Hourly visits or live-in care? Where the crossover is

Visits suit the person who is fine on their own for most of the day but needs help with particular things: getting up and washed, tablets, a hot meal, getting to bed. A 30 to 60 minute call at each of those points is what most agencies are built to provide, and at one or two visits a day it is by far the cheaper option. It also keeps the house yours; nobody is living in it but you.

Visits stop working when the gaps between them become the problem: falls, wandering, confusion in the evenings, or a night that cannot be left. Adding more visits fixes the daytime but not the gaps, and the bill climbs fast.

Divide the live-in weekly rate by the hourly rate and you get the number of visit hours a week at which the two cost the same: about 44 at typical rates. Below it, visits are cheaper. Above it, live-in is cheaper and comes with the night included. Most families cross the line somewhere between three visits a day and half-day cover, often without noticing because the visits were added one at a time.

If you are paying for more than five hours a day, price a live-in carer. You may already be paying more for less.

• A bedroom for the carer, with a door that shuts. A box room is fine; a sofa is not.
• Food: the carer eats with the household, and the shopping goes up accordingly. Some agencies add a food allowance to the invoice instead.
• A daily break, usually two hours, when someone else must be around or the person must be safe alone. This is the bit families forget to plan.
• Handovers: a live-in carer works a stretch of weeks then goes home, and a second carer takes over. Ask how the agency or platform manages the swap.

Nights are usually sleeping nights: the carer is in the house and gets up if needed, but is not paid to be awake. If someone needs help several times every night, a live-in carer cannot do that indefinitely and a waking night carer is added, which changes the sums.

Visits cover the day. If the night is safe, visits can carry on a long way. If it is not, there are three answers: a night carer on top of the visits, at £120 to £180 for a sleeping night or £180 to £280 for a waking night; live-in care, which includes a sleeping presence; or a move. Once you are paying for nights as well as three visits a day, live-in is almost always cheaper, and the costs guide has the night rates by area where agencies publish them.

Visits are priced per visit, so a couple who both need help at the same time may be covered by one carer for a little more, or by a double-up visit for twice the rate, depending on what is needed. Live-in care for a couple is typically fifteen per cent more than for one person with an agency, or £1,350 a week through PrimeCarers, against two care home places at well over £2,000 a week. For couples, live-in care is where the money argument is strongest.

• Add up the hours you are actually paying for now, including weekends, and the nights you are covering yourself.
• If it is under about 25 hours and the nights are safe, stay with visits.
• If it is over 35 hours, or the nights are not safe, price live-in care from two agencies and from PrimeCarers, and look at the estimate.
• In between, think about what the next six months look like. Needs rarely go down.

The agency or your own carer guide covers the other choice you will face either way.