THERE ARE MANY different ways of addressing care needs in older adults. From home-based care offered by family or a visiting aide to assisted living or nursing homes, there’s a care solution that can work for just about every senior and every family.
One option is live-in senior home care. This type of care features a full-time caregiver who lives in the home of a senior, much like some families hire a live-in nanny to care for small children. This type of care is best suited for seniors who need around-the-clock care, especially at night. If the caregiver needs to wake up several times a night to tend to a senior or help them take medication, a live-in caregiver might be the right solution.
There are two general ways that a live-in caregiver arrangement can be set up::
Live-in caregivers who maintain their own, separate residences. In this type of caregiving situation, there are actually two or more live-in caregivers who rotate the nights they work. Each caregiver will spend a night (or more) in the home of the senior and then trade off with the other caregiver when they go “off-shift.”Live-in caregivers who live only in the home of the person they care for. In these situations, the caregiver probably doesn’t have his or her own separate residence, but lives in the home of the senior full-time. This person is usually the sole night-time caregiver for the senior, but may have support from a visiting nurse or aide during the day so that he or she can have some off hours to attend to his or her own personal needs or work another job during the day. In some cases, the senior may go to adult day care during the day, and the caregiver typically has a couple nights a week off.
In both situations, the live-in caregiver needs to have a private room in which to sleep. In addition, the senior typically covers the cost of food while the caregiver is on duty. The caregiver’s duties can range widely depending on the senior’s specific needs. Typically, a live-in caregiver will perform tasks similar to a home health aide, which may include helping the senior with bathing and dressing, housekeeping, administering medications, making meals and running errands.
“Home care is the largest entity within senior care,” says Eleonora Tornatore-Mikesh, chief experience and memory care officer at Inspīr, a new senior living community in Manhattan. “About 70% of seniors are cared for in the home-care sector.” Finding the right combination of care can take some effort and patience, whether that care is round-the-clock or only part time.
When considering whether to hire an hourly visiting aide or a live-in senior caregiver, one approach isn't necessarily always better than another, Tornatore-Mikesh says. Rather, “it all depends on the situation.”
Families need to carefully consider what’s best for the senior from a variety of angles – health, overall wellness and family stress – to find the right solution. For some, a live-in caregiver may be the best option.
Pros and Cons of Live-In Senior Care
According to a widely cited 2010 study from AARP, the vast majority of adults aged 65 and older want to remain in their homes for as long as possible. But when that desire comes into conflict with increasing health problems or a rising need for assistance in completing the tasks of daily living – toileting, bathing, eating and keeping the home livable – that can create a problem. Live-in care is one solution that some families have turned to help a senior continue living well at home as long as possible.
The appeal of a live-in caregiver is simple: This person lives in the home and is available to assist a senior when an urgent need arises because of their proximity.
Advantages of having a live-in caregiver:
In some cases, the live-in caregiver becomes part of the family to some degree, which can lead to a better relationship between the senior and the caregiver.Less turnover than might be more typical with hourly visiting nurses and aides.Care is delivered on a one-to-one basis, which can make for a safer situation.Live-in senior care also helps the senior remain in his or her home as long as possible, which may be preferable to moving to an assisted living community or nursing home.
However, there are some challenges associated with live-in caregiving. First among them is the need for the senior to be comfortable with someone living in their home says Dr. Susann Varano, a geriatrician at Maplewood Senior Living, a Westport, Connecticut–based senior living residence company. “You have to consider whether you’re comfortable having someone in your house 24 hours a day. A lot of people say, ‘no, I’m afraid they’re going to hurt me or steal from me.’ There’s a tremendous amount of emotions and feeling that go into,” allowing a stranger into your home.
Disadvantages of having a live-in caregiver:
Lack of social support.Potential for caregiver burnout.If a senior is wandering, due to dementia or other reasons, this may be an untenable situation for a caregiver – especially when it occurs at night.Live-in care can be expensive and isn't covered by Medicare. [
Social isolation can be an issue for seniors who remain at home. Certainly, having a caregiver there provides some stimulation, but interaction with more people, especially peers, is very beneficial to overall health and wellness, Varano says. “It’s not in the caregiver’s job description to take you to the movies or socialize with you. They’re there to do whatever they’re there to do. For some people, that’s perfect because they don’t want to go out in groups and crowds.” But for others, that lack of social support can lead to depression and loneliness.
With increased health problems comes the need for increased health care, which can lead to “caregiver burnout and stress,” Varano says. As a senior’s health needs progress, it may become necessary to shift to an around-the-clock caregiving schedule that provides more intensive support than even a live-in caregiver can offer. “Having three well-rested caregivers arriving every eight hours,” to cover the full 24-hour period might be a better option for in-home care depending on the specific situation. Eventually, it may become time to consider moving to an assisted living community or nursing home.
Particularly if a senior is beginning to wander, as often occurs in cases of dementia, that might mean remaining in the home has become an untenable option. Nighttime can be challenging for seniors with dementia and their caregivers if wandering is becoming a frequent behavior. “Live-in caregivers have the right to sleep,” Varano notes, and they might not be aware if a senior manages to get out of the house while they are sleeping. She relates the story of one caregiver who went to the bathroom, “and in that couple minutes, the patient went out of the house.”
Depending on the situation, this could be a huge problem, so it’s important to recognize that no live-in caregiver can possibly have eyes on the patient 100% of the time. Still, she says these caregivers typically receive additional training that should help reduce the chances of a problem.
Live-in care can also be expensive. While some caregivers, such as a family member, might provide overnight care for a senior in exchange for room and board, professional caregivers likely also expect an hourly or day-rate wage. These fees can range widely, from $15 to $25 or more per hour or $150 to $300 per day, depending on where you live and the kind of care being provided. These fees can add up, making live-in care as expensive or more than moving into an assisted living facility. But there’s a lot of variation to these figures; so if you’re considering live-in senior care as an option, be sure to do your homework and compare different agencies, providers and options.Also, it’s important to note that Medicare doesn’t cover the cost of in-home care. Medicare covers up to 100 days per benefit period of care in a nursing home if it’s been ordered by a doctor. Medicare does cover some home visits from a registered nurse or a physical or occupational therapist.
Set Yourself Up for Success
If you’re hoping to remain in your home as long as possible, the National Institutes of Health has some tips to make your home safer and more comfortable over time as you age in place.
Invest in a walker or other mobility device to make getting around a little easier.Access volunteer escort services to assist you when running errands or going to the doctor’s office.Connect with a local senior center to access activities and find social connections. Attending social functions or adult day care can reduce feelings of isolation and loneliness.Consider getting an emergency alert system. That way you can call for help if you’re alone and experience an emergency, such as a fall or sudden health issue.Install a ramp up the front steps, grab bars in the tub and shower and easier-to-operate doorknobs and sink taps. All of these accommodations can make maneuvering around your living space easier and safer as your needs change.Contact your local Area Agency on Aging for help in finding out what resources and support are available nearby.