Carers and Personal Assistants In Your Home

While having a carer or personal assistant (PA) in the home is often essential for the health and well-being of you and your child, it comes with its own challenges and can be daunting at first. It is understandable if you have concerns; Will they fit into the family dynamic? Will they be reliable? Will they understand my child’s needs?

In this article, we look at ways to help you find the right carer and build a professional relationship.

Difference between Home Care and Home Help

Home care refers to day-to-day living tasks. This may include:

• Personal care
• Medical care
• Completing paperwork
• Taking children to activities

Home help is slightly different and refers to day-to-day domestic tasks that you may need help with, such as:

• Cleaning
• Laundry
• Gardening
• Shopping

You may have an agreement with your carer or personal assistant that they also undertake some home help, but it is important not to assume these tasks come with their role.

Unfortunately, most councils do not provide home help, but you can contact a charity, such as the Royal Voluntary Service or the British Red Cross, to see whether they can help you.

Employing a Personal Assistant (PA) or Carer

With the rise of Personal Health Budgets in recent years, employing a PA or Carer yourself can be appealing for parents who would like more control over who is in their home. For others, using a home care agency is less hassle.

A person is considered an independently employed home carer if you hire them and they are not self-employed or paid through an agency. You are classed as an employer if you pay a carer or personal assistant directly, even if you get money from your local council or the NHS to pay for them.

Pros of using an Agency:

• They will handle all payments, taxes, and insurance, saving you time.
• They will complete police checks and follow up on references.
• Using an agency may relieve some stress when you are new parents or coming home from the hospital for the first time. Having an agency take care of staff management and rotas may give you more time to concentrate on organising other responsibilities.

Pros of employing a PA or Carer:

• It gives you a more flexible and tailor-made package of support as per your care and support needs.
• You can choose to employ an individual who fits into your family dynamic.
• You have control over the rota of care.

Cons of using an Agency:

• You do not have as much control over who is giving care as you would if you were employing your own PA or Carer.
• You might have several different people visiting your home.
• Some home care companies are not regulated. For example, with introductory-type services, when a carer has been allocated, the person needing care and their family are responsible for managing them. If you want to avoid this type of company, ask them to send you a copy of their Care Quality Commission (CQC) registration. If they cannot, they may be unregulated.

Cons of employing a PA or Carer:

• You will need to advertise the position and interview potential candidates
• You will be the employer and have the responsibility to meet the employee’s rights, which can be time-consuming.
• You will have to find cover for when your carer is on holiday or absent from work.

If you have decided that you would like to use to an agency, you can find a list of CQC-registered agencies here, or you can visit the UK Home Care Association (UKHCA) website.

If you have decided that you would like to hire a PA or carer, Scope gives further information to help make sure you are fulfilling legal requirements, read their article here.

Top Tips for Managing a Carer in the Home

1. Due diligence

If you are using an agency, check the Care Quality Commission (CQC) website to find information about the service. The CQC is the independent regulator of health and adult social care in England; they make sure health and social care services provide people with safe, effective, compassionate, high-quality care, and encourage care services to improve when needed. The CQC have the power to take action if they find poor care. On their community service pages, you will find:

• The latest inspection report and ratings
• Older reports to download
• Information about who is responsible for running the service
• Contact details for the service.

If you are employing a PA or carer, make sure you:

• Check they have the right to work in the UK
• Ask for copies of personal and professional references and see if there is anyone you can speak to directly who has used their services
• Ask for a copy of their DBS certificate

2. Prepare for staff turnover and shortages

Staff turnover averages 30% at care agencies. This means that the home carer assigned may leave employment soon after starting. Staff turnover can be very frustrating and disruptive for families.

If using an agency, ask what actions management staff takes when a new carer has to be identified and introduced to your family. It is important to know if the agency take responsibility for training the replacement carer, or if the responsibility falls on you.

If you are employing a PA or carer yourself, you will need to discuss cover arrangements for their holidays and absences. It may be worth having several members of bank staff (flexible workers who can be contacted by an employer when the need arises) in order to cover short notice leave or sickness. Student nurses make good bank staff workers, as they have on the job training and often need to work part time during their studies.

3. Communication

Try and establish a relationship with the owner and/or supervisor of the care agency to support open communication about concerns you may have, and ways to identify solutions. You can ask how often the supervisory staff will contact you to request feedback, and about the frequency of supervisory visits to your home to ensure customer satisfaction.

If you are dissatisfied with your assigned carer, you can contact the agency and request a replacement. By establishing an understanding of care expectations, the agency can work to meet these goals.

4. Professional Boundaries

No matter how close you or your child becomes with your carer, remember that they are a professional and not a member of the family. By creating and maintaining a professional relationship you help ensure that the care needed is what is provided and avoids undue upset. You can ask for a list of professional boundaries or rules of the company so that you are aware of permitted and non-permitted activities so that you do not create complications for the carer.

Here are some things you can do to help promote healthy professional boundaries:

• Clear roles and responsibilities – Be clear about what is and what is not in the carers job role. Discuss how you would like them to engage with members of the household, including siblings.

• Values and cultural norms – While it is not normally appropriate to discuss religion or politics in a work environment, it is important to make sure your home environment is comfortable, for both you and the staff member. Discuss norms that are important to you and where you stand on matters like swearing and gift-giving.

• Uniforms– Staff wearing a uniform or scrubs while at work is not only good for hygiene, but helps as a reminder that even though it is a home environment, they are at work.

• Use of household items– Let the staff member know your feelings on the use of your household items while they are at work. While it is reasonable for them to use the facilities and drink water from the tap, let them know how you feel about taking food from the fridge or charging their electrical items.

• Shadow Shifts– Having carers attend one or two shadow shifts before employment may be useful. Both you and they can get a feel for how you would work together, and the carer shadowing can learn from experienced carers you are already working with.

Carers are usually directed not to provide personal information to clients. This includes personal mobile phone numbers, family information, and personal matters, for example, if they are having financial distress or problems at home.

5. Hygiene

Infection control is very important when working with children with serious medical needs. Ask your home carer to:

• Wear clean clothes for each shift
• Leave coats and bags by the entrance
• Remove any jewellery
• Adhere to the NHS recommended handwashing regime
• Use bacterial wipes throughout the day

You may still wish to display a poster if you child is particularly vulnerable to airborne illness, see our poster (PDF/1MB) for an example

6. Daily check sheets

It can be helpful to make a daily checklist for the carer to avoid unproductive time. Then request the carer document in a notebook the projects completed on the checklist or those that were uncompleted and why. This system of checks and balances ensures you are getting the right support and highlights any trends that need addressing. For example, the carer turns up for their shifts early, which seems like a good thing to them, but may actually be disturbing some precious quiet time you have!

For further information on what makes a good care agency see here.

If you have any comments, ideas, or suggestions about this article please contact us at [email protected]

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