The short answer
- Nursing is the legal lineInjections, wound dressings, drips and changing a catheter are nursing care. A carer does not do them unless a nurse has trained that carer for a specific task and signed it off in writing.
- Medication depends on the levelReminding and handing over a blister pack is everyday care. Measuring doses needs training and consent. Hiding tablets in food or changing a dose is never a carer’s decision.
- Keep carers away from the moneyNo bank card, no PIN, no gifts of value, no place in the will and no power of attorney. A float with receipts for the shopping is the normal arrangement.
- Restraint is only lawful to prevent harmHolding someone back or locking a door is allowed only when the carer reasonably believes it is necessary to stop harm and the force is proportionate. Never for convenience.
A self-employed carer is not regulated by the Care Quality Commission, so no inspector lists what they may and may not do. This page says which limits are law, which are training and insurance, and which are yours to agree.
Three kinds of limit
Who decides what a carer can do in your home
Families often expect a rule book, and there is not one. A private carer works under your direction, in your relative’s home, outside the regulator’s reach. The limits come from three places, and it helps to know which one you are dealing with before you ask.
The law
Applies to everyone
Training and insurance
Differs carer to carer
What you have agreed
Written in the care plan
The old idea that a private carer "cannot do anything regulated" is only half right. Personal care, which is washing, dressing, toileting, meals and medication prompts, is a regulated activity when an agency provides it, but the regulations except a carer engaged directly by the person or their family and working under their direction. That is why a self-employed carer does not need to register with the CQC, and why the same carer can do a great deal more than a visitor from an agency, provided they are trained for it and you have agreed it.
The 35 tasks
Thirty-five things families ask about, in three groups
Six areas, and inside each one the tasks sit in three groups: what a carer can normally do, what needs training and agreement first, and what is for somebody else, with who that somebody is.
- Can do6 of 35
A carer can normally do this
Ordinary care work. It goes in the care plan and a carer will do it without anything extra being arranged.
- With training and agreement11 of 35
Only with training, agreement and insurance
Not against the law, but it needs a carer who has been trained for it, a family or a nurse who has agreed it in writing, and insurance that covers it. Settle all three before the first visit.
- Should not18 of 35
A carer should not do this
Either the law reserves it for a nurse or a doctor, or it puts your relative, or the carer, at a risk no insurance will cover. Somebody else does it, and we say who.
Medication6 tasks
Reminding someone to take their tablets
Prompting is the lightest level of medication support. The carer reminds, watches that the tablets are taken and writes it down. Your relative stays in charge of their own medicines.
What carers can do with medicationHanding over tablets from a blister pack or dosette box
Handing over medicines the pharmacy has already sorted into days and times is routine care, as long as the carer records what was given and the family or the GP has agreed the arrangement.
Dosette boxes explained
Giving medicines from the original boxes
Measuring out doses from loose boxes, eye drops, inhalers and liquid medicines counts as administering. NICE guidance says the care worker should be trained and assessed as competent, the person or their attorney should have consented, and the arrangement should be written in the care plan.
Who does it instead: A pharmacy can put most tablets into a blister pack, which takes the arrangement back to handing over.
Handling morphine or other controlled drugs
A carer can prompt or hand over a controlled drug the pharmacy has dispensed, but only with clear written instructions, a record of every dose, and a nurse or GP who has set the arrangement up. Anything through a syringe driver is nursing.
Who does it instead: District nurses run syringe drivers and injected pain relief.
Hiding tablets in food or drink
Giving medicine without a person knowing is covert administration. It is only lawful after a best-interests decision under the Mental Capacity Act, recorded in writing, with the GP and the pharmacist involved. A carer must never decide to do it on their own.
Who does it instead: The GP, with a best-interests meeting that includes the family.
Changing a dose because your relative seems worse
Only a prescriber can change a dose. A carer who notices that someone is drowsy, in pain or confused should ring the GP or 111 and write down what they saw.
Who does it instead: The GP or the prescribing nurse.
Nursing and clinical8 tasks
Taking blood pressure, temperature or blood sugar
Reading a home monitor and writing the number down is fine, and useful. What a carer must not do is decide what the number means. Anything outside the range the GP gave gets reported, not managed.
Emptying and changing a catheter bag
Emptying a leg bag and swapping a night bag is everyday care once a nurse has shown the carer how. Changing the catheter itself is a nursing task.
Who does it instead: The district nurse changes the catheter, usually every few weeks.
Changing a stoma bag
Many carers have done this for years and do it well. It still needs the stoma nurse to show the carer once, and the carer’s insurance to cover personal care of this kind.
Feeding through a PEG tube
Tube feeding is a delegated healthcare activity. The dietitian or nurse who sets it up trains the carer, checks they are competent and reviews it. With that in place a live-in carer can run the feeds; without it they should not.
Complex care at homeSetting up or adjusting oxygen
A carer can help someone put on a cannula and check the concentrator is running, once the oxygen service has shown them. Changing the flow rate is a prescribing decision.
Who does it instead: The respiratory team sets the flow rate.
Giving an injection
Injections are nursing care. A nurse can delegate a specific injection, insulin most often, to a named care worker they have trained and signed off, but without that written delegation a carer should not put a needle in anyone.
Who does it instead: The district nurse, or the person themselves if they manage their own insulin.
Complex care at homeDressing a wound or a pressure sore
Wound care is nursing. A carer can keep the area clean and dry, change a simple plaster, watch for redness or smell and report it the same day, but dressings that a nurse has applied are for the nurse to change.
Who does it instead: District nurses, who will visit at home.
Telling you what is wrong with your relative
Carers see more of your relative than anyone else and their observations are worth a lot. A diagnosis is not theirs to give. A good carer describes what changed and when, and helps you get the GP in.
Who does it instead: The GP, 111, or 999 if it is urgent.
Moving and lifting4 tasks
Helping someone up and down the stairs
Steadying, walking beside and supervising the stairs is ordinary care. Carrying somebody up them is not, and if the stairs are no longer safe that is a conversation about a stairlift or a downstairs bed.
Using a hoist
Hoisting is a trained skill, and a lot of carers have it. Ask to see the moving and handling certificate, and ask the occupational therapist to show the carer the sling and the hoist you have, because they differ.
Getting someone up from the floor after a fall
If your relative is unhurt and can get up with help, a carer who has been trained can guide them up using a chair. If they are hurt, in pain, or cannot help themselves, the carer should make them comfortable and call for help rather than lift.
Who does it instead: The ambulance service or a community falls team lifts anyone who cannot get up.
What to do after a fall
Lifting someone who cannot stand
Lifting a person’s full weight by hand injures carers and drops people. Health and safety law requires the risk to be assessed and avoided, and a carer’s insurance will not cover a manual lift. If your relative cannot bear their own weight, the answer is equipment, not strength.
Who does it instead: An occupational therapist assesses for a hoist or a stand aid, free through the council.
Moving someone safely
Money and legal6 tasks
Taking cash to do the shopping
Normal, and most families arrange it. The safe way is a float, a receipt for everything and a note in the care diary, so nobody has to rely on memory later.
How careful carers handle money
Using your relative’s bank card and PIN
A carer should never know a PIN or hold a bank card. It leaves them open to accusation and your relative open to loss. Banks offer a separate card for a carer with its own limit, which removes the problem.
Who does it instead: A carer’s card from the bank, or an attorney under a lasting power of attorney.
Accepting a gift of money or a valuable item
A box of chocolates at Christmas is one thing. Money, jewellery or anything of value should be declined, however sincerely it is offered, and the carer should tell the family it was offered. It protects the carer as much as your relative.
Who does it instead: If the family wants to thank a carer, a bonus agreed openly and paid through the platform is clean for everyone.
Witnessing a will, or being left something in it
A witness to a will cannot inherit under it, and neither can their spouse, so a carer who witnesses a will loses any gift in it. Beyond that, a carer who becomes a beneficiary invites a challenge to the will after the person dies. Keep carers out of wills altogether.
Who does it instead: Two independent adults witness a will; a solicitor if there is any doubt about capacity.
Acting as attorney under a lasting power of attorney
There is no law against it, but a paid carer who also controls the money has a conflict of interest that the Office of the Public Guardian and the family will both question. The roles should be separate.
Who does it instead: A family member or a solicitor as attorney.
Power of attorney and responsibilitySigning documents on your relative’s behalf
Only an attorney or a deputy can sign for somebody else. A carer can help someone read a letter and hold the pen steady, but the signature is the person’s own.
Who does it instead: An attorney, or the person themselves.
The house4 tasks
Light housework around your relative
Wiping the kitchen down after a meal, a load of washing, changing the bed and running the hoover round the rooms in use are all part of keeping somebody safe and comfortable at home.
What counts as care
Feeding the cat and walking the dog
Most carers will, and many like to, but it is not assumed. Put it in the care plan so the carer has agreed to it and the time is allowed for.
Carers and petsDriving your relative to an appointment
Fine when it has been agreed. Whose car, whether the carer’s insurance covers business use, and whether mileage is paid all need settling in writing first. Mileage is only chargeable if you have agreed it in advance.
Carers who drive
Deep cleaning, windows, gutters and the garden
These are jobs for a cleaner, a window cleaner or a gardener, cheaper from them, and a carer’s insurance may not cover an injury on a ladder. If it is cleaning the whole house you are paying a carer’s rate for a cleaner’s job.
Who does it instead: A cleaner or a handyman, booked separately.
Behaviour and boundaries7 tasks
Photographing or filming your relative
A photo of a pressure area for the nurse, with your relative’s agreement, is sensible. Anything else needs consent every time, and nothing about a client belongs on a carer’s social media.
Cameras and carers at home
Holding someone back, or locking them in
Restraint is only lawful when the carer reasonably believes it is necessary to stop the person coming to harm, and the force used is proportionate to that harm. Locking somebody in, tying them to a chair or holding them down for convenience is never lawful. Where a person with dementia is at risk of wandering, the answer is a care plan and door sensors, agreed with the family and the council.
Who does it instead: The council’s social worker, if a person is being kept safe in ways that restrict their freedom.
Mental capacity and restraintInsisting on care your relative has refused
An adult with capacity can refuse a wash, a meal or their tablets, and a carer must respect that, then record it and tell the family. Persuasion is allowed, force is not. If your relative cannot make the decision themselves, what happens next is a best-interests decision, not a carer’s call.
When someone refuses careTelling other people about your relative
What a carer sees and hears in the house stays there. That includes not telling the wider family things your relative has asked them to keep private, and never posting about clients online. The one exception is a safeguarding concern, which must be reported.
Drinking alcohol or using drugs while working
Being under the influence on a visit endangers your relative and voids the carer’s insurance if anything goes wrong. It is a reason to end the arrangement the same day and to tell us.
Missing a booked visit without a word
A carer who cannot make a visit should tell you as early as they can, so cover can be found. On PrimeCarers, a carer who misses booked visits without telling the client can be removed from the platform.
Cancellations and late visitsBeing on their phone during a visit
An hourly visit is paid time and your relative should have all of it. On a live-in placement or a long night a carer will reasonably check their phone at quiet points, but not while somebody needs them. Say what you expect at the start.
A guide rather than a rule book. Every carer on PrimeCarers is self-employed and sets their own limits, so the middle group is where you and the carer agree things, and their training and insurance are for you to check with them.
Two patterns run through the list. Anything that goes into the body, through a needle, a tube or a wound, belongs to a nurse until a nurse hands it over. Anything that touches your relative’s money or legal affairs is best kept away from the carer entirely, not because carers are dishonest but because the arrangement should protect them from the accusation as much as it protects your relative from the loss.
Medication and nursing
Where care stops and nursing starts
This is the question behind most of the searches that bring people to this page. The answer has three levels for medication and one clear rule for everything clinical.
| What a carer does | What it needs first | What stays with a nurse or doctor | |
|---|---|---|---|
| Tablets | Reminds, watches them taken, hands over a blister pack or dosette box, writes it on the chart | Your agreement and a written record. Measuring doses from loose boxes needs a carer trained and assessed for it | Prescribing, changing a dose, and any decision to give medicine without the person knowing |
| Injections and insulin | Nothing, unless a nurse has trained and signed off that carer for that person’s injection | A written delegation from the district nurse or diabetes team, with a review date | The injection itself, and everything through a syringe driver |
| Wounds and pressure areas | Keeps skin clean and dry, changes a simple plaster, checks pressure areas at each visit and reports any redness the same day | Knowing what to look for, which the district nurse will show them | Assessing and dressing wounds and pressure sores |
| Catheters, stomas and tubes | Empties and changes bags, keeps the site clean, runs PEG feeds once trained | A nurse to demonstrate, a competence sign-off for feeds, and insurance that names personal care | Inserting or changing the catheter or the tube |
| Observations | Takes blood pressure, temperature and blood sugar on a home monitor and records them | The range the GP wants reported, written down | Deciding what the reading means and what to do about it |
Tablets
- What a carer does
- Reminds, watches them taken, hands over a blister pack or dosette box, writes it on the chart
- What it needs first
- Your agreement and a written record. Measuring doses from loose boxes needs a carer trained and assessed for it
- What stays with a nurse or doctor
- Prescribing, changing a dose, and any decision to give medicine without the person knowing
Injections and insulin
- What a carer does
- Nothing, unless a nurse has trained and signed off that carer for that person’s injection
- What it needs first
- A written delegation from the district nurse or diabetes team, with a review date
- What stays with a nurse or doctor
- The injection itself, and everything through a syringe driver
Wounds and pressure areas
- What a carer does
- Keeps skin clean and dry, changes a simple plaster, checks pressure areas at each visit and reports any redness the same day
- What it needs first
- Knowing what to look for, which the district nurse will show them
- What stays with a nurse or doctor
- Assessing and dressing wounds and pressure sores
Catheters, stomas and tubes
- What a carer does
- Empties and changes bags, keeps the site clean, runs PEG feeds once trained
- What it needs first
- A nurse to demonstrate, a competence sign-off for feeds, and insurance that names personal care
- What stays with a nurse or doctor
- Inserting or changing the catheter or the tube
Observations
- What a carer does
- Takes blood pressure, temperature and blood sugar on a home monitor and records them
- What it needs first
- The range the GP wants reported, written down
- What stays with a nurse or doctor
- Deciding what the reading means and what to do about it
Based on NICE guideline NG67 on managing medicines for adults receiving social care in the community, and the Skills for Care principles for delegated healthcare activities.
If your relative needs the things in the right-hand column every day, the district nurses will come in for them and a carer does the rest. Where the nursing need is constant, complex care at home explains how live-in carers with clinical training work alongside the nursing team, and how NHS Continuing Healthcare can pay for it. Live-in care for complex needs starts from about £1,260 a week on PrimeCarers, against £1,050 for ordinary live-in care.
Money, gifts and wills
Keeping the carer clear of your relative’s money
Nothing goes wrong more often, or does more damage to a good relationship, than money that was never properly arranged. The rules below cost nothing to put in place and protect the carer as much as your relative.
Settle these before the first visit
0 of 9 ticked
Everyday spending
Gifts
Legal roles
None of this is a comment on the carer you have chosen. Experienced carers ask for these arrangements themselves, because they have seen what happens to a colleague who was handed a bank card by a grateful client and then accused by a nephew. How careful carers handle money is written for carers and worth reading from the family’s side too, and am I legally responsible for my elderly parent? covers power of attorney properly.
Restraint and refusal
When your relative says no, and when a carer may hold them back
These are the hardest moments in care, and the ones where a carer most needs to know where the line is. The law here is the Mental Capacity Act 2005, and its rules apply to a private carer exactly as they apply to a nurse.
The words the law uses
- Capacity
- The ability to understand a decision, weigh it up and communicate it. The law presumes an adult has it unless shown otherwise, decision by decision. Somebody with dementia may have capacity to choose their lunch and not to manage their money.
- Refusal
- An adult with capacity can refuse a wash, a meal, their tablets or the carer’s visit. The carer may encourage and explain, then must respect the answer, record it and tell the family. Persuasion is care; force is not.
- Best interests
- When a person cannot make a particular decision, it is made for them by weighing what they would have wanted, with the people who know them. It is not a carer’s decision to make alone, and it is never a matter of what is easiest.
- Restraint
- Using or threatening force to make somebody do something they resist, or restricting where they can go. Section 6 of the Act allows it only when the carer reasonably believes it is necessary to prevent harm to the person, and the force is proportionate to how likely and how serious that harm is.
- Deprivation of liberty
- Keeping somebody under continuous supervision and not free to leave, which can happen at home when doors are locked or somebody is watched all the time. It needs authorising, through the council, and a carer should never be the one who decides to lock a door.
Refusal of care is common, and it is usually a sign of fear rather than stubbornness. How do you get someone to accept care? is written for families at exactly this point.
How a carer behaves
The conduct you can expect in your home
The rest of what a carer should not do is not written in any Act. It is what any family would expect of somebody they pay to be in their parent’s house, and it is worth saying out loud at the start so nobody is guessing.
What a good carer does
- Arrives when booked, and rings early on the day something has gone wrong
- Keeps what they see and hear in the house to themselves, including from the wider family if your relative asks
- Reports a fall, a change in mood or a bruise the same day, in writing
- Sits with your relative for the whole visit: a cup of tea and a conversation are part of the job
- Asks before doing anything new, and says no to a task they are not trained for
- Raises a safeguarding worry with the family or the council, even when it is awkward
What a carer should not do
- Misses a booked visit without a word. On PrimeCarers, a carer who does this can be removed from the platform
- Drinks alcohol or uses drugs before or during a visit, which also voids their insurance
- Spends an hourly visit on their phone. On a live-in placement or a long night, quiet moments are reasonable; while somebody needs them is not
- Posts anything about a client online, or photographs them without consent
- Brings other people into the house, or their own children, without asking
- Discusses your relative’s health or affairs with neighbours or anybody outside the arrangement
Confidentiality has one exception, and it is important. If a carer believes your relative is being harmed or neglected, by anyone, they should report it, and the family cannot ask them not to. That is the safeguarding duty every adult in care carries, and a carer who takes it seriously is the carer you want.
If something is wrong
What to do if a carer does something they should not
Most problems are misunderstandings about what was agreed, and a conversation fixes them. A few are serious, and those need to be handled in the right order.
- 1
Say it the same day
For anything that is not seriousA missed task, a phone on the table, a visit that ran short. Say what you noticed and what you expect, and write the outcome into the care plan so it is not a matter of memory next time. Most carers would rather hear it than lose the job. - 2
Write down what happened
Dates, times, what was saidIf it happens again, or if it involves money, medication or your relative’s safety, keep a note from the first time. It makes every later conversation easier and fairer to everyone. - 3
Tell us
0203 369 3624If the carer came through PrimeCarers, ring us. We can talk to the carer, help you find cover, and we remove carers who miss visits without notice or behave in ways that put a client at risk. You do not have to work it out on your own. - 4
Report harm to the council, or the police
For theft, abuse or neglectEvery council has an adult safeguarding team you can ring, and they will look into it whether or not the carer works for an agency. Theft is a police matter. Do not wait to be sure; that is their job, not yours. - 5
End the arrangement cleanly
48 hours’ notice for hourly careHourly care on PrimeCarers runs on 48 hours’ notice for visits already agreed, and there is no obligation to book more. Where there is a safety issue you can stop the same day. Have a second carer or a family rota in mind before you do.
Handling problems with a private carer goes through the common ones in more detail, and working with private carers covers how to set the arrangement up so that most of them never arise.
Questions
Questions families ask about what carers can and cannot do
Yes, at the right level. Reminding somebody to take their tablets and handing over a blister pack or dosette box the pharmacy has filled is everyday care, recorded on a chart. Measuring doses from the original boxes, eye drops and inhalers count as administering, and NICE guidance says the carer should be trained and assessed as competent, with your relative’s consent written in the care plan. Changing a dose, or hiding medicine in food, is never a carer’s decision. What carers can do with medication.
Not on their own initiative. Injections are nursing care. A district nurse or diabetes team can delegate a specific injection to a named carer they have trained and signed off, with a review date, and many live-in carers give insulin on that basis. Without that written delegation a carer should not put a needle in anyone.
Not by hand. Lifting a person’s full weight injures carers and drops people, and a carer’s insurance will not cover it. A trained carer will use a hoist, a stand aid or a slide sheet, and will guide somebody up from the floor after a fall only if they are unhurt and can help. If your relative cannot bear their own weight, ask the council for an occupational therapy assessment; the equipment is free. Moving someone safely.
A card or a box of chocolates, yes. Money, jewellery or anything of value, no, however sincerely it is offered, and the carer should tell the family it was offered. If you want to thank a carer, agree a bonus openly and pay it through the platform so it is recorded.
A carer should do neither. A witness to a will cannot inherit under it, and nor can their spouse, so a carer who witnesses loses any gift. A gift to a paid carer in a will invites a challenge after the person dies. Keep carers out of wills, and out of lasting powers of attorney, altogether.
Only when it is necessary to prevent harm and the force used is proportionate to that harm, which is what section 6 of the Mental Capacity Act requires. Steering somebody back from an open front door on a winter morning is proportionate. Locking them in, tying them to a chair or holding them down so a task gets done is not, and is never a carer’s decision to make. Where wandering is constant, the answer is door sensors, night care and a conversation with the council.
Yes, and a good one will. A self-employed carer sets their own limits, and should say no to any task they are not trained or insured for, and to anything they think is unsafe. If a task matters to you, agree it before the first visit and put it in the care plan, so that both of you know what the job is. Writing a care plan with a private carer.
Often, yes. An agency is regulated by the CQC and its carers work to the task list the agency has trained and insured them for. A private carer engaged directly by you and working under your direction is excepted from CQC registration, so what they can do depends on their own training, their insurance and what you have agreed, which is why it pays to check all three. Self-employed carers and the CQC.
Write down what is missing and when you noticed. Ring the police, because theft is a crime, and ring your council’s adult safeguarding team, who will look into it whether or not the carer works for an agency. If the carer came through PrimeCarers, ring us on 0203 369 3624 and we will help you find cover. Handling problems with a private carer.