What Is Live-In Care?

An elderly man and his nurse.

Families navigating care options for their elderly loved ones are faced with a dizzying array of choices to make in order to ensure the best care for their loved ones. Although many seniors are not interested in moving to a nursing home or assisted living facility, families may find that their loved one still requires more care and support than can be provided by family members or part-time home health aides. In these cases, families and seniors may wish to consider working with a live-in caregiver. 

This post will explore what live-in care entails, who may benefit from live-in care, and other considerations for families and seniors when evaluating if live-in care is the right choice for their situation.

What Is Live-In Care?

Live-in care is focused on allowing an individual to remain in their home while receiving round-the-clock support and monitoring from a caregiver or home health aide. Live-in care can be a temporary arrangement following a surgery or a health crisis, or it may be a long term solution to support someone with chronic health conditions or declining abilities who wants to remain in the comfort of their own home. 

Live-in care can provide peace of mind to families who want to ensure consistent care, familiar surroundings, and the best quality of life are available for their loved ones. Even though many consider residential care in one’s own home as a better option than a nursing home or other alternatives, it is important to understand what to expect and what to look for when considering live-in home care. 

Although having a full-time caregiver who moves into the home with the care recipient is what many people think of when they think of live-in care, there are actually a few options regarding how full-time care is rendered. After working through a care plan to evaluate wants and needs, families may consider hiring care providers for eight, ten, or twelve-hour shifts so that someone is available during waking hours only, or they may opt for alternating care providers who take over for each other (or for a family member) at the end of each individual’s multiple-hour shifts. This latter arrangement can be compared to in-home elder daycare, especially if a family member or close friend is able to provide care overnight or in the evenings after work. 

It is also important to understand that, in most cases, a live-in caregiver does not actually move into someone else’s home. Caregivers typically have their own homes, but they can stay and even sleep in your loved one’s home in shifts that can last for 24 hours or several days. Since the focus of live-in is to have a constant presence in the home, some live-in care providers alternate shifts with other in-home care providers so that your loved one always has a familiar face providing support. Home health agencies can help validate and coordinate care among their available care providers. 

Another factor to consider is whether the individual who needs care actually needs 24 hour, full-time care. In other words, do they need someone to be awake and monitoring their condition at all times, or can the caretaker sleep in their own room while their charge also rests? If so, then live-in care from a single person is an option since they can adjust their own rest schedule to provide waking care with the person they are caring for. If the individual truly needs care and monitoring for 24 hours a day, then alternating caregiver shifts will be required. 

Live-In care is a great way to keep your loved ones safe while allowing them to live at home.

Who Can Benefit From Live-In Care?

People who need live-in care typically experience difficulty with one or more activities of daily living (ADLs). Activities of daily living include the ability to do the following things without assistance: 

  • Walking or ambulating: This may include getting around the house, checking the mail, and the ability to do these things without a significant fall risk (with or without assistive devices). 
  • Transferring: This involves moving from one position to another, such as getting out of bed or moving from a sitting to a standing position.
  • Toileting: Toileting covers everything from one’s ability to maintain fecal and urinary continence to sitting down on the commode to appropriately cleaning oneself. 
  • Feeding: This activity of daily living is not about procuring and preparing food, but rather about the ability to get food from a plate or bowl into one’s mouth.
  • Bathing: Showering, bathing, and generally keeping oneself clean is another fundamental activity of daily living. 
  • Dressing: Pulling on pants and shirts, fastening buttons, and closing zippers all fall under this ADL. 
  • Grooming: Things like clipping fingernails and toenails, drying and styling hair, and applying lotions or powders are examples of grooming actions. 
  • Performing Basic Memory Functions: Although short-term or long-term memory loss is not necessarily an “activity,” it is often considered under the umbrella of functional ADLs since short- and long-term memory is essential to completing most of the other activities. 

Early indicators that an individual’s ability to perform functional activities of daily living is declining may include observed limitations in the instrumental activities of daily living (IADLs), such as preparing meals, doing housework, shopping for groceries, managing medications, making phone calls, paying bills, and/or getting to and from places in the community. 

Some of the people who benefit most from live-in care include individuals suffering from conditions that affect the memory and the person’s ability to orient to time and place. This is commonly seen in individuals with Alzheimer’s, dementia, or other neurological conditions. 

Other medical conditions that can create the need for live-in care include neuromuscular conditions like amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease), Parkinson’s, multiple sclerosis, and muscular dystrophy. Individuals who have experienced strokes or severe injuries, patients recovering from surgery, and individuals with disabilities may also benefit from in-home assistance or live-in care. 

What Are the Benefits of Live-In Care? 

The clearest benefit of live-in care is the person in need of care remains in the comfort of their own home. For elderly people or people with chronic conditions, in-home care can support a sense of independence and a higher quality of life than the individual would find in someone else’s home, a nursing home, or an assisted living facility.  

Live-in care includes a care plan that is personalized for the needs of the individual and is based on the expectations set forward by the individual, doctor, family members or other representatives, and any social workers and others who are invested in the care and treatment plan of the person. The overall goal of any care plan is to improve or maintain the individual’s quality of life. 

Some of the other benefits and services that can come from in-home care include improved safety for individuals who have a high fall risk, regular exercise or physical therapy support, and appropriate nutrition. Grocery shopping, meal planning, meal preparation, and assistance with taking in food and fluids are all areas in which the in-home caregiver can help support the dietary needs of the individual. Medication management, from picking up prescriptions to ensuring timely and appropriate dosages, can be overwhelming, and this is another of the burdens that an in-home caregiver can take off the plate of the individual and their family.

Light housework, running errands, and socialization, either through outings or simply through companionship, are all things that a caregiver can provide as a way to ease the mind of families and friends alike. Simple activities like a conversation, watching a program with someone, or playing a game can engage the individual and ward off feelings of isolation. Lower levels of depression and anxiety are also a positive outcome for individuals who have an in-home companion, and families also experience lower levels of stress when they know their loved one is in good hands. 

Depending on the details of the care plan, an in-home caregiver may provide transportation to and from doctor’s appointments, as well as to community and religious events. Taking the dog for a walk, watering plants, and helping with letters, phone calls, and even bill-paying can all be areas in the in-home caregiver can help support a high quality of life for the individual in their care. 

What Kinds of Questions Should I Be Asking of My Loved or the Caregiver?

It is critical for anyone considering live-in care to understand what kind of and what level of care is needed. Some of the types of questions to explore before or during the development of a care plan include the following:

  • Do they need assistance with catheters? Do they struggle with urinary or fecal incontinence? Can they go to the bathroom in the middle of the night by themselves? 
  • Do they need support all day or does their condition only get worse during certain times, like sundown or during the night? Can they sleep through the night but struggle to get out of bed in the morning? 
  • Are they isolated or alone? Are you worried about depression, anxiety, or other aspects of their mental or emotional health?
  • Are they missing or confused by medications? Do they need assistance monitoring blood pressure or blood sugars? Do their medications have side effects that need to be addressed? Are they compliant with medical recommendations? 
  • Does their condition require special attention to diet or fluid intake (as with most diabetics and patients with heart disease)? Are they able to chew and swallow without medical support? Are they able to plan meals and acquire food? Can they prepare meals consistently and safely? 
  • Can they get where they need to go, both inside the home as well as in the community? If not, can the caregiver support them with mobility? If they need transportation assistance, will the caregiver be able to drive them? If so, will the caregiver be driving their own vehicle, their client’s care, or escorting them on public transportation like busses, taxis, or subways? Does the caregiver have an unrestricted and a good driving record?
  • Is their condition chronic or temporary? Are their symptoms stable, improving, or getting worse?
  • Is your loved one open to the idea of in-home care? Do they have (or have they developed) personality traits or behaviors that you need the caregiver to be aware of and okay with? 
  • What kind of expectation do you and your loved one have about privacy? Should the caregiver report changes or concerns to the individual, an agency, a specific doctor, a family member, or someone else? Who has “final say” in decisions made by or on behalf of your loved one? 
  • Do they need specialized support due to memory loss or other chronic or progressive conditions? Does their condition put them at risk for wandering off? Are they prone to bed sores or other conditions that need monitoring? 
  • What kind of references and experiences can the caregiver provide? Did the agency do a background check? If you or your loved one has a concern with the type or method of care provided, what options exist for replacements or breaking a care contract? 

After reading through the questions above, you may find that you have other questions you will need to explore with your loved one and any potential caregiver. These questions are provided to give you an idea of the scope and focus areas that may need to be addressed as you explore the options for ensuring you or your loved one has the best quality of life possible. 

How Much Can I Expect to Pay for Live-in Care? 

Given the variety of live-in care options in terms of the level of service provided, length of shifts, and experience and training of the live-in caregiver, costs can vary. Other factors, like the location and reputation of the agency providing access to live-in caregivers, can also affect costs. In some cases, at least some aspects of live-in care costs may be covered by medical insurance or Long Term Care insurance, so always be sure to check and file the necessary paperwork to get financial assistance if needed. Medicare does not typically cover costs associated with live-in home care, though low-income seniors may be eligible to receive some assistance with costs through Medicaid. 

When working with a caregiver who stays and sleeps overnight, the hourly cost can be less because the caregiver is not actively monitoring and supporting the individual during the night. For caregivers or agencies that bill by the shift (rather than by the hour), most people can expect to pay anywhere from $100 to $300 per day for high-quality care, and hourly costs typically range from $15 to $25 per hour. National Public Radio (NPR) shared a MetLife Market Survey that was conducted in 2011. The study evaluated care costs for the elderly, and the low, average, and high hourly costs are broken down by state (including major cities within each state), by facility or type of care (nursing home, assisted living, adult day care, home care), and by care provider (home health aide vs. homemaker). Note that hospice and end of life care are different from live-in care, and hospice services are often covered by local government and charitable agencies and/or Medicare or health insurance. 

A great caretaker will be there for you when you need them the most.

How Do I Find a Live-in Caregiver? 

Organizations like Care As One provide job applicants, home care agencies, and individuals with access to databases that match job seekers with available positions. Home care agencies, like live-in caregivers, may be licensed or unlicensed, and it is important to check the credentials of any agency or individual you choose to interview. 

Licensed agencies and/or agencies authorized by Medicare follow local regulations and governmental guidelines for hiring and screening caregivers. Screenings for qualified caregivers may include mental and physical health assessments, criminal background checks, verification of any treatment specialties (such as dementia care and medical certifications), as well as evaluation of references and past experiences. 

Local assisted living facilities and government organizations may also provide support and direction for individuals seeking high-quality live-in care. Doing a couple of online searches and making a few calls is a good way to feel out the resources available in your area. In addition, church groups and community organizations are often filled with people who have experience with the many considerations that come from caring for disabled or elderly family members, and simply talking through options with someone who has gone through it all before can be reassuring for all involved. 

As you work through the questions, the various alternatives, and the best- and worst-case scenarios for your loved one’s care options, consider what you would like or expect if you were in the position to need care yourself. A quality caregiver is an employee, but they are also intimately involved in some of the most private aspects of your loved one’s life. As such, it is important to find a live-in caregiver who is trustworthy, dependable, and dedicated to ensuring a high quality of life for your loved one. The right personality and experience of the caregiver help ensure that everyone benefits from the in-home care experience. 

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