Why Live In Care Isn’t a Good Idea

Why We Don’t Provide “Live in ” Senior Care and Why We Don’t Recommend It

Live in care typically means someone is hired to stay with a senior around-the-clock.  When people think of live-in senior care, they often think about hiring someone to actually live in the house, perhaps for room and board in exchange for care.  This may appeal as an affordable option, to help the senior stay independent at a low cost.  We will first address some of the cautions you should consider if you are exploring this option.  We will then discuss “live in” care provided by home health agencies and registry services, which is a bit different but still something we choose not to provide at EasyLiving and we will explain why.

Live-in senior care hired privately (in exchange for room and board, for example)

We talk to many families considering this option.  Some of the ways we have heard of families going about this: hiring a nursing or graduate student to provide some help around the house in exchange for room and board while going to school, hiring someone who has previously helped a neighbor or someone you know who passed away, or advertising in the paper (or even using an online service that may offer background checks and profiles) for someone willing to provide some level of help for room and board or a small wage.  Some of these methods may offer some level of comfort, such as getting a recommendation from a neighbor, and you may do a background check to ascertain the person’s criminal history (or lack thereof, hopefully).  However, here are just a few of the things you should consider when evaluating this option so you know your risks:

  1. Consider supervision–who is going to watch over what is going on, provide training, troubleshoot any problems?  This is even more complicated in live-in situations than with hourly private care, as the relationship can become much more “entangled” and the living situation can create real tension if problems arise.
  2. Understand your liability.  If the person gets injured while working in the home, your loved one may have responsibility.  Do not assume your homeowner’s insurance will cover such issues–always check with your insurance and/or attorney.  The nature of in-home care can leave employees susceptible to injury, especially if not properly trained and supervised.
  3. Understand employment and tax laws.  Is a live-in caregiver considered your employee?  Who is handling taxes and social security?  Get professional advice, or this could come back to bite you.
  4. Do not neglect the details of the arrangements.  What happens if your loved one needs more care that this caregiver cannot provide?  What are the arrangements for sick time and vacation leave?  What hours and duties are expected and how does either side go about changing this?  What type of notice and payment is either side expected to provide if terminating the arrangement?
  5. Think about the challenges of “disentangling” from the relationship.  Not only should you outline the details of terminating, but think about how complex this might be in the actual situation.  Will your loved one feel so attached to the person that he/she will not terminate the relationship no matter what?  Will this become an impediment to making better arrangements (i.e. it might be more appropriate to move to assisted living, but your loved one fears what will happen to the caregiver or the caregiver may be motivated to make discouraging comments/influence the situation)?  Private live-in care situations tend to be the most problematic in these terms.
  6. Building on #4 and 5 above, think through the process as your loved one requires more care.  Often, live-in senior care help hired in exchange for room and board includes general household duties or occassional assistance.  If you have a student living in, what happens when Mom needs help during class?  Will you hire additional help and still have the person live-in?  Does the caregiver have any experience with dementia or personal care assistance?  Does he/she know how to properly lift someone or help with personal hygiene?

Live-in care from a home health agency or nursing registry

Some home health agencies and nursing registries offer “live-in” rates.  Typically, in Florida, this means a flat rate for a 24-hour period instead of a per hour rate, which reduces costs significantly when someone needs round-the-clock care.  Th expectation is that the person can sleep at night–generally a reasonable time, with minimal interruptions.  This is supposed to make it feasible for one person to do the job around-the-clock.  Here are a few more things to note about live-in care through an agency:

  • You have to provide a sleeping space/private room for the live-in caregiver.
  • The person is supposed to get 6-8 hours uninterrupted sleep/non-working time.  Reasonably, if an elder needs help several times during the night and most all the other hours, the situation is probably not realistic for a live-in caregiver to handle well.
  • If you have live-in care from an agency 7 days/week, you will likely be working with a couple different caregivers to handle the shifts.  As agencies face new labor laws and regulation changes, live-in care structures could become more threatened due to overtime, pay rules, healthcare and other issues that small business will have to analyze for continued feasibility.
  • Are your prioritizing live-in care’s reduced rate over the best possible caregiver?  In other words, if an agency’s best caregivers do not prefer this type of work, are you eliminating the best caregivers from the pool of potential help?

caregiver sleeping

Why EasyLiving Has Chosen Not to Provide Live-in Care

  • We want our caregiver’s time with you to be working time.  The line can get fuzzy with live-in care and the sleep piece can be complicated.  We just don’t feel it is the best way to support our caregivers in their professional role, and give you the best “bang for your buck”.  If our caregivers are working a night shift with you, they are available to come to your assistance and can also do other “quiet” household duties while you sleep.
  • In follow on to what we said above, we work with vulnerable clients who may need help at all hours–if they have a caregiver 24/7, we think they should have access to that caregiver 24/7.  A nighttime fall or wandering cannot be avoided 100%, but for many clients having an alert caregiver is essential to safety.
  • While we know affordability is a concern, we do not want to compromise quality care.  We try to work with clients and families on creative care plans to reduce costs.  The pool of caregivers who may want to work in a live-in situation is usually limited and we make a lot of efforts to hire good team members and set them up for success.
  • We work in a team approach, so that you have caregivers who can fill time slots you need as well as step in to cover other caregivers’ vacations, sick time, etc.  We like to work to get you a familiar team of people who know you and your care plan to maintain consistency, where feasible.  The team approach also allows us to ensure the most qualified caregivers are available to help, based on your loved one’s specific and sometimes changing needs.

If you are thinking about ways your family can afford to pay for in-home senior care, you might benefit from checking out our Guide to Paying for Long Term Care.  This free guide helps you organize and marshal your resources, understand where to turn for help and find affordable care options.  Our Senior Care Consultants are also personally available to help you anytime, answering your questions and identifying solutions that work for you.  Call anytime: 727-447-5845!