If you and your family have been trying to establish a plan of care and figure out all of the associated costs for your loved one, you have no doubt been met with a confusing myriad of choices. This article will help you understand exactly what live-in care means, the different types and experience levels of live-in caregivers, and how to determine what kind of live-in care best suits the needs and desires of your loved one. Along the way, we will also take a look at the cost range for care and the factors, such as location and tasks required, that affect how much live-in caregivers earn.
Types of live-in care may be dictated by the needs of your loved one and the availability and skill level of the potential caregivers. In general, the goal of live-in care is to allow individuals to remain in the comfort of their own home while recuperating, managing chronic conditions or dealing with declining health. For these individuals as well as their families, ensuring safe care, familiar surroundings, and the highest possible quality of life is paramount. Working with a reputable agency and/or vetting the credentials and dependability of any individual who is providing care to someone who may be vulnerable is essential to providing the best experience for everyone involved in this process.
First, it is important to know what live-in care means and what it can entail. A live-in caregiver can be someone like an aunt or a cousin who moves into a spare bedroom and shares space with an individual who is recovering from a long illness or dealing with some of the setbacks of aging in place. In this case, oversight and support are likely provided by a friend or a family member whose main form of payment is room and board, and they may or may not have nursing or caretaking skills. In exchange, they provide a familiar presence and assistance with instrumental activities of daily living (IADLs) like cooking, driving, managing medications, shopping, and/or managing finances.
For many individuals, daycare meets the majority of their needs. Daycare can mean that a caretaker stays with the individual during daytime hours, often when other family members are at work or in school. If the individual is mobile enough, they may also benefit from attending an adult daycare facility outside the home for social interaction under the eyes of trained staff. In terms of cost, these daycare options are often the most affordable, assuming your loved one can do some activities, especially toileting and feeding, without assistance.
Depending on the type of care needed and the hours of coverage desired, some may find that hiring care providers in shifts can work well. Unskilled providers can take lower maintenance shifts, leaving specific home health or other duties to the more skilled providers or a CNA in another shift. Depending on the guidelines of the state and local agencies, workers can be hired for shifts that range from eight to twelve hours. This is a good solution for families who are available during certain parts of the day (or night), as well as those needing temporary arrangements during critical illnesses or health crises.
Although a live-in caregiver does not typically move into someone else’s home, they can stay overnight in shifts that can last from 24 hours to several days. Longer or more intensive full-time shifts can be arranged, but live-in care providers often work in pairs or small groups to provide around the clock care while still being able to attend to their own homes and lives. Home health agencies are helpful in coordinating care among multiple home care providers. As you might imagine, this can be one of the priciest options, but some costs can be mitigated if the individual needs something more like companion care or personal care than skilled clinical support.
Home health aides and live-in caregivers may bring a broad cross-section of skills and experiences to help in any situation, but sometimes it makes sense to work with an individual who specializes in certain aspects of your loved one’s health or psychological needs.
Specialists in memory care, musculoskeletal issues, mental health, auto-immune, or geriatric health are just some of the types of specialties that you may explore when you are developing a care plan for your loved one. Working with someone who has experience with the unique needs and requirements of your loved one’s health conditions can provide the added security that comes with knowing that they are receiving the best level of home health care.
Now that you know a bit more about the different types and levels of care, we can begin to explore the customary rates associated with senior care or other live-in care situations. Across the United States, caregiver salaries (as well as the hourly rates for caretakers) vary widely. A number of factors, including the type of care services provided, background and level of experience of the caregiver, and geographic location, can all affect the average salary of a potential caregiver.
Some aspects of live-in care can be filed under health insurance or Long Term Care insurance. In certain cases, even some disability and life insurance policies have provisions that allow for accelerated benefits, especially when an individual’s activities of daily living (ADLs) are affected. Medicare does not typically cover in-home care costs, but in some cases, low-income seniors may be able to have some services paid for through Medicaid. However, live-in care is different from hospice or end of life care. End of life may be covered by insurances, governmental agencies, or local charitable organizations.
In 2011, MetLife, one of Fortune’s 50 top companies, released a study on the average costs for long term elder care by state and major city. They looked at different levels of care, including nursing homes, assisted living facilities, home care (or live-in care), and adult daycare.
Considered by many to be the most affordable option for families, the nursing home carries the unfortunate burden of being the least desirable option for aging seniors. Costs vary from one extreme to the other across the United States, with semi-private nursing homes offering more affordable options that private nursing homes. Nursing homes almost always have access to skilled care, and they are run based on the efficient and effective administration of health and safety protocols. The national average daily price of nursing home care in the U.S. was between $214 and $239 per day, with costs under $100 per day in the rural southeast and costs above $400 per day in cities like New York City or San Francisco.
This option is good for individuals (or even couples) who want to maintain a little more independence but for whom staying in their own home may no longer be viable. Assisted living facilities cost an average of $3,500 per month for baseline care (living assistance excluding specialized clinical intervention), and they range from around $1,500 to over $5,000 per month depending on location and level of facility amenities and clinical support.
These ranges apply primarily to facilities. In-home daycare costs will be covered in the next section. The average daily cost for adult daycare is $70 per day, with costs under $20 for minimally supervised adult day centers in the rural southeast to well over $100 per day in more populous or high-income areas. The higher-end costs of some facilities are similar to in-home costs.
As we discussed previously, the costs for in-home or live-in have the most variability because of the ranges of services, backgrounds, and specialties provided by an in-home care provider. In addition, the live-in caregiver laws and regulations of states and local municipalities can affect services provided by the caretaker, and this also affects live-in caregiver costs. Nonetheless, if we break down caregiver options into their most basic form, we will see that caregivers can be considered home health aides or homemakers.
A live-in caregiver who is a home health aide may have some level of clinical experience, perhaps as a certified nurse assistant (CNA) who has worked in home health, geriatric, or nursing home facilities. These individuals may earn a little more on average than homemakers, but there is a great deal of overlap in their respective duties. As the name implies, homemakers tend to offer services that deal with the physical upkeep of the home, such as housekeeping, cooking, or shopping. To learn more about the expectations and duties of a live-in caregiver or to access a caretaker checklist, check out this post.
To truly understand what type of live-in care best fits your needs, you and your loved ones may want to invest some time in developing a care plan. Ideally, this type of activity is best suited for when everyone who will be affected by it is in an appropriate mental and physical state to make good planning decisions. Obviously, this is not often the case, but taking the time to sort out what kinds of support you and your loved one need is the key to making good decisions about care. A good care plan makes sure that the person needing care, their health care professionals, the caregiver(s), and the family are all on the same page. Many home health agencies can assist with this process as well.
Other than skill and specialty level, the biggest cost differentiator for in-home care is the same as it is in real estate … location, location, location. For example, in Little Rock, Arkansas, the range for in-home care was $14 to $18 per hour in 2011. However, Maine’s rates for in-home care during the same period were $16 to $30 per hour, while rates in Mississippi were as much as $50 per hour and rates in Montana were as low as $9 per hour.
Like daycare workers and other care providers, in-home caregivers and home health workers are notoriously underpaid for the vital services they provide. Nonetheless, the best way to determine the going for in-home care is to research available caregivers in your area. Agencies such as Care As One work to connect caregivers with agencies and others who are looking for an in-home caregiver.
As you begin to think about the various options and alternatives for extended care for yourself or your loved one, a good first step is establishing what kinds of activities will necessitate in-home support. Assessing instrumental activities of daily living (IADLs) and activities of daily living (ADLs) is a good way to set a baseline of what kinds of activities one can do and to what level they will accept (or require) assistance.
One of the first signs that an individual may need additional support is when they start to overlook or mishandle some of the instrumental activities of daily living. Instrumental activities of daily living include things like shopping, driving to and from appointments, preparing meals, and managing prescriptions. Worrisome driving tendencies or frequently skipped meals can be indicators that your loved one could benefit from in-home care. When assessing what level of service you as a caregiver can provide (or you as a person in need of a caretaker are seeking), creating a checklist of IADLs helps to establish clear expectations for both the family and the loved one as well as for the caretaker.
Group each of these IADLs into sections like Independent (can do this activity without support), Needs Help (can do this activity but may need voice guidance), Dependent (can do this activity with another person’s support), or Cannot Do: grocery shopping, planning meals, cooking, driving, using the phone, doing housework, doing laundry. You may have other items that are unique to your loved one, such as working in the yard or garden, volunteering at community functions, or caring for pets. As more items move into the “Needs Help” category, it may be time to start looking for options for live-in caregivers.
Managing finances and paying bills are other areas of concern, but most experts recommend that someone other than the caregiver assist with financial management. Financial management is important to not only keep the lights on but also so that your loved one does not fall victim to the financial abuse that can affect so many vulnerable seniors.
Loss of instrumental ADLs is an indicator of declining abilities, but losing the ability to complete standard activities of daily living almost always requires some level of intervention. Like IADLs, ADLs can be grouped into Independent, Needs Help, Dependent, and Cannot Do categories. The standard ADLs include eating (not cooking, just the ability to eat), bathing, dressing, toileting (includes using the commode as well as clearing oneself), transferring (moving from bed to chair, for example), walking (with or without assistive devices), climbing stairs, and mouth care (brushing teeth or maintaining dentures).
When the ability to do many of these activities begins to decline, live-in care may become a critical consideration for the health and safety of your loved one. Although these IADLs and ADLs focus on physical activities, it is also important to note that one of the biggest advantages of a live-in caregiver is that they can provide insight into behaviors and abilities based on what level of assistance the individual requires.
A live-in caretaker, regardless of skill level and experience, should be reasonably compatible with the personality of the person they are caring for. Companionship is a critical but overlooked aspect of aging in place, and the simple, stabilizing presence of another person can keep depression and anxiety at bay while providing family members with the reassurance that their senior family member is being watched over by someone they trust. Most lists assess physical abilities, but families may feel themselves at a loss when their loved one’s physical health is intact but their emotional, neurological, or psychological health is at risk. Skilled caregivers can work on memory games, put on favorite programs, chat, and help your loved one remember how to complete basic tasks. Sometimes the simple, stabilizing presence of another person in the home provides all the care needed for a loved one in the early stages of dementia.
Working to find the best solution for yourself or a loved one can be stressful as you sort out what kind of care is the best for your specific situation. One of the best things about trying out in-home care is that if the caregiver turns out to be the wrong fit or if your loved one’s needs change, you can simply make a different decision about long term care options. Unlike moving into an assisted living facility or nursing home, working with a live-in caregiver is a temporary solution, and this fact can be reassuring to families and seniors. Care As One’s job board is a great place to start evaluating what kind of talented caregivers are out there.