The Cost of a Live-In Caregiver:

If you need a live-in caregiver, Assisted Hands in the Michigan area can help provide care for you and your loved one.

Introduction:

The idea of live-in caregivers is appealing to many families caring for elderly loved ones because they offer an alternative to assisted living or nursing homes by providing around-the-clock or overnight care in the home.
This article explores how to live in caregivers’ work, costs, Medicare and Medicaid benefits, and other financial assistance and payment options.

How Live-In Care Works:

There are two types of live-in caregiver situations.
The caregiver must be provided a space (and bed) to sleep, and those who do not require a caregiver be given a bed and asleep break.
The care recipient must provide care even during nighttime hours in either situation.
Commonly, persons use “live-in” and “24-hour” care to mean the same thing.
However, while both types of care essentially are live-in caregiver situations, there are distinct differences between the two types of care, which will be covered below.
This difference impacts the amount and type of care provided and the cost of care.
In addition to “live in” and “24-hour” care, the third option of live-in Caregiving is available and is “overnight” or “daytime” care.

“Live-in” Caregiving:

With “live in” Caregiving, the main caregiver generally works between 4 and 5 days each week, providing 24-hour care during this time.
The caregiver is given 8 hours to sleep at night (a bed must be provided with this type of care).
However, their sleep may be disrupted to provide care throughout the night.
In addition, the caregiver is given a 4-hour break during daytime hours.
During this break, another caregiver may or may not cover the primary caregiver, depending on the care recipient, their needs, and the family’s decision.
An alternative caregiver works the days the primary caregiver is off.

“24-hour” Caregiving:

With “24-hour” Caregiving, there will be two or three caregivers who work 8-12 hour shifts in the care recipient’s home, providing “round the clock” care.
This type of live-in care is more appropriate for individuals with higher care needs.
Sleeping breaks are not provided with this type of care unless a family allows the caregiver to sleep.

Overnight / Daytime Caregiving:

With overnight Caregiving, the caregiver generally provides care a couple of hours before the care recipient goes to bed, during the night (if needed), and a couple of hours in the morning when the care recipient wakes up.
In most cases, the caregiver can sleep during the night, as long as the care recipient’s needs allow it.
In some cases, the caregiver may live with the care recipient in the home.
Alternately, a caregiver may provide daytime assistance, live in the home, and provide nighttime assistance on an “as needed” basis.
In this case, the caregiver’s presence in the home at night is thought of more as a safety measure or as an “on-call caregiver.”
It is not expected their help will be required every night.

Types of Care Provided by Live-In Caregivers:

Live-in caregivers provide all the same types of care and have the same duties as other home care or home health care workers. In addition to supervision, they can provide:

Personal care
A home health aide
Assistance with the activities of daily living
Companionship
If trained, nursing services

Personalized private care:

Care is (or can be) on par with that provided in assisted living or nursing homes.
It is very common for live-in caregivers to prepare meals, do light house cleaning, give medication reminders, do the shopping, and provide transportation assistance for recreational activities or medical appointments.
Live-in caregivers are especially common when assisting persons with Alzheimer’s.
This is because they require supervision but not necessarily constant care. Persons with Parkinson’s disease also utilize live-in care, as they require assistance with mobility, but not necessarily higher-level nursing skills.

What is the cost of a private caregiver?

Unlike other types of aging care, it isn’t easy to estimate what live-in caregivers cost.
Estimates range from as low as $1,000 / month to more than $5,000 / month.
At Assisting Hands home care in Michigan, we provide hourly rates decided after a personalized assessment. Generally, these begin at around $28 per hour for an experienced caregiver.
Other factors include if a caregiver will provide a vehicle.
Or vice versa, if the care recipient provides the caregiver with access to a vehicle and if it can be used for personal use.
Finally, the expected frequency of sleep disruption during nighttime hours is of great sensitivity to the caregiver and sometimes undervalued by the care recipient’s family.

How does this compare to a nursing home cost?

A live-in caregiver is typically less expensive than full-time home care or nursing home care.
But it is financially similar when considered as an alternative to assisted living.
Of course, homeownership, mortgages, rents, and other utilities play into the equation.

Live-In Caregiver Agreements:

It is very common and strongly advised that live-in caregivers and their clients (the homeowners/care recipients) make a Live-In Care Agreement or Contract for both parties’ benefit and protection.
At Assisted Hands Milford, we strongly pre-qualify our caregivers and use a Ph.D. psychologist and physician to train and supervise your caregiver plan.
This is especially important considering the lack of live-in caregiver laws and regulations in most states.
We are well-reviewed and have an excellent track record in the community working with us.
We pride ourselves on our communication and the ability

Health Agency vs. Private Caregiver?

However, for those hiring private individuals as live-in caregivers, not through an agency, they should make certain their agreements include the points from the following checklist in addition to the usual contractual information.
Estimated monthly hours of active care to be provided by the caregiver.
Estimated number of hours the caregiver will be “on-call” during the month.
Total payment due to the caregiver.
A portion of payment due to the caregiver is offset by room, board, and other expenses.
Overtime expectations and compensation.
Expected usage of caregiver’s vehicle for work purposes and the form and amount of reimbursement for such usage.
Areas and rooms of the home to which both the caregiver and the care recipient will have access and those which are deemed off-limit
Each party’s contract termination rights (to prevent forced, immediate move-outs or leaving the care recipient without assistance).
Other house rules and conditions of the agreement include guest and pet policies.

Risks of hiring your caregiver:

It can generally be cheaper to hire your caregiver if reliable and well trained, but this can be extremely difficult to do.
These are generally not supervised or bonded caregivers.
They usually do not undergo drug testing, pre-screening, and regular training.
We receive regular calls from those who do not receive reliable or trustworthy help.
We provide a name, credentials, and testimonials that you can trust!

Payment Options for Live-In Care:

Providing room and board and possibly a vehicle is a smart way for older adults to maximize the underutilized assets at their disposal.
Offering these to caregivers at no cost offsets the dollar amount they would otherwise be required to pay.
Payment for live-in care, for the most part, comes out-of-pocket.
When financial assistance is available, it is typically not designated specifically for live-in help, rather for home care in general.
The benefits of programs commonly available to the elderly and how these programs might be used to pay for live-in care.

Medicare:

Does Medicare pay for live-in caregivers?

Unfortunately, the answer is no.

Medicare does not assist with live-in caregivers.

Medicare, in limited situations, will cover the cost of home health care visits.
But these visits are for medical care (not personal care) and are reserved for individuals who are physically unable to leave their places of residence.
Medicare does not consider live-in care a covered benefit.
Therefore Medicare Supplemental Insurance policies also do not cover this service.
These policies only pay the deductibles and co-payments of services covered by Medicare.
They do not broaden the range of services.

Medicaid:

Medicaid is complicated, and its benefits differ in every state.

In many states, there are Medicaid programs that provide financial assistance that can be used to pay for a live-in caregiver.
Assistance is most likely provided through “consumer-directed HCBS waivers.” HCBS Waivers are programs for persons requiring nursing home level care who elect to receive care at home instead of a residential care facility.
Consumer-directed HCBS Waivers provide the care recipient with flexibility regarding choice of care provider and what care is necessary for their needs.
Given this flexibility, Medicaid beneficiaries may use their allocated care budget to retain a live-in caregiver. A complete list of state Medicaid Waivers relevant to the elderly offers a consumer-directed option.
Further, some Medicaid Waivers allow adult foster care or adult family care.
This benefit is usually intended to allow an older person to move into another person’s home.
However, some allow for the reverse situation where a live-in caregiver moves in with the care recipient.

Veterans’ Assistance:

The VA has no formal live-in caregiver program in which unrelated individuals care for elderly veterans by living in their homes.
However, the VA does offer two programs that provide veterans and their surviving spouses with financial assistance that can be used to pay for a live-in caregiver.

Reverse Mortgages:

Reverse mortgages offer a way for aging homeowners to receive a portion of their home equity in cash every month, which can then be used to pay for care.
Reverse mortgages are particularly well suited to pay for live-in caregivers when considered an alternative to assisted living or nursing home care.
One requirement reverse mortgages have is that the homeowner lives in their home.
Obviously, in the case of assisted living or nursing homes, the homeowner does not live at home.
Therefore, reverse mortgages cannot be used to pay for these types of care.
Live-in caregivers provide a nice workaround to this problem. By hiring a live-in caregiver, the elderly individual or couple can remain in their home.
As long as they remain in their home, they can receive a portion of their home equity in cash each month, which can then be used to pay for their live-in caregiver.

Long Term Care Insurance:

For persons who have long-term care insurance, coverage may be provided to help pay for live-in caregivers.
Unfortunately, this type of insurance is costly, and for persons who have an immediate need for care, this is not a viable option.