Live-In Home Care for Seniors

Live-in care is for seniors who need around-the-clock assistance from a caregiver. Assistance is generally non-medical and includes such tasks as medication management, shopping, and assistance with activities of daily living (ADL).

Though caregivers sleep at the senior's residence, they generally aren't required for assistance at night. Caregivers do not actually move in to the client's home. But they could spend periods of from 8 hours to several days at a time at the residence.

Often, caregivers work in rotating shifts of 12 hours so the client sees the same two people every day. The client provides the caregiver food and a place to sleep.

What Is Live-in Elder Care?

Live-in elder care is a 24-hour service that focuses on keeping an elder in their home. This level of service is often provided by a nursing service which places a Home Health Aid or another type of caregiver in patients home in shifts that range from 12 or 24 hours to several days or even a full week. The nursing care provided ranges from housecleaning and grocery shopping to bathing, dressing, and meal preparation. A live-in caregiver is present 24 hours per day, but they do not actually live at the seniors home. What that means is that they have their own home and they work in 24-hour shifts.

The general premise is that the elder is able to sleep through the night and does not need care after they go to bed. In this way, live-in care differs from 24-hour care, in that the live-in caregiver is allowed to sleep undisturbed through the night. When 24-hour care is needed, the caregiver must be awake and available every minute of their shift. For that reason, 24-hour care is usually broken into eight- or 12-hour shifts. It is also important to know that while a live-in caregiver sleeps at the elder's house, they do not actually live there – in most cases. Care is usually provided by two or more caregivers over the course of a week.

Live-in care, however, is available from different organizations and an elder or their family have options and should research those options based on the elder's needs. Other options include hospice, volunteers, and of course family members. There are governmental agencies that also help with live-in care or who help with certain aspects of elder care. A good example is Meals on Wheels, which delivers meals to elders.

What Are the Benefits of Live-in Elder Care?

The primary benefit is that the elder remains in their home. This, of course, is balanced with improved safety and improved quality of life. Even when the elder faces extreme illnesses, remaining in their home is a benefit to them. Live-in care is based on a personalized plan of care which outlines the goals set forth by the care team, which may include the elder, family, doctor, or social worker and generally whoever has the legal right to approve these sorts of decisions. The plan of care helps to focus care on those areas that improve the elder's quality of life. Tasks can range from meal preparation, assistance with eating, housework, running errands, and personal care.

The benefits include:

• Improved patient safety
• Regular exercise, ambulation and help with ongoing therapy, such as those that might be considered “home instructions” from physical therapy, occupational therapy, etc.
• Improved nutrition through dietary management and meal preparation
• Improved medication management and reminders to take medication as prescribed
• Improved socialization, especially for elders that are isolated.
• Improved family involvement
• Decreases in stress and anxiety, especially around things like getting to and from a doctors appointment or to and from the grocery store.

In general, the plan of care should address all of the deficits that decrease the quality of life of the elder.

Who Requires Live-In Care?

In general anyone who:

• Is recovering from a sickness or illness
• Has limited mobility
• Is isolated and withdrawn from others
• Is feeling overwhelmed taking care of themselves
• Lives far away from the family or friends who could lend a hand
• Is suffering from Alzheimer's or dementia

Live-In Care Services

The kinds of services provided will depend on the agency and the individual caregiver. In general, expect the following:

• Companionship
• Medication management
• Light housekeeping and laundry
• Running errands
• Meal preparation and clean up
• Shopping
• Transportation
• Conversation
• Alzheimer's and dementia care
• Assistance with pets
• Assistance with appointments
• Playing games
• Exercising—going on walks, to the gym, etc.
• Letter writing
• Bill paying

Evaluating Needs for Live-In Care

Whether you are evaluating your own needs for live-in care or the needs of a loved one, start out by writing down what needs to be provided. What does a typical day look like from waking up to going to climbing into bed?

Think about the following:

• Hours– How many hours a day is care needed? When is care most intensively needed? Will they require help in the middle of the night with going to the bathroom?
• Dietary– Are there special cooking requirements? Does the senior have allergies? How will groceries be purchased?
• Transportation– Does the client need transportation to doctor's appointments, social events or other activities? Can the caregiver drive the client's car? Will they be insured for this? Can the caregiver escort the client on public transportation, such as a bus or taxi?
• Medication Management– How does the senior currently manage their medication? Are they being taken correctly? What side effects are there to the medications? How often are they being refilled?
• Memory Loss– Is there memory loss? Does your loved one need to be tested?  Knowing this will help the agency assign the properly trained caregiver.
• Other Skills-Are there other requirements such as blood sugar testing, taking blood pressure, etc?

Choosing a Live-In Care Agency

Selecting the right care provider for you or your loved one is important. So how do you know which agency to pick?

Think of it like a job interview, and you are the employer. You want just the right fit for your team. Here are some areas to consider in the hiring process.

• If working with an agency, find out exactly what is covered. Read their contract carefully. What fees are included and what services cost extra? How is a contract terminated by either party? How much notice is required?
• Is the agency Medicare certified? This means they've followed a set of stringent federal guidelines to be able to provide care. They've also been inspected.
• Interview several candidates before hiring. Meet the caregiver in a public place first. If it works out, invite them to your home or your loved one's home. Ask that person about their experiences and qualifications. Give them worst-case scenarios about what they can expect. Don't sugarcoat anything. It's better to have all expectations and potential trouble areas out in the open. Ask if they've ever worked with someone with similar needs. Ask open-ended questions. Give them a specific scenario—ask them how they would respond.
• Check references. Be careful and diligent when talking to references. Would the reference use the caregiver again?
• Do background checks on your top candidates. Usually, an agency will provide this service. Do they provide a criminal background check? Credit check? Driving record? Legal working status?

How Much Does Live-in Elder Care Cost?

The cost of live-in care varies from one agency to the next, and one type of organization to the next.

For elders who use a home care company, the cost is usually shift-based and often less expensive than their hourly rate because the caregiver is not required to do more than be present during the night. That cost is not always the case and for agencies that bill by the hour, the rate can be over $200 per day. In general, expect to pay around $100-300 per day for live-in care if billed by the shift rather than by the hour.

Learn more about the hourly cost of home care by state.

With hospice, there is generally no cost to the elder when 24-hour care is needed and the elder is under hospice care.

Paying For Live-In Care

Live-in care is a far less costly alternative to assisted living and nursing home facilities. However, the costs can still add up. Expect to pay between $15 and $25 an hour for live-in care.

Medicare does not pay for live-in care. Many seniors pay for this care with private funds or long-term care insurance. Some others options:

Medicaid collaborates with each state to provide benefits for low-income seniors. This is called the Medicaid Home and Community-Based Services (HCBS) waiver program; It can supplement coverage for non-medical home-based care. Check your state's Medicaid services department for details.

States have programs for senior who do not qualify for Medicaid. Contact your local Area Agency on Aging (AAA) to find out what programs are available in your area.

How Do I Find a Live-in Caregiver for the Elderly?

Finding a live-in caregiver is generally not difficult except in rural locations. The greatest challenge to finding a live-in helper is matching the personalities of two strangers. If you are looking for a live-in care provider with national resources such as:

• SeniorLiving.org – We offers free information to seniors and their families. We also offer a search by zip code tool that helps you find live-in care providers in the elder's location. This information gives you a good idea of the types of organizations that offer live-in care for that area.
• Agencies – Home care agencies that are both licensed and unlicensed. What is important to realize between different organizations is that the hiring process is not always the same. It is a good idea to work with an agency that adheres to state and governmental rules and regulations for hiring caregivers. This means criminal background checks, health screenings, and verified medical certifications, and reference check. In addition, a quality agency also verifies skill levels of those people they employ.
• Hospices – Hospice provides a variety of services that revolve around end-of-life-care. While many expect the family to be an active participant in the elder's care, they do provide 24-hour care as needed. Be sure to interview hospices in your area and set up an appointment to talk about the needs of the elder with their social worker.
• Check the Internet for Local and State Governmental Agencies – Many governmental agencies offer resources that help seniors find care. You can often find a good list of these agencies on the internet.
• Word of Mouth – Ask your friends. Many people have had to deal with organizing live-in care and your friends might have a great referral for you. Also, check with your local church leaders and with organizations in your community such as the local senior center.

What Types of Live-in Elder Care Options Exist?

• Live-in Memory Care – Works well for people with various stages of dementia. Memory caregivers help to keep patients safe without isolating them. Care may involve day trips to the senior center, doctors appointments, and other outings that enrich the elder's life. Generally, caregivers have more experience dealing with seniors who have dementia including behavior modification. With the use of tools such as bed alarms, the caregiver is still able to sleep at night. This type of service makes a great respite for family members who also care for the elder.
• Live-in Companion Care – This type of service is more generalized from that of live-in memory care. It still should work off of a plan of care that addresses all of the needs of the senior.
• Live-in Hospice Care – Provides end-of-life-care for those people who are terminally ill. The patient may not be elderly and hospice provides services to the entire family, such as grief counseling.

When live-in care is based on a plan of care, the type of care is customized and that means that each elder receives care that helps to improve their quality of life.

Summary

Live-in care for seniors allows your loved one to remain in their homes and to be as independent as possible. It also adds to their quality of life because the caregivers are there around-the-clock. If you'd like to compare live-in care with other senior living options, read Senior Retirement Lifestyles. To find live-in senior care in your neighborhood, see our senior home care or companion care page to point you in the right direction.