Approaching respite care for older people

For family caregivers, arranging respite care for an older loved one starts with discussing the possibility with them. While some older people are very open to receiving replacement care in order to give their family members a break, others can feel worried by the thought and may even refuse to accept respite care. For this reason, approaching the subject with your older loved one requires forward-planning and sensitivity in order to help them understand the need. Here, we are looking at the best ways to begin “the respite discussion”, including the benefits you can talk about, involving your loved one in the choice of respite care, what to do if they continue to refuse, and where to seek further advice and support. At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For nearly 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global home care network, supporting over 100,000 older adults with personalised, tailored care at home. Whatever questions you have about respite care, we can help.

How do I know if I need respite care?

Caring for an older family member can be very rewarding, however the day-to-day duties of this role can be challenging. There is no doubt that looking after a loved one who perhaps has mobility or cognitive issues can be exhausting at times, and respite care should always be considered when the stress of caring becomes too much. For clarity, a caregiver is someone who provides physical care, mental health care, or additional help to a person who is unable to do the same for themselves, but sometimes this can feel hard to define in real life. If you are unsure if you are in a carer role for a family member, it can help to ask yourself questions like:

Am I helping them with personal care, like using the bathroom or getting dressed?
Am I managing their medication schedule?
Am I managing their visits from healthcare providers or specialist carers?

For many family caregivers, it can be difficult to recognise when they are in a carer role and when it is time to seek respite care in order to avoid burnout or to attend to something in their personal life. Caregiver burnout is a recognised state of physical, emotional and mental exhaustion, and is commonly experienced by both professional carers and family caregivers, as well as those caring part-time and full-time. Some signs of caregiver burnout include:

Physical exhaustion, or aches and pains
Feeling emotionally drained
Withdrawing from friends and family – research suggests 50% of carers say they feel lonely, so isolation can be a key problem
Losing interest in activities once enjoyed
Feelings of hopelessness, feeling stuck, or like a dark cloud hangs overhead – research suggests 49% of carers feel depressed, so this is important to address
Changes in appetite and/or weight
Changes in sleep, such as insomnia
Struggling to focus
Physical symptoms such as headaches, stomach troubles or tense muscles
Becoming sick more frequently
Becoming irritable or frustrated by the care receiver – compassion fatigue is a lack of empathy for the person requiring care, and is a common symptom of carer burnout
Turning to unhealthy coping habits like smoking, alcohol or junk food
Becoming more anxious about whether or not the appropriate care is being provided – research suggests over three quarters of carers feel stressed or anxious

If you have been experiencing any of the above emotions, it could be time to look into respite options so you can take a break and recharge your batteries. You can read more about this in our article: Carer’s Burnout: Knowing You Need Respite

When should I bring up the possibility of respite care with my loved one?

Your loved one may feel worried when they hear about the possibility of you leaving and a respite carer visiting instead. For this reason, you should bring up the concept of respite care as early as possible. By broaching respite as a possibility for the future, you can start to float the idea as a positive solution rather than something imminent that they should worry about. This way they may feel less intimidated and be more willing to talk about it with you. You may also want to do things in advance to prepare them for the change, like having another family member pop in to sit with them for a few hours, or hiring someone to help with housework and cleaning to get them used to the idea of having strangers around.

How should I broach the subject of respite care? Starting the respite discussion isn’t easy, but there are some tips for speaking to older people that can make this subject more approachable so they stay open to the idea.

Use questions: Although respite care is typically arranged to address how you – the caregiver – are feeling, it can help to keep the focus on your loved one in the beginning by asking how they feel. Direct the conversation using questions like ‘How have you been feeling about our care arrangement recently?’, or ‘Is there anything you think you need that I have not been helping with?’. These questions could open up a discussion about the possibility of bringing in the help of a respite carer.

Come to the discussion prepared: Do some initial research into the types of care available, and what you think would help your loved one most. It can help if you already know things like the cost of respite care and how to arrange it, along with a pros and cons list (our list below could help with this).
Let them be part of the decision: Ultimately the final decision on respite care is up to you as the caregiver, however you should still be listening to your loved one and taking their recommendations to make sure they still feel in control of their own situation. Never assume you automatically know what’s best for them.
Reassure them that it won’t come out of the blue: If your loved one is worried that you will spring respite care on them suddenly, ensure they know you will keep them in the loop as the arrangements evolve and give them plenty of notice.
Explain that you will help with the transition: Many older people worry that a respite carer won’t know what they need when taking over from a family member, so let them know you will be around to help with the transition when the time comes, and will ensure the respite carer has all the information to provide continuity of care.

Give them further reading: Sometimes a short initial discussion is best, followed by offering your loved one some resources to read so they can take the idea in by themselves and spend time thinking about it. Age UK has a lot of helpful information on respite care for older people.

What should I say to them?

The best way to approach the discussion with a hesitant older loved one is to relay the many benefits that respite care has for both you (the caregiver) and them (the care receiver). In fact, there is a lot of evidence to suggest respite care can benefit everyone involved in the care process. Start with the benefits older adults could experience through respite care:

Opportunities to socialise with new people: Respite carers can be a new face and a new chance for companionship and mental stimulation for your older loved one, so bring this up as a positive. Speaking to someone new can provide fresh activities (within their usual routine), and an opportunity for them to bring up anything they don’t feel comfortable discussing with you.
The chance to stay in their own home: Having a respite carer visit your loved one’s home to provide care alleviates the need for them to move elsewhere, for example, to another relative’s home or a care home. Staying in their own home can foster a sense of comfort, familiarity and security for them, which is particularly helpful for anyone living with dementia. One study found those living at home with dementia experienced higher activity levels, quality of life, and felt more socially connected than those living in a care home.
No gaps in care: If safety and health are their main concerns, then bringing in a respite carer is the best way to ensure continuity of care while you are away. If medications still need to be administered, and care needs attended to, then a respite carer can tailor their care to meet your loved one’s needs and preferences.
Maintained independence: Sometimes an older person will worry that a respite carer will change their routine and control aspects of their life that they do not want to change. It can help to reassure your loved one that respite carers are there to support their independence, meaning they can stay at home and stick to their preferred schedules for meals, activities, rest, and more.
Peace of mind: Having a respite carer available in your loved one’s home can put their mind at ease in terms of their safety, so there is always someone around should they be needed in case of an emergency. For older adults who may be worried about what will happen if their regular carer is off sick or is suddenly unable to look after them, knowing that respite care is available can be a positive thing.
An increase in the quality of their care: Although your loved one may be comfortable with your care, sometimes respite carers can bring additional training and qualifications, and can point out any areas of care that could be improved. Also, if the regular carer reaches the stage of burnout they could begin to unintentionally provide care that does not meet the required standard, or they could miss key symptoms in the person’s health. Having regular breaks with a respite carer can help to avoid this.

There are also benefits for caregivers like yourself when respite care is engaged:

Avoid caregiver burnout:Caregiver burnout is a state of physical, emotional and mental exhaustion that happens as a result of an overload of caring duties for an extended period of time. Respite care can help to avoid this burnout by offering regular breaks to reduce stress and overwhelm. You can read more about this in our article: Carer’s Burnout: Knowing You Need Respite
Improve your health and wellbeing: According to the Mental Health Foundation, 71% of carers have poor physical or mental health, and research suggests 55% of carers report suffering from depression. Your health and mental health are important, so having regular time off through respite care can help you to focus on your wellbeing without compromising on the quality of your loved one’s care.
Manage your personal responsibilities: When caring for a loved one, you may find yourself dropping the ball on your own life responsibilities. Respite care offers the opportunity to manage these around care duties to maintain balance in your own life. Research shows 75% of carers in employment worry about juggling work and care, so respite care can help you manage things if you have a job outside of caring.
Less worry: It can be difficult to leave a loved one in the hands of a stranger when you are so dialled in to their care needs, and feelings of guilt and worry are common. Having a trusted respite carer means you know there is someone around who understands the complexities of your loved one’s needs and can step in to help. You may not feel as confident leaving them with a sitting service or adult day care centre.
Opportunities to attend important events or go on holiday: Your own life responsibilities may include attending events like weddings or birthdays, or going on a regular family holiday. You should not avoid these things just because you are providing care, as respite care is designed for exactly these reasons. Respite care means your loved one will be looked after when you are not around, so you can attend events without having to leave early, and book holidays without worrying that something bad could happen while you are gone.
A stronger relationship: When you are caring for a loved one – such as a parent, a partner, or another relative – your relationship with them can begin to change and become more of a caregiver/care receiver relationship. Respite care offers you both a chance to spend time away from each other, or to spend time together as a family rather than with you in a caregiver role.
Breaks during periods of increased demand: There are always other life responsibilities to take into account alongside your caring role, and when larger events come up – such as a big house move or a new baby – it can be difficult to stay on top of everything. During periods of increased demand, respite care takes over when you need it so you do not need to split your focus.

What types of respite care are available?

There are a few different types of respite care that can be arranged for your loved one, and each will have its own benefits depending on their needs, any medical conditions they have, and how long you would like respite care to last for. These include:

Sitting services – Charities like Age UK offer sitting services. This is when a trained volunteer will sit with your loved one for a few hours to allow you (the regular caregiver) to take a break. This might be for everyday things like eating a meal, running errands, or to have a short break for your mental health.
Day care centres – Adult day care centres are also offered by charities or local councils, providing a safe environment for older people to attend and take part in activities and socialise with others in the community. All of this happens while their care needs are overseen by a team of staff, so you can rest assured they are in good hands for the day.
Care home or nursing home – In some cases, temporary stays in care homes or nursing homes can be arranged. This provides respite to an older person’s regular carers, as the facility’s regular offerings (such as meals, activities and medical care) will be extended to your loved one too.
In your loved one’s own home – If you look after your loved one in their own home, then respite care can be arranged within their home, meaning minimal disruption to their environment and routines. While there are benefits to all types of respite care, respite care carried out in a person’s own home is particularly helpful for older adults as the World Health Organization recommends they are cared for in their own homes for as long as possible to maintain a strong sense of wellbeing.

What if they don’t agree to respite care?

If your older relative does not agree to receiving respite care, it’s important to approach the situation with patience and understanding.

Start by listening to their concerns and reasons for resistance without dismissing their feelings. Rather than pressuring them to receive respite care, it is important to listen to their objections and personal reasons. Try to understand any doubts or fears they have so you can respond appropriately to put their mind at ease. Some of these reasons may include a fear that they will lose their independence, a fear that their routine will change, worries about paying for respite care, worries that you will stop visiting, a fear of strangers in their home, or something else. Acknowledge their perspective on the matter and validate their emotions while also reassuring them that you will address any concerns they have.
Express your own needs as their caregiver. You are allowed to let them know when you are feeling burnt out or stressed, or if you need time off for a specific reason. Understanding how much this could help you could cause a change of heart, so don’t be afraid to express any issues you are having.
Provide information about the benefits of respite care for them and for you, as mentioned above. They may find some of the benefits on our list interesting.
Talk about the options together so they are part of the discussion. Find out if they would rather stay in their own home to receive respite care, what routines they would definitely like to stick to, anything they are worried about or do not want, and any activities they would like to try while you are gone – looking forward to positive things could counteract the worry they feel.

Where can I get more advice and support on arranging respite care?

It is common to feel overwhelmed by caring duties from time to time, so having discussions about respite care can help you feel like there are options for the future if the workload starts to get on top of you, or if your health or mental health begins to suffer.If you are looking to arrange respite care for any reason, you may want to begin by organising a Care Needs Assessment with the local council who will discuss with you future respite care needs in advance, and which type of respite care might be best for your loved one. If you are thinking about private respite care providers, research the home care agencies in your area that can offer the type of care you are looking for, with qualified and trained respite carers. You may find more helpful information on cost in our article: How Much Does Respite Care Cost?Remember to discuss the transition with your loved one ahead of time by involving them in the discussion and decisions on the best type of respite care, and introducing them to the replacement caregiver so they feel comfortable accepting their help. At Home Instead, we can support you in organising the best respite care arrangement for you and your loved one, so if you have any questions about how this works, please feel free to reach out to our friendly team. Our Care Professionals are highly trained to deliver the services you need, so no matter what type of home care you are looking for we can provide a tailored service that suits you and your loved one. Home Instead is an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.

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