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Live-in carers

Professional and informal carers

Live-in carers, as the term suggests, live in the home of the person to whom they provide care. In many cases, live-in carers offer a more affordable alternative to residential care, enabling family carers to better coordinate their personal and professional obligations, and enabling people with dementia to continue to live in their own homes and communities. Live-in carers are sometimes described as belonging to the ‘grey’ care labour market.

“Grey market care refers to care work which is paid outside the formal economy thus avoiding taxes and social insurance fees. It also means that none of the parties involved are insured against unexpected events like accidents, illnesses, mistreatment or unemployment” (Kröger and Zechner 2009, p.20).

The consequences of such care arrangements and the impact on the lives of the live-in carers need to be considered. Limited research has been carried out on the experiences of such carers in the context of dementia. Often, studies exploring the experiences of live-in carers are not focused on dementia care but cover the care of children and older dependent people, as well as people with dementia.

Some live-in carers benefit from certain rights and protection (e.g. having been registered as employees, had their social contributions paid and/or simply being aware of their rights, especially those who are European citizens) (Doyle and Timonen 2009). Herz (2018) has compared different systems of live-in care in a range of countries, including some in Europe. In Austria, for example, live-in care arrangements were regulated in 2007 and are now formally recognised as part of the Austrian social care system, with possibilities for means-tested financing of such care. Known as 24-hour care, two live-in carers are usually employed on two-week rotating basis. Almost all are self-employed (Herz 2018). In the German-speaking part of Switzerland, live-in carers are usually taken on for periods of two to twelve weeks. In the UK, on the other hand, live-in carers are employed on a private basis, with no funding from the state and no official policies governing their terms and conditions of work (Herz 2018). Nevertheless, there are care agencies in the UK, which are regulated by the Care Quality Commission and provide live-in carers, as well as training, security checks and arrangements for leave and hours off.

Live-in carers employed on the grey market are becoming increasingly common in the Mediterranean countries such as Italy and Spain (Herz 2018). They are not formally registered as residents or employees. Even when official registration of their work and residency status would be possible, live-in carers are sometimes still taken on illegally and paid in cash by the care recipient or their family. Many live-in carers are not entitled to social benefits or minimum periods of time off, receive insufficient payment in exchange for their services, may lose their jobs in an instant, not receive their pay and would be in a difficult situation if they became ill. There are also implications for their future wellbeing and even survival if their pension contributions are not paid. Live-in carers with no residency rights (e.g. non-European citizens) are at greater risk of exploitation (Ungerson 2004, Degiuli 2007). However, even for Europeans, certain conditions must be met in order to have the right to reside in a different EU-country on a long-term basis[1] so even European live-in carers may find themselves in a difficult situation if employed on the grey market.

People receiving care as well as their relatives may also have concerns about the care arrangement and even experience abuse. People with dementia may at times have difficulty understanding or communicating various forms of abuse and there is a risk that they will not be believed if they report it (Ayalon 2009b in Herz 2018). People with dementia and their relatives may also be concerned about retribution from the live-in carer, should they complain and for this reason, might prefer to suffer in silence or take measures to keep the live-in carer happy (Herz 2018).

Different cultural backgrounds and languages may well make it difficult for live-in carers to adjust to their new environment. Families may also find it difficult to adjust to having a stranger in their homes at first. In some countries, certain nationalities are preferred over others because they are perceived as being more similar in terms of language and religion and as having certain positive personal characteristics. In Spain, for example, there is a preference for Latin American women, particularly Dominican, Ecuadorian, Bolivian, Colombian and Peruvian (Romero 2012). Very often, though, live-in carers come from countries with very different cultures, values, languages, and religions than the people they care for. Moreover, the choice of a live-in carer on the basis of ethnicity or nationality reflects the stereotyping of groups of people (e.g. people from one country or ethnic group are perceived as hard-working, those from another as being gentle and caring) (Herz 2018).  Live-in carers are generally required to provide care and assistance but are sometimes also expected to have certain characteristics such as being kind, sensitive and affectionate (Romero 2012) which seem to be more in keeping with a search for a life partner than an employee. This raises the issue of relationships and emotional attachment. It also reflects an emphasis on personal qualities rather than on knowledge and skills (Herz 2018).

Due to the long hours that they are expected to work, they seldom have time off and therefore spend almost all their time with the person in their care and the family. Some become almost a member of the family rather than just an employee. Karner (1998 in Weicht 2010) has described how migrant carers, especially live-in carers, are sometimes practically adopted by families and treated as ‘fictive kin’. This total emersion in the family life may be positive in some ways but could also lead to emotional strain, differences of opinion, limited opportunities for social interaction outside the family, social isolation and lack of opportunity to maintain contact with their own family and friends in their country of origin.

Some Alzheimer Associations have recognised the need to support both live-in carers and the families who employ them so that they can have a better understanding of each other’s needs and cultural background. The Alzheimer Society of Israel, for example, provides training for live-in migrant carers and families so as to promote a better understanding between the two. Alzheimer Uniti also provides language training as a means to empower live-in carer and promote their adaptation to the Italian culture. At the level of the State, Weicht (2010) and Romero (2012) describe State provisions for the care of dependent older people in Austria and Spain as being very male orientated, reflecting a male-breadwinner, female-carer ideology, with the majority of people being cared for at home. The ideology of family responsibility for care, which is frequently associated with minority ethnic groups, may also contribute towards the employment of female migrant workers by some majority ethnic groups. Live-in carers may be a mutually beneficial arrangement for many people but an approach that is open to abuse and the unethical treatment of live-in carers due to its largely unregulated nature.

[1] Extract from: EU freedom of movement and residence – “EU citizens with a valid identity card or passport may (…/…) live in another EU country for longer than 3 months, subject to certain conditions, depending on their status in the host country. Those who are employed or self-employed do not need to meet any other conditions. Students and other people not working for payment, such as those in retirement, must have sufficient resources for themselves and their family, so as not to be a burden on the host country’s social assistance system, and comprehensive sickness insurance cover” https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=LEGISSUM:l33152

 

 
 

Last Updated: Monday 08 April 2019

 

 
  • Acknowledgements

    This report received funding under an operating grant from the European Union’s Health Programme (2014-2020) and from the Robert Bosch Stiftung. The content of the report represents the views of the author only and is his/her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains
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