired a live-in carer before, how do I hire a live-in carer? covers the job description, the questions to ask and how the first fortnight normally goes, whether you are hiring one carer or two. For the rest of what overnight cover involves, overnight care is the pillar guide.