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.

Assisting Hands Home Care Michigan
A caregiver may seem expensive at first, but this can be a much more cost effective option and proceeding with nursing home care.

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.

Table of Contents

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.