Informative Health Articles And News: Paying for care at home: how to negotiate the minefield

How much should you pay for care in your own home as you get older – from getting in and out of bed to taking medication or help with shopping? And how do you find a carer? With adult social care in crisis as local authorities struggle to meet soaring demand at a time of cutbacks, Guardian Money tested prices and services in a town with a high density of older people: Eastbourne in East Sussex.

Pinning down providers about their precise charges, however, proved tougher than we expected. Someone needing personal care for just one hour a day could be billed more than £7,500 a year by an agency. But we also found high-quality services for half that – with the emergence of independent “personal assistants” who contract directly with the individual, often at much below the rate charged by the big agencies. The highest bills we saw were for a live-in care assistant. One agency told us the annual cost starts at £1,500 a week, equal to £78,000 a year.

Several agencies, some local to Eastbourne but others operating across the UK, declined to give us prices. Many insist on meeting a potential client in their home before agreeing a price, which while understandable given the wide variety of needs that an older person may have, makes it difficult for families to carry out proper cost comparisons. On top of that, care is not just about cost – personal recommendations can be crucial, as well as the overall quality of care.

Here we guide you through how to get a free care assessment, and the financial assessment that follows. Note that if you qualify, the money can be paid directly to the individual, who is then free to choose the care assistance they need. But should you choose an agency, or opt for a personal assistant that you deal with directly? There are pros and cons for both.

Using an agency
These cost more – our survey found that prices start at around £18 an hour but rise to £22.50 at weekends, and as much as £45 an hour on bank holidays. Personal assistants are cheaper, but agencies are better able to guarantee care, usually able to find someone to come out even if the regular person they send falls sick or is holiday.

Ian Cottrell of Home Instead’s Eastbourne and Hailsham branch told us: “Our visits to clients are always at least an hour, often more, because we believe that good-quality, companionship-based care can’t be delivered in less. We aim to meet the ‘mum test’ – care we would want our own family and loved ones to receive.”

He said it always pays its carers above the national living wage, currently £7.20 an hour, rising to £7.50 from April.

We also spoke to a carer who worked for an agency a year ago in the Eastbourne area, although not one of the ones named in this article. She spoke on condition of anonymity: “We were paid around £7 an hour but were charged out at nearly £25. We did not have much time to get from one appointment to the next, and you often felt that you were rushing clients. The sad thing is that the clients often didn’t know who they were getting, sometimes with different people one week to the next.”

Using a personal assistant
The NHS says personal assistants offer all you would get from an agency worker, but you get continuity, familiarity and an ongoing relationship. However, if you employ a personal assistant, you then have the legal responsibility of an employer. This will include arranging cover for when they are ill or on holiday. The Rowan Organisation is a charity that can advise on these issues.

To find a personal assistant, we used the Support With Confidence database of approved care providers. It operates in East Sussex, Oxfordshire, Berkshire, Nottinghamshire, Surrey and a few other locations around England. It’s then up to you to contact the assistant directly and arrange care. They are cheaper than agencies, at around £10-£15 an hour, although when we rang we found many were already fully booked.

“It’s the best of all worlds,” said one male aged 60, who took early retirement then retrained as a personal assistant and now works part-time with male clients. “Gentlemen of a certain age sometimes feel a greater afinity with another chap for company. As a man, arguably, I am also better able to cope with the physical aspects of dealing with a bulkier client. The arrangement is made directly with me. I mostly do weekdays, but at weekends I take a client to a football match. I do a lot of respite care, which means giving the regular carer, often the wife, a break.”

If a PA is unavailable – because of holidays or illness – it can be possible to arrange an alternative personal assistant to take his place, using informal contacts locally. “It’s a zero hours contract – if I’m not there, then the person is not charged.” He chooses not to offer assistance with medication, thereby highlighting one of the issues when choosing a carer: you very much have to discuss the parameters of what they will, or are qualified, to do. “They are mostly really grateful for someone to be there – and it’s a very rewarding job,” he says.

What they charge

All the prices we obtained were for at-home care services in Eastbourne. Many of the national chains work on a franchise basis, and rates may vary markedly across the UK

Everycare

Twenty locations across England, Wales and Scotland, offering all aspects of at-home personal care, holiday escorting and outings. In Eastbourne it has a minimum charge of £37.80 per week.

• Weekday hour: £18.90

• Weekday hour after 6pm: £20

• Weekend hour: £22.50

• Weekend hour after 6pm: £25

• Bank holiday hour: £32

• Night sleeper (carer has bed and is disturbed no more than twice in night): £125 weekdays, £145 weekends.

• Night sitter (carer stays awake): £175 weekdays, £200 weekends.

Home Instead

The biggest home care provider in the UK, operating from 170 locations. Globally it has around 1,000 offices from Topeka to Tokyo. Prices listed below are for its “companionship and home help” service. For “personal care” the price is an extra 50p an hour.

• Weekday hour: £20

• Weekday hour after 7pm: £22

• Weekend hour: £22

• Weekend hour after 7pm: £22

• Sleepover (carer must achieve at least four hours continuous sleep, or extra charges will be applied): £170.

Prestige Nursing+Care

This agency has 45 company-owned and franchised branches across most of the UK, with more than 2,500 nurses and care workers. It did not give us a full price list for its Eastbourne branch, but gave the following information:

• Weekday hour: £18 for healthcare assistant or £40 for a nurse.

• Weekend hour: “Rates are typically 10% higher”, eg, £19.60 for a healthcare assistant and £44 for a nurse.

• Live-in care: “It is difficult to give an exact cost for 24-hour care as every client’s needs are unique. Our costs would typically start from £1,500 per week.”

Support with Confidence

This is the service offered by East Sussex County Council, which lists approved personal care providers. Some are agencies, but many are individual personal assistants that the elderly can personally contract with. Available online at Eastsussex.gov.uk, it lists 57 providers within the Eastbourne area. Each sets their own rate, so we had to rely on individual calls to carers. Not all will provide full care services – some, for example, offer medication assistance, but others do not.

• Hourly rate: £10-£15. Extra for weekends and bank holidays.