The Benefits of Live-In Care and 24/7 Care During Social Distancing
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It’s common for older adults to need home care services for a wide variety of reasons. For certain situations, it is particularly helpful to have a caregiver present in the home around the clock. In most states, you have two options to consider: Live-in care or 24- hour care. These two options are different in a couple of important ways. We are here to help you understand the difference between live-in and 24-hour care, and which option would be best for your loved one based on his or her situation. Live-in Care is not available in the state of California. However, Home Care Assistance has great 24/ 7 care options throughout the state.

We will help you understand the difference between 24-hour and live-in care . Older adults or people with mobility issues may have a constant and unpredictable need for care. People with dementia often have safety concerns such as wandering, agitation, falling, cooking, or using household equipment.

The difference between 24 hour and live-in care is explained below. Knowing how each works will help you decide which solution is best for you and/or your family. Realize that as needs change, you may decide to choose one over the other, regardless of how you started. These programs are a good way to keep your loved one safe and happy.

When is it Time for 24 Hour or Live-in Care?

There are many reasons one may need 24 hour or live-in care:

  1. Wandering and agitation. For those who have dementia, managing sundowning can be a serious problem. “Sundowning” is typified by late-day confusion and periodic agitation, which are common symptoms of dementia. Having someone available to monitor and manage this daily can be invaluable. A caregiver can redirect someone by shifting their attention to other activities. This is a common technique that can have a calming effect on people with dementia.
  2. Personal care and transfers. Sometimes assistance is needed with bathing, dressing and transferring. This could be due to dementia or a physical problem related to an injury or chronic medical problem. Someone may need assistance with toileting and/or dressing. Bathing safely can be a big issue for many people. It can be a huge relief to family members to have a caregiver either standing by for safety reasons or assisting with bathing. A caregiver can also help someone with dressing, undressing, and personal hygiene.
  1. Fall prevention. A caregiver can help prevent falls for seniors. Falls are more likely to occur at night on the way to the bathroom. A live-in or 24 hour caregiver can accompany someone to the bathroom at night. During the day, a caregiver can monitor a person’s movements and encourage safe activity to strengthen muscles. If physical therapy has been involved, caregivers can help by making sure that clients do their exercises safely.
  2. Assistance with cooking and eating. Neurological conditions and dementia can impact someone’s ability to cook and eat. Loss of appetite is a common problem for people with dementia. A 24 hour or live-in caregiver can cook, help with proper eating and provide hydration reminders. They can shop and plan specialty meals for any dietary restrictions. Having a caregiver eat with someone can help increase their appetite.
  3. Pet care. People often need help with caring for their pets. This can include feeding, grooming, kitty litter duty, and vet visits. Pet walking is a significant trip hazard for seniors. A caregiver can accompany your loved one while he or she walks the dog, for example, to help maintain safety.
  4. Companionship and stimulation. In many cases, there is a combination of factors that necessitate 24 hour or live-in care. Companionship and stimulation can have a significant positive impact on someone’s mood and wellbeing. A caregiver can help keep someone with dementia stay busy, and provide stimulating activities. Some suggestions include games, movies, or puzzles.
  5. Medication reminders. Many states do not allow caregivers to administer medications. However, caregivers can give medication reminders or create a medication list to help to maintain consistency. A caregiver can also report any medication compliance issues. They can also monitor any possible side effects of medications.

What is Live-in Care?

Live-in care is where at least two caregivers live 24 hours a day at someone’s home. Here is the federal U.S. Department of Labor requirements for live-in care, though the hours for each requirement vary by state:

  1. A caregiver must have a place to sleep.
  2. They are not considered to be a resident of the home.
  3. The same caregiver can only be booked for a certain number of days in one period. Another caregiver would need to take the other shifts.
  4. A break must be given to the caregiver during the 24 hour period. Private sleeping quarters in a homelike environment must be provided.
  5. If a caregiver is interrupted during the sleep period, they must be paid for that time.

Each state has different rules around the exact hours of care that can be provided each day. Home Care Assistance Care Advisors can walk you through the specifics of your state and make sure the care is in compliance with regulations.

California generally does not allow any form of live-in care. Where your state does not allow live-in, you should consider 24 hour care.

What is 24 Hour Care?

If your state does not allow live-in care, or you do not want or have accommodations for live-in, consider 24 hour care. This is also an option for those who need care around-the-clock and are unable to give a caregiver a solid block of uninterrupted sleep.

24 hour care may be the right choice for you if your loved one needs care at any hour of the day. That care may be difficult to anticipate so the caregiver needs to be available at all times to respond to wandering, helping someone to the bathroom, preparing meals, giving medication reminders. For people with dementia, 24 hour care means someone is available at all times to keep them safe.

Live-in care, due to sleeping requirements, may not cover all of the care that your family member needs.With 24 hour care, two caregivers are booked daily and work 12 hours each, or three or more caregivers work for eight hours or less. One caregiver can work a maximum of four 12 hour shifts per week, thereby eliminating the need for sleep breaks. However, you can allow the overnight caregiver to sleep if you choose.

Advantages of 24 Hour Care

  1. Sleeping quarters do not need to be provided. That doesn’t mean the caregiver doesn’t sleep on duty at night, but it is not required.
  2. There is a lot of flexibility on how and when you want to schedule caregivers. As a family member of your loved one, you can decide how to best structure shifts.
  3. The no sleep requirement allows a caregiver to actively monitor someone at night. This can be especially helpful for people who tend to sundown and are more agitated during night hours or need to get to the bathroom.
  4. 24-hour care means peace of mind. You know that someone is always there to respond to emergencies and report on your loved one.

Benefits of Live-in or 24 Hour Care During Social Distancing

Social distancing is a word we are all familiar with at this point. It is a concept that has grown out of the coronavirus pandemic that recommends all people stay at least 6 feet apart to help slow the spread of the virus.

Depending on where you live in the country and what your housing situation is, some people are under orders to “shelter in place.” This means that people are urged not to leave their homes except for emergencies or essentials. Let’s look at some of the benefits of live-in or 24 hour care during social distancing.

  1. Safety and Quality of Life. Live-in caregivers have specific safety protocols they must follow. These are strict guidelines to protect their clients from infections. Caregivers are invaluable in the effort to reinforce virus protection efforts for their clients.
  2. Helping clients comply with protocols. This includes hand washing, disinfecting surfaces and maintaining 6 feet of social distance. They can also help to coordinate telehealth visits with doctors and nurses.
  3. Running errands. Keeping people safer means reducing the number of times they go into the greater community. Caregivers can go grocery shopping, pick up prescriptions and get any other needed items.
  4. Coping with social isolation. Here is where caregivers can shine. Social isolation and loneliness are a big concern during the coronavirus pandemic. This means the loss of contact with family and friends. Live-in caregivers can help older adults stay connected using Facetime, Facebook, Zoom, and other technologies. Caregivers can also provide stimulating activities and companionship using puzzles, games, conversation, and walks in the sunshine.
  5. Fears and anxieties. Fear and anxiety are a normal response to this time of high stress. Many older adults rely on limited news sources for their information and much of it isn’t current or accurate. Caregivers can help soothe anxieties by keeping people up to date on virus restrictions and the reason for those restrictions. For loved ones that have memory problems, this can be a challenge. People may ask over and over again why they have to stay home and what these restrictions mean. Caregivers can use strategies such as placing written reminders throughout the home.

Surveys show time and time again that as people age, they want to remain in their own homes. The need for care can happen incrementally or all at once. Knowing your options and being prepared can help you make the best choice for your loved one. If at all possible, don’t wait for a crisis to occur! Then when the time comes, you will make the best and safest choice for your family member.

About the Author(s)

Amanda Lambert is the owner and president of Lambert Care Management, LLC which provides care management for older and disabled adults. She is the co-author of, Aging with Care: Your Guide to Hiring and Managing Caregivers at Home (Rowman and Littlefield, 2018). She has worked for over 20 years in the senior-related industry including mental health, marketing and guardianship. She has a passion for topics related to health, wellness and resilience as we age.

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