Choosing a Live In Caregiver

A live in caregiver, home health aide, or personal care aide cares for a senior or person with limited abilities in their own home. Although the terms “live in care” and “24 hour care” are often used interchangeably, the types of care they represent are different.


Different Kinds of Caregivers

Live in caregivers.

Live in caregivers essentially have their permanent residence in the home of the person they are taking care of. They usually work between four and five days a week and provide 24 hour care when they are on duty. Typically, a live in caregiver is given eight to ten hours to sleep every night, and a bed must be provided for them. The sleep time might not be a continuous 8-hour period, especially if the caregiver needs to provide care to their charge during the night.


Live in care providers should also be given a four-hour break during the day. If the person who is being cared for requires constant care, another caregiver may need to fulfill the caregiving duties while the primary caregiver is on break. Another caregiver will also need to be brought in on the off days of the primary live in caregiver.


In some cases, a live in caregiver may only work during the day but is on standby during the night. In these cases, the caregiver is not necessarily on duty during the nights. Instead, they are there as a safety measure in case their assistance is needed.


24 hour caregivers.

Those with higher care needs might require 24 hour caregiving. In this case, two or three different caregivers will work between eight and twelve hour shifts. With 24 hour caregiving provided by multiple caregivers, there is no need to provide a bed unless the family and the person receiving the care choose to allow the caregiver to sleep. This is usually only the case for caregivers who work the night shift. Having said that, it is usually expected that the person who provides 24 hour care stays awake to assist the care receiver throughout the night. Typically, someone who provides 24 hour care has a couple of short breaks during their shift.


Overnight and daytime caregivers.

Overnight caregivers mainly provide care during the night. They typically arrive at the care recipient’s home in the evening, assist them before going to bed, and stay overnight. They also provide care for a few hours in the morning once the person whom they care for wakes up. Overnight caregivers can sometimes sleep during the night depending on the needs of the person they are taking care of.


What duties do live in caregivers perform?

Live in caregivers provide the same care that someone would receive in an assisted living or nursing home, but in the person’s own home. They assist with daily activities like shopping, cooking, and doing light housework. They can assist with personal care activities like bathing and dressing, giving medication reminders, and driving them to medical appointments or social activities.


Live in caregivers provide companionship to the persons they are caring for. They are also the point of contact for family members and the care recipient’s medical team and are responsible for keeping all parties informed on the care recipient’s medical status.


Benefits of Having a Live In Caregiver

When using a living caregiver, the person who is cared for can stay in their own home. This is often more comfortable as they remain in familiar settings, with all of their personal things around them instead of living in a long-term care facility, assisted living facility, or nursing home that could be clinical and impersonal.


Live in caregivers provide one-on-one care to the persons they are assisting. It is typical for the live in caregiver to become part of the family and build a connection and relationship with the person they are taking care of. There is a lower turnover of caregivers which means that the person who is being taken care of doesn’t need to get used to a stranger being in their home as often. The deep bond cultivated between the care recipient and the caregiver could provide some comfort and negate the care recipient feeling unsettled by multiple persons entering their home.


Because the live in caregiver only takes care of one person, the care is more personalized. The caregiver’s focus and attention are dedicated to only one person. This creates an atmosphere of trust, nurturing, and safety. There is also no nervousness or anxiety that might sometimes accompany the changes of shifts between different caregivers.


Since only one person is responsible for the patient’s care, the care is consistent. This is especially beneficial if the care recipient has an injury or illness and eliminates the possibility of information being misunderstood or falling through the cracks with the handover between shifts. Having one live in caregiver creates one point of contact between the caregiver and the care receiver’s family.


Live in caregiving is more expensive than care at a long-term care facility. However, it is less expensive to have one live in caregiver instead of multiple caregivers that provide 24 hour care.


Some Challenges of Using a Live In Caregiver

When using a live in caregiver, you’re essentially inviting a stranger into your home –  and that person may be around 24 hours a day. This might cause some concern or anxiety for the person who is being cared for. That’s why it is crucial to involve the person who needs care in the screening and hiring process.


If the person who is being cared for often wanders due to dementia, one caregiver may not be able to manage their care effectively. Individuals who have dementia and tend to wander require constant care. However, live in caregivers need time off. Even while they are on duty, they may need to leave the person in their care by themselves for a few minutes, for example, when the caregiver is using the bathroom facilities, preparing a meal, or sleeping at night. It’s times like these when someone is not actively watching the care recipient, that they may wander off.  Although live in caregivers receive training to deal with these kinds of situations, they cannot watch the person in their charge every minute of the day.


Having a live in caregiver means that the person receives the care they need in their own home. While the caregiver does offer some degree of social interaction to the person they are looking after, that is not their primary function. They often need to focus on other tasks. Because the person who is being taken care of seldom leaves their home, they have few opportunities for social interaction. This could cultivate feelings of isolation and loneliness.


Creating a Care Plan With the Family

Few states have live in caregiver laws and regulations. Therefore, it’s essential that a plan of care is established before the caregiver begins their duties. This plan should include at least the following points:

  •         A brief history of the care recipient’s life. This could include their age, their profession, and information on their family members. It could also include information on activities they enjoy and social gatherings they participate in.
  •         Detailed information about the care recipient’s medical condition(s) along with any special requirements relating to their care. This includes physical and mental health and any dietary restrictions or allergies that the care recipient might have.
  •         Whether the care recipient is currently taking any medication. You need to list all the medications and the prescription number, the prescribing doctor, instructions for use, and the dosage for each medication.
  •         List all items the care recipient uses like glasses or contact lenses, hearing aid, a walker or cane, prosthetics, and dentures.
  •         How much and what kind of assistance the care recipient will need. This includes whether the caregiver will need to assist with physical transfers from bed to wheelchair or chair and other personal care services. You could include information on whether the care recipient is allowed to go out with other individuals (if so, with whom) and whether the caregiver can leave their charge alone while they run errands.
  •         Discuss scheduling – what is the personal schedule of the person who is receiving the care as well as the general home schedule. The care recipient’s personal schedule will include when to bathe and what time meals should be eaten. Home schedules include things like trash pickup or when the lawn service or housekeeper comes in.
  •         Provide home safety information such as alarm instructions, codes, and keys.
  •         How will the money be handled, documented, and reimbursed? This specifically refers to money spent on behalf of the care recipient.
  •         Any housekeeping responsibilities, including whether the caregiver will be responsible for looking after any pets.
  •         What kind of activities the care recipient enjoys and which activities should be limited.


Things to Include in a Work Contract With a Live In Caregiver

A live in caregiver is essentially an employee, and you or your loved one is their employer. Therefore, you need a contract to stipulate each party’s expectations and requirements. These contracts should include the following along with the usual contractual information:

  •         The total payment due to the caregiver and how often this will be paid. A provision for overtime hours should also be worked in. You could also include the method of payments in this section.
  •         An estimate of how many total hours the caregiver will be on duty and provide care weekly or monthly.
  •         An estimate of the number of hours the caregiver can expect to be on call during the month. You should also discuss compensation for this time.
  •         Whether a portion of the caregiver’s payment will be offset by room, board, and other expenses. Live in caregivers typically have access to the household’s food and beverages at the client’s expense. These could be worked in as part of their remuneration package. On the other hand, live out staff, like 24 hour caregivers, must bring their own food and beverages.
  •         Whether the live in caregiver will use their personal vehicle for work purposes and how this will be reimbursed. 
  •         Whether any rooms or areas in the home are off-limits to the caregiver or the person they provide care for.
  •         Contract termination rights of each party. This includes notice periods that apply to all relevant individuals.
  •         Any other house rules and conditions that may apply. This could relate to topics like guests and pets.


How to Find a Live In Caregiver

There are various avenues to pursue when looking for a live in caregiver for your loved one.


Hiring privately.

If you are looking at privately hiring a live in caregiver, your best option is to use a referral website. You can also check newspapers or magazines.  You can also ask friends, family, or acquaintances for personal referrals or make use of lists provided by public agencies or organizations. You could also consider placing your own advertisements in local newspapers or magazines.


While it might seem that privately hiring a live in caregiver is less expensive, there are some things that you need to consider if you go this route. You will still need to conduct payroll, pay taxes and workers compensation, and miscellaneous fees that could include things like car insurance if the caregiver’s car will be used on the job. You will also need to thoroughly vet all candidates to confirm that they have specific qualifications and do a criminal background check.


Home care agency.

If you find a live in caregiver through a home care agency, the caregiver is essentially employed by the agency. That means the agency pays the caregiver’s wages and benefits along with dealing with the taxes. The agency then bills you or their clients for all expenses to be paid.


Home care agencies continually hire new caregivers. That means that they will be able to provide you with the caregiver best suited to meet your loved one’s needs. They also provide a fill-in caregiver when your primary caregiver has time off. These agencies do a thorough vetting process on all of their caregivers, including reference and criminal background checks. Most home care agencies will schedule regular home visits to observe the caregiver while they are on duty. This ensures that the standard of care provided by their caregivers is consistent.


Referral agencies.

Caregiver referral agencies could be seen as a hybrid between the service you would receive from a home care agency and hiring a caregiver privately. These referral agencies refer caregivers to their clients. The clients then hire the caregiver directly as an employee. The referral agency ensures that their candidates have been trained through a reputable caregiver program, have the necessary work experience, and are thoroughly screened. They also ensure that the caregivers hold the required work permits allowing them to work in the United States legally.  Although a caregiver referral agency does not provide services like payroll, taxes, and workers compensation, they can provide clients with guidance and referrals for these services.


Things to Consider When Hiring a Live In Caregiver

A live in caregiver will be living in your loved one’s home and provide them with medical care (depending on their qualifications) as well as assisting them with their day-to-day activities. You must ensure that you hire the right candidate who will provide the best care and keep your loved one safe.


Conducting a criminal background check, both federal and in the county, is essential. You could request a ‘Live Scan.’ A Live Scan requires the candidate’s fingerprints to be taken. It will then generate a report that includes all arrests, probation and sentences, court cases and dispositions, and any other post-conviction orders that might apply to the person you consider hiring. The report will also include any civil matters relating to the individual, such as involuntary mental health commitments, restraining orders, civil contempt findings, and any other miscellaneous law enforcement-related issues.


Besides conducting a criminal background check, you also need to check their references.


If your live in caregiver will be driving while on the job, especially with your loved one in the vehicle, you need to ensure that they have a valid driver’s license. You can also check for DUI’s, moving violations, and suspensions. They should also have their own car insurance if they own a car. If they are making use of your or your loved one’s car, they need to be added to the car insurance policy.


Other types of insurance that you will need to have includes workers compensation insurance, liability insurance, and possibly a Fidelity bond.


A home caregiver provides care to your loved one in their own home. They usually work with individuals who do not require 24 hour care but still need assistance and prefer the comfort of in-home care. This provides individuals with more personal care than they might receive in an assisted living facility.

A live in caregiver’s job not only involves providing assistance with activities that form part of their daily living but also offers companionship to your loved one. They often form deep connections with them and provide social support.