Visiting Carers

• getting dressed
• taking medications
• heating ready-meals etc, and dishwashing
• toileting
• washing/bathing
• hoisting for people who are immobile
• checking everything's ok
• providing some social interaction, and managing entertainment such as the radio
• helping them keep in contact with you, if they have difficulty with the telephone
• potentially, if agreed: simple pet care - but also see our section on dog walking and help with pets.

• clothes washing
• shopping
• house-cleaning
• delivery of 'meals on wheels'
• gardening
• hairdressing
• podiatry / chiropody
• eye test
• window cleaning

In the UK, social care is provided by the County Council or equivalent. Go to their website and search for "adult social care". They will be able to make a 'care needs assessment' of your loved one's needs in terms of numbers and types of visits, and of other things such as house adaptations. They will also be able to make a 'financial assessment' of whether the Council or your loved one should pay (and they may also refer to 'NHS continuing healthcare'). More information on paying for care is available in the NHS website's social care and support guide.

If you're paying privately, you may, of course, make arrangements for visiting carers yourself.

You may also pay for additional care visits beyond the level assessed by the Council. In that case it's preferable to use the same provider for the additional visits, for staff continuity and for simplicity.

It may be difficult to get signed up straight away for as many visits as you'd like, if the agencies don't have enough carers to be able to take on additional visits. Unfortunately, while giving care is a very rewarding job in terms of job satisfaction (if there's enough time to do the job well), it isn't well paid and so recruitment's difficult.

There are significant time pressures on carers - they typically only have half an hour per visit, and may be allowed insufficient travel time, particularly when there's heavy traffic. A visit may end up shortened once the key things have been done, simply to make it practical for them to get to their next appointment and make sure everyone gets care.

Unfortunately it's not unheard of for a scheduled visit from a carer to be missed, either because there's been a mix-up at the office, or there's been an emergency on an earlier part of their round, or because of snow etc. If you're not near enough to visit, is there a trustworthy neighbour or a capable friend who could help on the odd occasion?

In order to know when a visit's been missed, you may find it useful to have the visiting carer phone you from your loved one's phone each time they're there - particularly as this can also be very useful if your loved one doesn't always put the phone down correctly and you can't get through, or there's some difficulty your loved one has mentioned in an earlier phone call and you want to ask the carer to do something or check something.

The agency should give you a number to call if you think a visit's been missed.

In the UK, the following government organisations regulate and inspect agencies providing visiting carers:

• In England, the Care Quality Commission (CQC) website lists services in your home, and their quality grades. You can use filters including proximity, Overall Rating, and Conditions: Dementia/Alzheimer’s.
• In Scotland, the Care Inspectorate website allows you to find a care service, and its quality grade. Enter your postcode, then select the plus sign next to Support Service, followed by the plus sign next to Support Service Care at Home, then tick Support Services - care at home, then click the Search Care Services button. You can use filters including proximity and Grades.
• In Wales, the Care Inspectorate Wales website has a directory of registered care services, and their quality grades. Select Service Type: Domiciliary support service, then click Update results. You can use a filter for proximity.
• In Northern Ireland, the Regulation and Quality Improvement Authority (RQIA) website lists inspection reports. Select Choose Service Type: Domiciliary Care. You can use a filter for location.

Also in the UK, the NHS website has a directory to find homecare services.

For someone with dementia it's best if you're involved as the plan is drawn up, answering questions and volunteering information you think will be useful. The sorts of information covered are outlined further below. We'd recommend reading a copy after it's completed, to check everything's right and nothing's been missed.

The care plan shouldn't simply list tasks to be done, it should give any necessary details of how to do them. For example, "Fingernail cutting - She gets very nervous unless you soak the nails in lukewarm water for a couple of minutes first, and use clippers not scissors", or "Toenail cutting - a chiropodist visits every 6 weeks (contact details ...)". Similarly, the care plan shouldn't list problems without giving solutions as best as there are, for example "Sometimes she gets anxious about what to be doing and needs reassurance that she won't forget to do anything because the carers come when it's time to do something. You can use the landline to call her son to have a chat with her, as that settles her.".

The care plan should be reviewed periodically and updated where necessary. This may be annually, or after an event such as a fall, or when it's felt that physical or mental capabilities have changed. If you have a copy of the care plan in a hospital bag then update that too.

The areas covered by a care plan should include:

• admin:
  • how to get in e.g. key safe and who has the code
  • contact details for loved ones
  • contact details for doctor etc, NHS/other medical number, and medical insurance details where applicable
  • where things are kept, especially medicines or other things locked away for safety
  • location of the main gas valve, the main water stopcock, and the electricity consumer unit with the circuit switches (or 'fuse board'). (If a triangular key is needed to open a meter cupboard then make sure it's available.)
  • arrangements that have been made for shopping, washing clothes, house cleaning, medicine supply, financial arrangements etc
• abilities and needs:
  • communication abilities (and language if not English)
  • walking aids and mobility
  • toileting needs
  • washing and dressing needs
  • eating and drinking needs - see further below
  • medical needs - see further below
  • behaviour patterns, including commonly occurring themes, their triggers and reassurances
• wearables:
  • whether there's an emergency call system pendant or wrist button to be worn
  • whether there are spectacles (and which are for what distance), hearing aids or dentures
• medical needs
  • medicines (prescription and non-prescription)
  • any allergies to medicines
  • medical conditions including any effects on breathing pattern
  • medical history
• food and drink:
  • food allergies, and anything that must be avoided because of interactions with medicines or because of religious belief
  • whether thickened drink or textured/pureed food is required
  • whether any assistance (e.g. food to be cut up) or encouragement is needed for eating and drinking
  • any particular likes and dislikes
  • snacks
• sleeping, including preferred bedtime and getting up time
• entertainment at different times of day
• preferred room temperature and how the heating is controlled
• pet care
• things the carer is to do during each type of visit
• arrangements for planned and unplanned hospital visits etc
• where your contingency plans are if you have them.

• don't be tempted to get a cheap one - get one with good reviews (e.g. on Amazon), and in the UK look for one with the “Secured by Design/Police Preferred Specification” accreditation.
• get one with weather protection - usually an additional plastic cover that hinges over the metal safe. (This also helps make it less obvious to passers-by.)
• many have buttons instead of rotating rings of numbers for the code, so while the carer is inside the house it's less easy for anyone to see what code has been left set.

• choose a random code, and keep several copies of the code.
• test that the key safe works several times before putting it on the wall (unlocking when it should; not unlocking when it shouldn't).
• it needs to be very firmly secured to a flat surface of brick or stone, by drilling into the wall.
• consider getting it supplied and/or installed by a house maintenance service for the elderly. They may even know of a free scheme for those needing carers.
• place it out of obvious sight if possible, whilst ensuring it's easily accessible to the carers and visible in the dark.
• for ones that have buttons instead of rotating rings of numbers for the code, don't be tempted to set more digits than it states, as that would actually make it less secure (because the buttons can be pressed in any order, so you'd just be reducing the buttons that need to be left unpressed).
• if the button labels are simply raised numbers in the same colour as the body, consider dabbing a little paint onto the raised surfaces to make them stand out.

• make sure you have spare keys in case the key safe jams shut (or a carer forgets to put the key back when they leave).
• don't have a door chain unless a carer will instead be able to get in via a locked but not bolted back door.