Hiring a Live In Caregiver: Pros and Cons

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As parents age and require more and more help at home, live-in care is often considered as an alternative to moving into senior living. But, is live-in care comparable in costs and care level to senior housing options like assisted living? Explore the benefits of live-in care (and its limitations) for a loved one who wishes to age in place.

What Is Live-In Home Care?

Live-in care is often confused with 24-hour or overnight care. Live-in care, whether provided by a professional caregiver or a private hire, implies the provision of room and board to the caregiver. The live-in caregiver takes up residence in the home with the care recipient and is permitted respite and sleep. There may be some sort of schedule adaptation so that the care recipient and the caregiver’s sleep schedules are aligned, but generally, a live-in caregiver has a five- to eight-hour period of sleep built in to the care plan.

Overnight care and 24-hour care also occur during hours when the care recipient is asleep, but the caregiver in these agreements is paid to remain awake and on-duty. Often coordinated by an agency, the 24-hour period is broken up into shifts covered by multiple caregivers so that a senior is never left unattended. Hiring around-the-clock care ensures a senior remains as safe as possible at all hours of the day and night in the comfort of their own home.

What Is the Cost of Live-In Caregivers?

As noted in AgingCare’s Caregiver Forum, families often consider live-in care to be a less expensive option than senior living facilities or hourly in-home care services. After all, your sister-in-law, friend or distant relative needed a place to stay anyway, right? Unfortunately, it’s not that easy.

The Fair Labor Standards Act (FLSA) sets the federal standards for wages, hours and special rules for certain types of workers. Depending on the nature of a live-in caregiver’s employment and work, certain FLSA provisions, such as minimum wage and overtime pay, may or may not apply.

While there is an overall lack of employment laws specific to live-in caregivers, 10 states (California, Connecticut, Hawaii, Illinois, Massachusetts, Nevada, New Mexico, New York, Oregon and Virginia) and two major cities (Seattle and Philadelphia) have passed additional protections in the form of bills of rights for domestic workers. Each bill of rights varies, but general regulations state that:

  • Pay is independent of and in addition to room and board.
  • A household employee is entitled to time off within the work day.
  • A household employee is entitled to five to eight hours of sleep.
  • A household employee may be entitled to overtime pay.
  • Household employees are protected from discrimination and harassment in their workplace.

Regardless of the state in which you reside, keep these regulations in mind when reaching a fair agreement with a live-in caregiver. According to PayScale.com, the average hourly pay for a live-in caregiver is $12.27 in 2021. Note that room and board alone cannot be considered an even trade for the provision of care, so it is either used to offset hourly costs or is provided as “free” in addition to an agreed upon salary.

To estimate total pay, determine the cost of renting a room and the hourly in-home care rate in your area. Then, create a formal care agreement to clarify the details of a live-in caregiver’s compensation plan.

Create a Live-In Care & Compensation Agreement

Calculate the Following:

  1. What is the estimated value of room and board?
  2. What is the agreed upon hourly rate for care?
  3. How many hours of care will be provided per day?
  4. What is the amount of pay due to the caregiver after subtracting room and board?

Having thorough discussions now about responsibilities and expectations will ensure everyone is on the same page and help eliminate future conflict. Consider these additional points when finalizing your live-in care agreement:

  • Outline specific caregiving duties. Create a detailed care plan to identify expectations in the areas of companionship, personal assistance (e.g., bathing, toileting), pet care, cooking, housekeeping, transportation, etc.
  • Will time off be built into the weekly or monthly schedule?
  • Who will coordinate coverage of unattended hours?
  • Will there be overtime pay offered (or mandated) for care provided in addition to the agreed upon schedule?
  • What are the house rules regarding use of shared space, guests, pets and vehicles?
  • How will money be handled when making purchases for the household?
  • Under what conditions can the agreement be terminated?

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Live-In Care vs. Assisted Living

According to Genworth Financial, the median cost of assisted living is $4,300 per month in the United States. Just like in-home care costs, assisted living costs vary by location and the exact care services that are added on to a facility’s base rate. While many seniors balk at the cost of assisted living, aging-in-place might cost more than you think. There are many expenses associated with maintaining a home, even if it is owned free and clear. Property taxes, insurance premiums, home modifications, repairs and upkeep coupled with the cost of a live-in caregiver add up. For a senior who truly needs supervision and/or assistance with 24-hour availability, assisted living may be a more economical choice than live-in home care.

Benefits of Live-In Care

There is a significant benefit to reducing the cost of care by offering room and board, especially when the senior has plenty of space at their current residence. A senior who stays at home is able to receive the assistance they need in a private setting, set their own schedule and remain part of their home community. Live-in aides may also provide companionship and socialization to an otherwise isolated senior. Families often find peace of mind in the knowledge that a caregiver is in the home with their aging loved one around the clock.

Drawbacks of Live-In Care

However, the cons of hiring live-in care may be dependent on who you hire and the details of their contract. Long-term care, particularly when paying out of pocket, is expensive. Since the majority of live-in caregivers are privately hired, the logistical challenges are largely the same as when hiring an independent caregiver. Checking the caregiver's background, references and qualifications is entirely up to the family. Once hired, the family must also handle complicated tax commitments, managing payroll and other paperwork.

More importantly, though, consider your candidates carefully. The demands on a live-in caregiver are intense and may cause relationships to sour. If there is some risk that one or both parties may feel taken advantage of, an alternative care option might be a better solution.

As a senior's needs increase, it isn't reasonable to expect untrained caregivers to provide skilled care services or 24/7 care day in and day out. Respite is necessary for any caregiver to avoid burnout and ensure the provision of quality care. If a senior needs or is approaching around-the-clock care, it may be time to consider transitioning to a senior living facility.

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