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Practical support

Home care

Having someone who comes into the home of the person you care for to help with their care can be important. You may be able to get paid care workers (known as home help) to provide help in the home of the person you're looking after. These care workers can also be known as care attendants or personal assistants. They provide practical support to help you to continue to care for the person you're looking after.

Home help can provide services such as:

  • Domiciliary care for the person you're looking after. This includes help with getting up and going to bed, bathing, dressing, meals and medication. 
  • Help with shopping.
  • Sitting with the person you're looking after to allow you to have a break.
  • Helping the person you're looking after to go to the cinema, pub, shopping or to enjoy any other community activity.
  • Practical tasks around the home such as cleaning and cooking.

However, some local authorities only fund home help in exceptional circumstances.

If you need to find home care services you can search NHS Choices directories for:

or

If you believe that the person you're looking after may benefit from home help, the first thing to do is to contact their social services department to ask for a community care assessment. To contact social services go to GOV.UK: find your local authority

A community care assessment is an assessment of the needs of the person you're looking after. Either you or they can request this.

In a community care assessment, social services gathers a range of information about the circumstances of the person you're looking after and their need for community care services.

After the assessment, the local authority that runs social services will explain whether it is able to provide services, what it can provide and for how long. The department will then carry out a financial assessment to decide whether the person you're looking after can afford to contribute towards the cost of the service.

Social services may provide or arrange the help themselves, or the person you're looking after may choose to receive direct payments or a personal budget in order to purchase their own care.

If the person you're looking after chooses direct payments, or they are not eligible for help from social services, or they simply wish to arrange their own care privately, this can be arranged in several different ways.

Independent home care agencies

If you use an independent home care agency, you or the person you're looking after has to find the care agency and pay them. The agency will provide a service through a trained team of care workers, which means you may not always have the same person visiting your home, although the agency will do its best to take your choices into account. Independent home care providers are regulated by the Care Quality Commission (CQC). Agencies can:

  • Take over the burden of being an employer, for example, payroll, training, disciplinary issues and insurance.
  • Vet workers before engaging them by taking up references and carrying out checks on potential employees.
  • Train their workforce through induction, national qualifications and service-specific training.
  • Replace workers when they are ill, on holiday or resign.
  • Put things right when they go wrong.

To find an agency visit the United Kingdom Home Care Association (UKHCA).

Hiring a personal assistant

You can hire a personal assistant on behalf of the person you're looking after. The person you're looking after will then have the legal responsibility of an employer. There may be agencies that can assist them with their duties as an employer, for example payroll services. For more information on becoming an employer visit GOV.UK.

Home care from charities

Charities such as Age UK and Carers Trust can provide home help and domestic assistance services. Crossroads Care supports carers by giving them a break from their caring responsibilities.

Marie Curie Nurses can provide practical and emotional support for people near the end of their lives in their own homes.

UKHCA represents home care providers across the UK and can provide useful information about home care.

You can also find information from the CQC, which inspects and regulates care services for adults in England. Use the search box below to find CQC-registered homecare services in your area.

What can voluntary care workers do?

The person you look after may benefit from personal care or support. This could be provided by care workers or personal assistants who are paid to do this work, but in some cases, unpaid volunteers can provide care.

Types of volunteer

The work a volunteer does can vary enormously, and could include:

  • Befriending. This could include regular visits to someone in their own home or going out with them to leisure, social or educational activities.
  • Specific activities such as doing the gardening or jobs in the home.
  • A more extensive role, such as living in shared accommodation and providing assistance or supervision.
  • Accompanying the person when they go on holiday.

Example

Joy is frail, her family lives a long way away and she doesn't have much social contact with anyone. Her daughter contacts Age UK and they introduce Joy to a volunteer befriender who visits her on a regular basis and takes her to a local social group once a month.

Flexibility

The help a volunteer provides can be invaluable. It is likely to be more informal and flexible than help from paid workers. A volunteer may also be able to provide care and support in situations where it's difficult to find a paid care worker.

However, it is sensible to take some basic precautions if a volunteer is going to provide some care for the person you look after. The type of checks you need to make will depend on your circumstances and the work the volunteer is likely to do.

If the volunteer is introduced to you by an organisation, ask the organisation about the following matters:

Criminal Records Bureau checks

Ask whether an enhanced Criminal Records Bureau (CRB) check has been done. This check identifies whether the volunteer is unsuitable to work with children and vulnerable adults. A new vetting and barring scheme for people working with children and vulnerable adults was planned for July 2010, but this scheme has been halted as it is being reviewed by the government.

References

You should also ask whether the organisation has checked references for the volunteer.

Manual handling and personal care

If the volunteer will be doing any manual handling or personal care tasks such as washing the person you care for, you should confirm whether they've had any relevant training and experience. You should also check whether they're covered by insurance (see below).

Health and safety

The person you look after has a duty to ensure that conditions are safe for the person providing them with care. This is no different for an unpaid worker. A risk assessment should be carried out to establish whether there are any particular tasks or hazards that could cause problems for the volunteer.

Insurance

You and the person you look after need to consider insurance cover for two reasons. First, to cover any risk of injury to the volunteer and, second, to cover the risk of the volunteer injuring the person you care for.

Check with the organisation supplying the volunteer whether there's any existing insurance cover for either risk. Check also whether the person you care for already has appropriate insurance, such as employer’s liability insurance or public liability insurance.

Code of conduct

Ask the organisation introducing the volunteer whether it has a code of conduct for volunteers to work within. This may include, for example, the volunteer agreeing to respect confidentiality, privacy or the cultural preferences of the person they're looking after.

If you or the person you care for have found someone to provide unpaid care without going through an organisation, it is probably even more important that you carry out as many checks as you can and make sure that insurance is in place.

Regulation of care workers

Since October 2009, there have been two lists: one for people barred from working with children, and one for people who are barred from working with vulnerable adults.

Safeguarding vulnerable groups

Since January 20 2009, the Independent Safeguarding Authority (ISA) has held responsibility for making decisions about who is unsuitable to work or volunteer with vulnerable adults or children. It makes this decision based on information held by various agencies, government departments and the Criminal Records Bureau (CRB).

The ISA will decide who is unsuitable to work or volunteer with vulnerable adults or children. Decisions will be based on information held by various agencies, government departments and the Criminal Records Bureau (CRB).

Any questions about the Vetting and Barring Scheme can be answered by the Vetting and Barring Scheme call centre on 0300 123 1111. Opening times are Monday to Friday, 8.00am to 5.30pm.

Once the scheme is in full operation, it will be illegal to employ a person to do certain types of work with vulnerable adults or children if they have not first been checked by the ISA and registered with them.

Since October 2009, the ISA has held two lists: one for people barred from working with children and one for people who are barred from working with vulnerable adults.

Safeguarding vulnerable groups

A new vetting and barring scheme for people working with vulnerable adults or children was to have been introduced by the ISA in July 2010. However, the government is now reviewing this scheme. As a result, the scheme will be halted while the review takes place.

Although the vetting and barring scheme has been halted, the safeguarding regulations introduced in October 2009 still apply. This means that:

  • If someone who is barred from working with children or vulnerable adults is working, volunteering or trying to work or volunteer with these groups, they are breaking the law. They could face a fine and up to five years in prison.
  • Employers must apply for an enhanced Criminal Records Bureau check when taking on new employees or volunteers to work with vulnerable adults or children. This includes a check of the barred lists. If an organisation fails to make the relevant checks, they can be penalised.
  • If an organisation dismisses an employee or volunteer for harming a child or vulnerable adult, they must tell the ISA. The ISA must also be notified if any employee or volunteer harms a child or vulnerable adult, but isn't dismissed because they leave voluntarily. If their organisation does not tell ISA, they will be acting illegally.

Any questions about the Vetting and Barring Scheme can be answered by the Vetting and Barring Scheme call centre on 0300 123 1111. Opening times are Monday to Friday, 8am to 5.30pm.

Employing a care worker on a private basis

If you employ a care worker privately, you will not be obliged to use the ISA scheme, but you can use it if you choose to. You need to ask social services or the police to make the checks on your behalf. The care worker must have already applied to be vetted, and must consent to the check.

If you have concerns about the suitability of someone you employ privately to work with a vulnerable adult or child, you can ask social services to investigate the matter. They can refer the worker to the ISA on your behalf.

Manual handling

The person you care for may have personal care needs that involve 'manual handling'. Manual handling means helping someone to move, and can involve lifting. These needs can include help getting in and out of bed, going to the toilet or getting washed.

Health and safety

Manual handling can put the person doing it at risk of injury. In some cases it may cause back pain and, in the most serious cases, permanent disability.

The law says that employers must take reasonable precautions to ensure their employees don't do any manual handling that carries a risk of them being injured. Employers should carry out a risk assessment to establish what those risks are, and should ensure that employees are suitably trained and have the right equipment to minimise any possible risk.

Local authorities and policies about manual handling

Local authorities are sometimes so concerned about avoiding any possible risk that they won't allow services to be provided at all if they involve manual handling.

A policy that forbids all manual handling is likely to be illegal. Local authorities should weigh up the risks to their employees against the needs of people with disabilities. Failure to lift a person with a disability may affect their dignity and privacy and could be a breach of their human rights.

Using direct payments to employ someone to do manual handling

If you or the person you care for receives a direct payment to employ a care worker, the responsibility for their safety becomes yours and not that of the local authority.

If the care worker is required to do manual handling, you'll need to do a risk assessment to ensure that they're not required to do anything that would risk damaging their health.

It is particularly important to consider insurance in this situation. This would cover any risk of the care worker injuring themself, as well as any risk of them causing an injury.

Carers and manual handling

If you're involved in manual handling, you should take precautions to minimise any risk to your own health and safety. Ask the local authority to provide you with equipment to make the work safer and easier, and training in manual handling. If the local authority doesn't run its own manual handling courses you can ask for a direct payment so that you can pay for a course of your choice.

You may only be providing manual handling for the person you care for because the local authority refuses to allow its care workers to do those jobs. You should make it clear to the local authority that you're risking your own health and it has an obligation to you as a carer to avoid that risk.

For more information see moving and handling.

Using a home care agency

If you and the person you're looking after employ a care worker privately or have a direct payment from social services to do so, you may choose to use a home care or nursing agency.

A home care (also known as domiciliary care) agency should provide trained and experienced care workers to meet the needs of the person you're looking after. You may be looking for temporary or permanent help, someone to work a few hours during the day, sleep over some nights of the week or even to live with you. A nursing agency can help you find workers with more specialist nursing skills.

An agency will usually arrange to see you and the person you're looking after so that they can assess your needs. This also means that a joint decision can be made about the most appropriate type of care and support.

What are the advantages of using an agency?

Agencies recruit staff, which means that you don't need to advertise privately. The agency will assess the needs of the person you're looking after and suggest an appropriate care worker. They normally also check references and provide training, supervision and support to the care worker.

If there are any concerns or problems, they will liaise between the care worker and you and the person you're looking after. If the care worker is on holiday or ill you'll be able to ask the agency to provide an alternative worker. If you don't use an agency you will have to do all of these tasks yourself.

What are the disadvantages of using an agency?

The main disadvantage is the cost of using an agency. The agency will charge a fee on top of the payment made to the care worker. You normally have to make a regular payment to the agency, which includes both the worker’s earnings and the agency’s fee.

Questions to ask

The fees some agencies charge can be quite high. Before deciding to go ahead with an agency, you should ask questions about the fee and what it covers, including:

  • Does the agency check references?
  • Do they carry out Criminal Records Bureau (CRB) checks?
  • What training and supervision do they provide?
  • What is their complaints policy?
  • Who will be responsible for insurance?
  • Is there any out-of-hours or emergency contact if needed?
  • Will they be able to provide staff if your own care worker is ill or away?

Regulation of home care and nursing agencies

Home care and nursing agencies have to be registered with the Care Quality Commission (CQC). There are national minimum standards and regulations that agencies must follow. The CQC covers matters including the way in which supervision is carried out or the qualifications the agency manager needs to have. The CQC has the power to inspect agencies and enforce standards.

How to find a home care or nursing agency

One way of finding an agency is by word of mouth. Ask family members or friends if they can recommend an agency they have used themselves. You may also be able to get a list of local agencies from social services. Another option is to use a service such as the United Kingdom Home Care Association (UKHCA). This is a professional association of home care providers that can refer you to agencies in your area.

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In this video, Claire and her family talk about the decision to care for her mother at home.

Media last reviewed: 05/08/2013

Next review due: 05/08/2015

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The 6 comments posted are personal views. Any information they give has not been checked and may not be accurate.

TiredChris said on 01 May 2014

I am suffering even More,Now;& I'm going to try & Appeal Hull Social Services Recent decision Not to increase my hours....
- I'm waiting for a letter on H-O-W to go about it...
I Havn't been able to get DLA in the past & I Applied for P.I.P. in Dec 2013,and I'm waiting for a "Healthcare professional" from ATOS to visit me & write a report that he said he caught me Training for the weightlifting event in the 2016 Olympics or some such rot Like that,that they've written the last 2 times. What he saw was nothing like what they wrote.... :(
(Not that they lie Or anything like that U understand.... :(
-I'm Also so Glad that we live in a 'free' society where U can tell the truth without censorship.... (Like they used to have in communist russia/east germany,etc..... :)
The 'healthcare proffessionals' get £250 a time Just to make sure i don't get a fair deal.... :( I wonder how they sleep at night.....I Really do....

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liveinhopejulie said on 06 March 2014

Hi TiredChris and givinUp, I too suffer from ME and have done for several years. I have 5 hours a week care which is just being increased to 6.5 hours. It is not a lot but I am very grateful for it since I can do so little for myself. My Dr arranged for social services to visit me initially and, fortunately, they understood my condition and my circumstances and so arranged the care. Maybe your Doctor could do the same. I seem to recall (brain fog) that he pointed out that without help, I would end up in hospital. I also, finally, got through the DLA system and use that money for cleaners and additional care time. Don't give up. I know how very hard it is to pursue these things when you are exhausted but if you get the help it makes life some much easier. Hope this is of benefit. Julie Suffolk

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teenycherryboob said on 07 October 2013

I have always wanted to be a carer or home help since I was young.... I have had 2 children which has kept me busy but my 2nd starts school next year so I keep thinking maybe I should try to get into it...
It's a sector I feel needs a lot of support.... My gran gets a home help and it's in and out really and it shouldn't be like that....
I have no idea how I get into it... Will have to google it....
But if I got unwell I would want care and these 15 min visits some are doing are not enough :-(

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givenup said on 02 October 2013

Hi TiredChris, I have the same illnesses as you plus other serious long term illnesses.
I live in Birmingham and I get zero hours home help/personal care so you are doing better than me!!
I am so ill that I have not been able to leave my home for more than 2 years....

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TiredChris said on 30 June 2013

I live in Hull,and I have Really Bad "Chronic Fatigue Syndrome"/Myalgic Encephalomyelitis / Fibromyalgia (a combination of all 3 medical conditions), and ALL I get from Hull Social Services is 9 hours per week (out of 168) home-help / 'Personal Assistance",and it Isnt a small fraction of the 'home-care' I Really Need.......... :(
- I'm so weak that I Couldn't kick the skin off a rice pudding........... :( I Dont Think though that complaining to Hull Social Services 'vulnerable adults' Dept will help me get more 'hands on' help though,unfortunately........ :(

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User769117 said on 29 April 2013

how ideal home care

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Page last reviewed: 15/08/2012

Next review due: 15/08/2014

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