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It might seem self explanatory, but how does it actually work? My mom's doctor recently said that she can either have in-home round-the-clock" care or go to a facility. Does this mean someone actually living in the house? Or they just stay overnight? What kind of degrees are there to this? I guess there probably are a lot of different levels to this depending on her condition and finances, but basically it's because of dementia and a lack of self-care, and my dad who's also 90 and got his own issues doesn't know what to do. The idea of someone living in their house seems kind of like a fantasy to me, that they won't really put up with it or know how to handle it. She has already said she "doesn't want a girl" because she's worried my dad will "mess around" with them (which is ridiculous, FYI).

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My mother had to have 24 hour care after my father (her nighttime caregiver, as we had day help) passed away. It was hugely expensive, and I only kept it as long as it took to get her into a facility. They worked 8 hour shifts, and the nighttime girl stayed awake all night to make sure Mom was taken care of, as she wandered around in the middle of the night. Be aware, that weekends and holidays may cost extra. I now have her in a very nice memory care senior living situation, which is just a little over half the cost of the 24 hour care she had for the 6 weeks it took me to get her into the facility. I do like the facility better, more activities for Mom to do, more structure, and she has more people her age to talk to and interact with, which she likes. Also, we had a few items grow legs and disappear during her 24 hour in-home care. Hope this helps.
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Reply to Tressie14
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Imho, 24/7 x 365 care is going to be super expensive. Prayers sent.
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Reply to Llamalover47
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My MIL had 'round-the-clock home health care for awhile. It means that a home health care aide will be present and caring for her and her needs 24/7. Usually the aides are on 12 hour shifts, but some places have 8 hour shifts. The aides will be awake the entire time and will do whatever is needed to care for their client including light housework meal preparation, and in my MIL's case transportation in their own car.

My MIL currently has 2 caregivers that take turns caring for her. One cares for my MIL during the day and the other cares for her at night. They are awake while they are on duty. They do whatever she needs - which is everything - since she lives alone in her condo in Hawaii (her choice long ago) while the rest of the family lives on the mainland.
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Reply to Taarna
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24/7 care is just as it sounds. It is usually recommended because the person needs assistance in walking and toileting in particular. You will need a place for the caregiver to sleep (extra bedroom). If there is someone who lives in the house, you'll still need to hire others to "spell" that person occasionally; how much depends on the level of care and how much your dad can contribute safely. Your parents will have to adjust to people coming into the home, if they can afford to use this model of care, or it will necessitate your mom going into a nursing home as many assisted living facilities don't take high care residents. If your mom can adjust to people coming into the home to help and isn't too infirmed, there are ways to assist your parents more passively to fill in the care gaps if they can't afford assisted living. Do look into community support programs for the elderly. My parents tapped into Meals on Wheels, a once a week housecleaner, and eventually my mom received home health care, a med machine that tied into her phone, and some help with grocery shopping (not money but quick trips to pick up bread or milk) and food preparation. She received about 20 hours a week, split between morning and suppertime 5x a week. I stepped in on weekends. This arrangement extended her ability to live in the home by another two years or so. I would ask the doctor exactly what he means by round the clock and the why. Is he most concerned about safety (will she start a kitchen fire) or care (will she remember to eat or forget to bath for months.) If you haven't done so, staying at their home for a few days might help you understand your parent's deficits, and give you some insight to what can be improved or changed.
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Reply to lynina2
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I was going to say don't YOU become the 24/7/365 live-in caregiver! But then I saw where you have invited them to both come live with you (according to your post almost 2 months ago). So I'm afraid you WILL become the live-in caregiver.
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Reply to CTTN55
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24/7 care is going to be expensive regardless of the setting unless it is an "under the table" deal which can have its own monetary risks (liabilities). And if through an agency, the actual caregiver, depending on their training, may only be getting $15-16/hr with the rest going to the agency to cover their overhead and salaries. One thing to remember is that even with three shifts and the caregiver being awake to watch the patient, caregivers do need to attend to the calls of nature. We had one resident who seemed to sense when the caregiver (built in caregiver radar??) left to use the restroom as he was up in a flash by the time she closed the bathroom door; he fell everytime!! Drove both the caregiver and the family nuts! Tried everything.... bed alarms, mat alarms, motion sensors you name it. Resident was faster than Jesse Owens. Finally found the strangest solution.... a large male caregiver (resident got along really well with all the caregivers - even the one he drove nuts). No he didn't do anything special but for some reason, I guess he might have given the resident a sense of real security because there was no more trying to get up in the middle of the night. That caregiver could have gone down to the lobby to get a soda and the resident would wait until he returned and then ask for an assist. We always joked and said that resident was a closet misogynist, lol!
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Reply to geddyupgo
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My mother's neurology tests determined that she too needed 24/7 care. Due to a diagnosis of 2nd stage dementia, the physician recommended in home care or care at an assisted living facility for safety reasons. Paying for care in the home was financially out of the question. This type of care is called custodial care and is primarily private pay. Medicare and Tri Care will only pay for skilled care ordered by a physician. This could be home health care (not usually 24/7) or skilled nursing home care which is 24/7. Medicaid might pay for part time home care but this is not what the physician recommended. The Dept. Of Health and Human Services also has a part time community aide program but my mother did not meet the financial eligibility but again, not 24/7. After, further research, we determined that a licensed residential home for the elderly was the most affordable. Most people are not aware of this option for elder care and you might consider researching this further. Good luck.
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Reply to Johnson1
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Round the clock means exactly what it says. 24 hours a day and 7 days a week.

Mom is at a stage in her dementia that is quite common - thinking hubby will have an affair. Sometimes it's because of a very old memory of when dad did mess around and got caught or mom was always the jealous type and accused him quite often. Even if they both go to a facility, this accusation can transfer to one of the staff who mom sees talking to or laughing with hubby.

It's very possible your parents aren't going to agree to in home care. If they understand at all, explain what the dr said and tell them you have no choice. Something has been recognized by this doctor as unsafe living conditions for your parents. Hire the 24 hr care or place them before something happens
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Reply to my2cents
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Hello! I’ve been using Home Health care 24/7 for a year. There are typically 3 shifts and yes, they are there all the time. We had a few bumps getting started, however we have a trusted team of caregivers now. They come from an agency that is liscensed, bonded and insured. They do an FBI level background check. It is expensive, but less than a home and during COVID it’s great that they are safe and well. Bet the agency well, read their reviews.
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Reply to Rrieger1
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Round-the-clock could be live-in, but otherwise an agency will usually send 3 people on consecutive 8-hr shifts, or 2 people on 12-hr shifts, or some combination to make 24 hours. Live-in is more difficult to find, and the person living in would usually be off 2 days/week, in which case, you'd have more than one caregiver. Normally, hourly caregivers are expected to bring their own food, although it's nice to offer them a soda, coffee, etc. I think a live-in caregiver would eat the food of the client with the client, but I don't know if that's what actually happens. Someone else will know and answer. I believe a live-in may be less expensive, but sounds like it's not a good plan for your for the family. BTW, there are very few men that work as caregivers; and I doubt that it would be appropriate to have a male who needs to help with toileting, dressing, etc., if these kinds of assistance are needed--and I doubt your mother would like it, either!
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Reply to caroli1
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When my mom was released from the hospital ( 13 days, broken rib, pneumonia) she was too weak and needed more help than her memory care could provide. With her memory issues she needed someone near to help her with transfers, to assist in PT, make sure she didn't try to get up without assistance and fall again. We were faced with either placing her in a rehab nursing care, or back to memory care with 24/7 aides. We decided on going back to a more familiar place rather than the unknown of a nursing home/rehab where we didn't know anyone, Her memory care had an in house PT program.
But, wow, it is expensive! We paid $28/hr for 2 12hr shifts a day. PLUS her regular Memory Care rent and fees.
We just recently went to night only after 3 weeks of 24 /7.
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Reply to Gracie61
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jacobsonbob Dec 9, 2020
WOW--that would come to $668 per day--over time that's definitely not "chump change"! Only the most expensive facilities would be likely to cost this much, unless your mother lived in an area so expensive that nearly any facility would cost this much.
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You will need to ask the doctor what in the world he means. If you mean your Mom needs someone present 24 hours a day 7 days a week (the definition of round the clock) then what are the duties expected. Is this care needed to insure safety? Might your Mom wander? Is your Mom severely demented and could be in danger, say leaving stoves on, causing fires?
A sitter is fine if it is as simple as needing someone awake and present. If there is more involved in this care, adminstration of medications, dressings, oxygen, and etc. more care may be needed.
Some doctors feel the spouse, your father, is enough; others feel that with a sleeping spouse an elder still could wander. It is up to you to clarify the meaning in your Mom's own case.
Whether you are looking at just a CNA or a sitter, the cost of this care 24 hours a day will be amazingly high, well over the cost of a good LTC assisted living, and equal almost certainly to memory care.
Wishing you good luck.
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Reply to AlvaDeer
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jacobsonbob Dec 9, 2020
My mother's nursing home (or long-term care; she was bedridden were fairly severe memory issues and needed help with nearly all ADLs) was $210 per day, so I doubt any kind of in-home 24 hour care could come even close to matching this (even for a student or teenage paid "under the table"). Would a "live-in" potentially be competitive with this rate (although one person would require time to sleep, so it wouldn't really be 24 hours of vigilant care)?
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