Live-in care for older people with a focus on those living with dementia: a scoping review

Research has shown that adults prefer to remain in their own homes as they age. Care homes are expensive and as the population ages, availability is likely to become more limited and unaffordable to many. Live-in care, when a paid worker moves into the care recipient's home to provide support, offers a potential alternative to residential care. This is the first scoping review of research on live-in care with a particular focus on people living with dementia. It seeks to reframe understanding of long-term care options for people with dementia.

This scoping review followed conduct guidelines as described by the JBI. Systematic searches were conducted using seventeen bibliographic databases and sources rich in grey literature for quantitative or qualitative studies investigating live-in care. Results were double screened by two independent reviewers. Data were extracted and checked. Common findings found during data extraction were translated into themes. A lay advisory group was also consulted as to which themes were most relevant to them.

Most studies were qualitative in nature with a focus on the experience of the live-in care worker. In all studies live-in care workers were from countries outside of where they worked. Common themes arising from the findings of the studies included: motivations for choosing live-in care; relationships between live-in carer and care recipient and their families; exploitation of care workers and perceived quality of the care provided. Only seven studies focused on live-in care for people with dementia. These results address a critical gap in knowledge about a global form of care.

Live-in care offers a promising alternative to residential care. Existing studies highlight a range of issues that should be addressed with live-in care arrangements, including exploitation of the workforce, cultural differences between workers and the families, a lack of training for live-in care workers and the importance of good relationships with this model of care. This scoping review identifies a previously unrecognised pattern, namely a focus on the live-in care worker, rather than the experiences of those receiving care. More studies investigating live-in care specifically for people living with dementia would help inform whether this model of care is effective for them.