What You Should Know About 24-Hour Home Care

elderly woman and 24-hour home care aide

As an aging loved one’s health declines, the level of care needed to keep him or her safe and healthy may grow beyond the abilities of loving family and well-intended friends. And depending on the amount and degree of care required, some form of round-the-clock care may be needed.

Assisted living facility can provide that level of care, but it may also be possible to get the care you need at home, from a few different options.

Here’s what you need to know when exploring your options for 24-hour in-home care.

SEE ALSO: Find In-Home Care Help Near You

What are my options?

There are two general types of round-the-clock in-home care, says Susan Sender, RN, chief clinical officer for Amedisys, a national home health, hospice and personal care provider.

Live-in care typically means that one caregiver (a home health aide or a personal care worker) lives in the home with the individual. “The primary duties involve safety and companionship along with personal care services,” says Sender.

In this instance, a caregiver stays with the client 24 hours a day and does not leave. “They must be able to sleep for at least eight hours and five of those hours should be uninterrupted (often when the client is sleeping),” says Joyce Barocas, owner of in-home care franchise Right at Home of Lower Manhattan. Generally, caregiving shifts consist of three days for one caregiver and four days for another caregiver.

24-hour care consists of caregivers being alert and on duty at all times of the day or night. “This is typically for individuals who cannot be alone and need an alert caregiver nearby at all times because they do not sleep well, or sleep at odd hours and may be unsafe in their homes,” explains Sender.

SEE ALSO: Find In-Home Care Help Near You

Twenty-four-hour care is often broken into two 12-hour shifts or three eight-hour shifts in a 24-hour period, says Barocas. “The caregiver does not sleep.”

How much does 24-hour home care cost?

Live-in care is generally charged as a daily rate, whereas 24-hour care is generally charged at an hourly rate, explains Lakelyn Hogan, a gerontologist and caregiver advocate with Home Instead Senior Care. "No matter the level of care, the cost of either option varies based on the level of care needed and by the city and state of residence," she says.

Although sometimes live-in care costs can add up to less than what you might pay in assisted living, you also need to factor in the caregiver’s meals plus room and board. “Some states also have overtime laws that would also result in added expenses for live-in care,” Hogan says.

Depending on the level of care needed, live-in care and 24-hour care can exceed the costs of assisted living.

But Hogan says that paying those costs may bring families invaluable peace of mind. “Having 24-hour or live-in care ensures that a patient has one-on-one care, whereas a senior care facility generally has a higher staffing ratio of one caregiver to 6-8 older adults depending on the state regulations and company policies,” she says.

Who provides the care?

The skill and training of a caregiver depends on the complexity of the case and the request of the family. If the care needed is within the scope of a companion caregiver or home health aide, it’s not necessary to pay the higher rate of hiring a registered nurse or licensed practical nurse (LPN) as a caregiver. "Depending on a client’s needs, anyone from a home health aide to an RN can be scheduled for both live-in or 24-hour care. It all depends on a person’s needs," says Barocas.

What type of care is best for your loved one?

There’s no one formula to determine who is -- or is not -- an ideal candidate for 24-hour home care. “It truly comes down to the individual’s needs and the availability of the family,” says Hogan. “If the individual truly needs around-the-clock monitoring, 24-hour care would be the best option as the caregiver rotation would insure that there is someone available to assist around the clock unlike the live-in caregiver that requires eight hours of sleep per night.”

And for those with dementia, live-in care is generally recommended, since having multiple different caregivers could cause confusion, says Barocas.

When is it time to consider these options?

If a person cannot be left alone, is unable to exit the home in the case of an emergency or has any sort of cognitive impairment that could lead to them wandering or becoming disoriented or lost, it’s probably time to consider 24-hour in home care, says Hogan. “It is important for families to assess their loved one’s situation on a regular basis and plan for their future care needs and explore all of the options,” she says.

Where can I find this type of care?

Ask your loved one’s doctor or case worker for recommendations. Your state may also offer services to help you locate and/or evaluate potential 24-hour caregivers. “It is important for families to do their research and interview several companies and determine which one is best suited to fit their needs and their budget,” says Hogan. “Important questions to ask include: Are the caregivers screened, trained, bonded and insured?”


Gina Roberts-Grey

Gina Roberts-Grey is an award-winning writer whose health features have appeared in numerous publications including Glamour, Woman's Day, Family Circle, ESSENCE and websites such as Lifescript, MSN and NextAvenue. See full bio


4 months ago, said...

I have a question as a washington state in- home 24hr. Caretaker to a family member who has to be careful not to do any lifting of things that are heavy or make any possible chances of falling what do I do about the relative constantly buying pets to add to the responsibility of the caretaker and making things harder to manage daily as well as more of a risk for them to harm themselves so what do I do cause they keep adding more pets to maintain in our single wide trailer which we dont have room for in the first place and it is becoming a problem but they wont listen to me when comes to getting more and they expect me to care for them on a daily basis as well when its becoming rediculous and actually not a healthy situation for the pets nor the relative patient neither in such small living space as it as well. So far there are 5 dogs one snake many rats to feed to the snake as well as for pets to that she wants to breed and sale to the pet store as well along with three fish tanks with fish and one of the tanks is a 75 gal. Fish tank full of fish and then the payient is expecting me to clean it cause they cant be lifting things do to taking a chance of injuring themselves again or taking a possible fall as well cause of already having done back surgerys, neck surgerys as well as knee surgery and looking to possibly have to go into another neck surgery cause if they get worse she may end up with a steel rod down her neck if she doesnt but they are expecting me to care for all of this as a responisbility for me to look after for her but that is a lot to handle and I know nothing of fish for starters as well as she wont allow me to even try to help as well cause she wants it done a specific way she likes it done but the way she does it is not sanitary as well as everything everywhere causes a possible chance of her tripping and falling pver things as well as her causing herself more stress from it to that she also isnt suppose to have neither. But she expects me to pretty mich be cinderella and do as I'm told and follow and listen to everything she decides to do or things she says and if I dont without stating my opinion of what I believe wouldnt be a healthy situation for hef she finds that I'm not doing my caretaker duties. So what do I do about this situation now because its really becoming a problem for both of us and there is always problems now arising daily because of this situation. I need to know exactly what duties that I'm responsible for exactly because I didnt sign on to being a caretaker for the patient as well as a housemade to pets to the extreme along with a fish caretaker and snake caretaker and babysitter to her son and grandson along with being a mechanic, plumber, repair person, landscaper, and counselor, and parent duties to the patients son and grandson neither. Along with a pet caregiver to add as well as maintaining safety to the patients healthy living neccessaties daily to someone who won't even care to even listen to anything I try to advise her mot to do cause it can put her at risk of harm so then its either I put myself in harms way of having to do it or they end up doing it themselves cause they wont listen at all to any help you try to suggest to give to the patient. Help me with this situation please someone does anyone have any suggestions on any of this??????