'She's not just my carer, she's my friend' - how care workers make a difference

"Old age crept up on me," says Liz Sinclair as she looks out over the honeysuckle, rhododendron and rose bushes that colour the garden of her family home.

Her husband Alistair would spend hours working on the garden. They planned it together decades ago and it hosted countless playful afternoons for their two sons.

Things are dramatically different now for the 82-year-old, who said she thought she would always be able to cope, but had to ask for help when she realised she could not.

She is one of tens of thousands of men and women in Northern Ireland who receive a home care package.

In 2025, Alistair was diagnosed with dementia. Liz found him "the right care home" and began a new chapter without him.

Carrying a multitude of stories, the softly-spoken former teacher, who is originally from England, now lives a quiet existence, her days punctuated by visits from home care workers, like Freda.

As she spoke, her occasional search for words and an encouraging nod from Freda that what she was saying was right, indicated Liz's own diagnosis of memory loss and early dementia.

"Freda is not just my carer but my friend and someone I can chat to and laugh with, laughing is still important, in fact we tease each other," she said.

There are other subtle signs of her diagnosis dotted about the house, like support railings on walls and, in the kitchen, post-it notes with written reminders about visits, meals and medication.

Looking out over the now-overgrown garden, Liz recalled how much time her husband would spend there up until a few years ago.

"Just like Alistair and I, the garden now needs tending to. We could no longer cope with it all and sadly it's overgrown and a bit wild looking," said Liz.

"My home holds lots of memories, happy memories with children growing up and tea in the garden - while I am here I can still enjoy those memories."

But despite the challenges, Liz continues to live at home with carers calling to take her shopping, do housework, ensure medication is taken and, perhaps most importantly, talk to her.

That support means she can stay at home, maintain her independence and live among the artwork and books that line the bookshelves of her home.

Liz's life encapsulates what it means to give older people autonomy, choice and respect.

But that care is paid for by her to ensure the visits happen and are at least 30 minutes, longer than the average 15-minute care visit.

The independent health care sector in Northern Ireland provides about 80% of home care visits to the elderly and vulnerable with health trusts delivering the rest.

However, home care packages in rural areas are under threat after one of Northern Ireland's leading independent health care companies said it will have to pull out of some rural areas as it can no longer afford to provide it.

Connected Health said the failure of government to properly fund the independent care sector means services will be cut with families losing out.

The Department of Health has previously said the entire health and social care system was facing significant challenges given the lack of an agreed budget.

Home Instead is another independent company which delivers thousands of care packages including to Liz in Newtownards.

Its director Lynne Elliott told BBC News NI they have seen a 25% increase in enquiries in recent months, especially from families in rural parts.

People want to stay at home for as long as possible, Lynne said.

She added that while most independent home care companies are busy, they could be busier if the health trusts employed more of the sector's services.

"Sometimes in order to keep their costs low health trusts don't use us just as much and that can be a short-term gain but that will only bring further pressure down the road.

"We believe it doesn't pay to be penny wise and then pound foolish - investing in home care keeps people out of hospital and independent in their own homes," Lynne said.

These are people like Bronagh Moore and Kellie Stewart, two carers whose days start at the crack of dawn when they will be changing stoma bags, personal pads and, in call-outs where they work together, hoisting clients from their beds to an armchair.

Bronagh has been working in the independent care sector for almost 30 years. Her watch dictates her day, but it is a role she finds rewarding but also tough physically and mentally.

For her, the clients are "extended family" but they are people she often finds lying on the floor after a fall.

"Recently I had to perform CPR on a wee lady and I was on my own but we got her to hospital and she survived another three days, the family were grateful they'd that time and that their mum didn't die alone," she said.

When we met, Kellie, who works with Bronagh on double calls, had just found out a man she had been visiting for four years had died.

"It wasn't just about making his lunch or changing his bed and making sure he took his medication he was like one of my family - and now he's passed away and I will miss him," Kellie said.

They are two of 34,000 people working in Northern Ireland's independent care sector, with most dedicated to calling to homes to make sure people can retain their independence and stay out of hospital.

They each drive to about eight clients, from first thing until late afternoon.

One client, 91-year-old Alan Gregg who is recovering from cancer and has chronic arthritis, said he has four care visits a day.

"The women are so good to me, I like a wee bit of company and, yes, to some extent they keep me alive."

Alan may have a stoma and a catheter, and require personal care, but he still considers himself independent.

"I worked in the Navy most of my life, so being independent at this age is important. And I am still able to read and lift weights."

But it is challenging work for the likes of Bronagh and Kellie, from paying for fuel and keeping their cars road worthy.

Bronagh said politicians and officials in the Department of Health do not appreciate the job that carers do in keeping people at home and out of hospital.

"We just don't feel appreciated. We aren't paid enough," she added.

It is a view Liz understands. She said more people like Freda in Northern Ireland would allow more people like her to live at home and save the health service money.

She is still coming to terms with how her life has altered, and the acceptance of her husband's departure for a care home.

"He loved the garden and walking in the countryside but had started to wander off, I miss him but have accepted our lives have changed," Liz said.

"I still have a little bit of wit – I am fine and I just tend to write a lot of things down," she said.