Home care services can be a crucial part of a senior’s wellness plan, but as an older adult needs more and more care, how do they continue to get the care they need? Perhaps a caregiver visiting for four hours each day simply isn’t enough anymore, or a full eight-hour day of caregiver support still leaves your loved one feeling unsupported in the evening or nighttime hours. There are options for continuing home care services as needs grow: 24-hour care and live-in care.
These options are similar but different enough that you’ll need to know more about each in order to make the best decision for your loved one. Here are some facts that can inform you as you determine which solution could be the right one for your specific situation.
Live-in care definition
Live-in care is a type of home care service in which a caregiver stays at the client’s home overnight for extended periods of time. With this type of home care, the senior client has the same caregiver all the time. The caregiver essentially lives in the home with them. The caregiver is not technically on duty when they are asleep, and they must have some time off according to state employment laws.
24-hour care definition
24-hour care is a type of home care service in which a senior client receives home care support 24 hours a day. A constant rotation of caregivers goes to the senior’s home to provide services. For example, a caregiver might have the first shift from 7:00 a.m. to 3:00 p.m. A different caregiver may arrive for a second shift from 3:00 p.m. to 11:00 p.m. A third caregiver will provide care during a third shift from 11:00 p.m. to 7:00 a.m. The senior client will have multiple caregivers throughout the day, but they will have a caregiver on duty even in the middle of the night.
Similarities between live-in and 24-hour home care
Both live-in and 24-hour home care are services that ensure a caregiver is in the home with your loved one around the clock. A caregiver hired through a home care agency for either live-in or 24-hour care is trained in senior care techniques and follows a care plan that is written specifically for your loved one.
Nonmedical home care agencies are more likely to offer 24-hour and/or live-in care than home health care agencies that provide skilled medical care in the home. The caregivers at home care agencies are there to support seniors with nonmedical tasks that can include:
- Assistance with activities of daily living (ADLs), such as grooming, bathing, dressing, toileting, ambulation, and transferring.
- Meal preparation.
- Light housekeeping and laundry.
- Safety oversight.
- Medication reminders.
- Transportation.
- Companionship.
For some people requiring around-the-clock care and skilled nursing care, moving to a nursing home might be a more suitable option: Most medical home health organizations (the agencies that bring skilled care into homes, as opposed to home care agencies that bring nonskilled personal care assistance into homes) do not offer live-in or 24-hour care for extended periods of time.
Differences between live-in and 24-hour home care
While there are similarities between live-in and 24-hour home care, there are some key differences that might make your decision more clear:
- A live-in caregiver is consistently living in the senior’s home around the clock. The caregiver can request days off per their employment contract, and another caregiver will come in to cover those days. However, the majority of the time, there will be one caregiver with your senior loved one. This can be an excellent option for someone who prefers maintaining one relationship or for someone who might struggle with more than one person in the home.
- A live-in caregiver must be given at least eight hours to sleep during a 24-hour period, as well as four hours off of caregiving duties during the day, depending on state regulations. In addition, most live-in caregivers have two days off per week when another live-in caregiver fills in. The home care agency that matches you with a live-in caregiver will know the employment laws that apply to your area.
- In contrast, 24-hour home care is given in shifts by different caregivers. These caregivers would remain fairly consistent, so you would typically know that a certain person is in the home in the mornings for the majority of the week. However, caregivers rotate in shifts throughout the day and night. This option can be best for a senior who benefits from a change of pace and personality throughout their day. There also is no downtime in care in this model.
- Live-in care can be more difficult to find and organize through a home care agency, depending on the state your loved one lives in. This doesn’t mean you cannot get live-in care, but you might need to find and employ the caregiver on your own. Employing a live-in caregiver on your own requires you to find, interview, and vet the caregiver in addition to ensuring they receive the correct amount of breaks, have a designated sleeping space in the home, and have a fair compensation plan in order to meet the Fair Labor Standards Act.
Considerations as you make a decision between 24-hour care and live-in care
Here are some things to consider when determining which option might best benefit your loved one. Remember to plan for their needs and preferences now and forecast into the future as much as possible so you don’t have to modify your plans significantly in the coming months.
Costs and paying for care
Home care, especially around-the-clock home care, can get expensive quickly. Ensure you are working with a home care agency that will do their best to bring down your out-of-pocket costs. Agencies might have a discount for hourly rates for those who need more than 18 hours of care, or you might be able to receive a discount on services if you book a live-in caregiver for a set number of months.
In addition, ensure you are working with a home care agency that accepts any Medicaid waivers or other assistance you might be using to pay for care. If your loved one has other home care insurance benefits, work with an agency that will accept these benefits so that you are paying the least amount out of pocket as possible.
If you choose to work independently and without a home care agency, consult with an attorney to be sure you are aware of any additional benefits or expenses you will need to pay on top of an hourly rate for the caregiver(s) you use in the home.
Type of care needed
Skilled care, or care that must be given by a licensed professional like a nurse or therapist, is typically not given in a 24-hour model in the home. However, that doesn’t mean that your loved one can’t have that support in the home for a shorter amount of time. For example, you might have a nonmedical caregiver to support your loved one with oversight and assistance 20 hours a day and then a licensed professional for skilled care for four hours a day. If possible, work with a home care agency that can provide you with all the care your loved one needs so that you don’t have to use multiple agencies.
It can also be helpful to review the type of assistance your loved one needs and when they need it. For example, if your loved one requires extensive support during overnight hours, it might be more reasonable to go with a 24-hour care model so that the overnight caregiver is awake and fresh during their shift. A live-in caregiver model might not work in this case, as they will also need to sleep at some point and they may be tired during overnight hours.
Your loved one’s preferences
Finally, consider your loved one’s preferences and personality. They may not like the thought of having too many people in the home, especially if they have dementia and may experience paranoia. A live-in caregiver might be better for this situation, as they will always have the same person in the home with them.
In contrast, having a new face in the home every eight to 12 hours might suit a senior who prefers a little variety throughout the day. It can be quite beneficial to have multiple caregivers, as each one brings their own style and perspective to their care. Your loved one can enjoy getting to know their caregivers and develop unique relationships with each one.
If you’re not sure which model might be best for your situation, contact a home care agency to discuss it further. The professionals there can assist you in your decision as they learn about your loved one’s needs and preferences.
