Live-In Care

Section 01Service definition

Live-in care provides a continuous presence in the service user's home, delivered by a carer living on-site for periods ranging from a fortnight to several months.

It differs from domiciliary care (visit-based), residential care (institutional) and supported living (separated tenancy and support). Live-in is typically commissioned as an alternative to residential placement for people with complex needs who wish to remain at home.

Section 02Typical client cohort

Adults requiring 24-hour support, including older people with dementia, adults with physical disabilities, end-of-life and palliative service users, and adults with complex health needs requiring round-the-clock supervision.

Referrals come from social care, NHS continuing healthcare, hospital discharge and self-funded private placement.

Section 03Commissioning and procurement context

Spot purchasing is dominant due to placement complexity. Frameworks exist but are less common than for visit-based domiciliary care.

Joint commissioning between local authorities and NHS ICBs is frequent for CHC-eligible packages.

Section 04Core service requirements

24-hour cover protocols, statutory rest-break arrangements under the Working Time Regulations 1998, continuous cover handover, supervision while the carer is on rest, lone-worker safety, and emergency cover.

Specifications expect named carer matching, family liaison routes, and care planning that captures whole-day support rather than discrete tasks.

Section 05Regulatory and compliance framework

CQC registration for personal care, Working Time Regulations 1998 (rest breaks), HMRC compliance for live-in worker pay arrangements.

Section 06Key operational challenges

Carer recruitment and retention is the dominant pressure. Statutory rest breaks require clear protocols and back-up carer arrangements. Family dynamics around the carer's presence in the home demand robust safeguarding boundaries.

Section 07How we approach this setting

We document the cover model, the rest-break protocol, the family liaison framework and the named carer matching process. Each is anchored to dated operational practice rather than implied capability.

Section 08Typical starting points we handle

Providers stretching from visit-based to live-in delivery, providers entering CHC commissioning, and providers responding to hospital discharge expansion.

Section 09Outcomes achieved

Spot placement awards, framework entry on combined home and live-in lots, and CHC package allocation.

Section 10Related case examples

The case studies below match this care setting and demonstrate the operational evidence base behind successful submissions.

Section 12Where this applies

Local authority adult social care, NHS continuing healthcare, hospital discharge pathways, and combined home and live-in framework lots.