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Is It Time For 24 Hour In-Home Care?

Photo: caregiver helping woman out of bed

This guide and checklist will help you through the transition from daytime care to 24 hour in-home care.

24 hour care is around-the-clock, daytime and overnight.

While each state has its own regulations, typical options for 24 hour care include:

  • One caregiver works a full day, with breaks, followed by 8 hours rest in the client’s home.
  • Two caregivers work in 12 hour shifts. The evening caregiver stays awake through the night.

Benefits of 24 Hour In-Home Care

Providing care in the home allows an aging parent or spouse the ability to continue to live where they are most comfortable. Preparation can make the difference between calm and chaos. Learning to be an active partner will help.

The benefits of 24 hour care for your family are:

•    Calm agitation in people who have lost their sense of time and place
•    Reduce skin infections and urinary tract infections with 24 hour care regimen
•    Fall risk reduced for people who need assistance to get out of bed
•    Lower risk of dehydration and related fainting
•    Avoiding kitchen or bathing accidents
•    More time with a companion improves socialization
•    Meet personal and medical needs at night

How to Know it is Time for 24 Hour Home Care

The decision to either start with 24 hour home care, or increase to this level of care, can be difficult.

As family members, we do not want to accept our loved one’s limitations. Or, we live in denial about their dementia or illness. Don’t wait for a crisis to occur before making this decision.

Be aware and involved. What you learn through this process will be invaluable.

Look for these signs that it may be time to change from hourly to 24 hour care for your elderly spouse, parent or friend:

  • Falls become frequent
  • Confusing daytime and nighttime, frequently awake in the middle of the night, or agitated in the dark
  • Recently hospitalized or stayed in a rehabilitation facility after a hip fracture, stroke or heart attack
  • Fainting from dehydration
  • Difficulty eating or drinking without assistance
  • Wandering from home, by foot or vehicle, and getting lost or confused
  • Confused by short absences of family, friends or caregivers
  • New or increased bathroom accidents
  • You are afraid to leave the person at night, or are not getting regular sleep because you are tending to their nighttime needs

Download this checklist: Is it Time for 24 Hour Care?

Getting Started With 24 Hour Care

Most people look to a licensed, bonded agency to fill the need for care for an aging parent or spouse. Hiring through an agency brings peace of mind and security.

24 hours is a long time. Coordinating care should be a partnership between you and the agency you choose. The more involved you are, the better things will go.

Questions to Ask About 24 Hour Home Care

Ask your home care agency these questions to get started with 24 hour home care for your elderly parent or your spouse:

  1. How many caregivers should I expect during a shift? How are shifts divided?
  2. Can I interview each of these caregivers? Can I have each caregiver meet with my elderly parent, or my spouse, to see if there is a good fit?
  3. Will these same caregivers rotate throughout the week?
  4. What if someone can’t make their shift? How do you handle “fill-in” caregivers?
  5. Can family caregivers share duties with agency caregivers? How will we coordinate this?
  6. Who do I speak to if there are problems?
  7. How many of the caregivers are certified nursing assistants?
  8. What specific tasks is a caregiver allowed to perform?
  9. Will a supervisor visit my home? How often?

Consistency Leads to Trust

Having a consistent team of caregivers is more important than people realize. Consistency and continuity of care build trust.

Different caregivers coming in at different times of day can be confusing. It can also lead to poor communication.

Consistent caregivers leads to consist care.

The Person Receiving Care

Sometimes lost in all the planning is the person receiving the care! Unfamiliar people coming into the home, providing intimate care, can be a shock at first.

Make an effort to honor and respect your aging parent or spouse’s wishes and needs.
Include them as much as possible in selecting caregivers. Respond to their ongoing concerns once staff are in place.

It is not uncommon for a favorite caregiver to leave. Talk to your parent or spouse about their feelings. Reassure them that you and the agency will find a suitable replacement. Check in frequently to see how things are going and request adjustments as needed.

Paying for 24 Hour Care

24 hour care is frequently less expensive than a private room in a skilled nursing facility or memory care. Let’s take a look at ways to pay for care.

Long Term Care Insurance

Some long-term care policies provide a daily amount toward the cost of care at home. Many policies have 90-day waiting periods. If you qualify, consider tapping into this resource. If you choose a home care agency that processes these claims on your behalf, you’ll save yourself hours of paperwork and daily record keeping.

Medicare

Many people believe that Medicare pays for home care. Medicare does pays for medical services that take place in your home, with a doctor’s order. This includes nurse visits, and physical and occupational therapy.  Medicare does not pay for non-medical care in private homes.

Work with Professionals

A financial advisor or elder care attorney can look at the big picture and make recommendations for structuring finances to pay for care.

Be flexible and patient through this process of setting up 24 hour care. Work closely with your home care agency to provide safe, consistent and quality care to your aging parent or spouse.

Coordinating 24 Hour Home Care Without an Agency

You may be tempted to hire someone you know to care for your aging parent or spouse. Do this with your eyes open and attention to detail.

  1. You will be responsible for payroll, taxes (if the person is classified as an employee), workman’s comp, and liability insurance.
  2. You will be responsible for managing and coordinating schedules for all your parent or spouse’s care.
  3. You will need to find, often on short notice, replacements for caregivers who can’t come to work due to illness. Or find a replacement for a caregiver who takes another job.
  4. Check with your homeowner’s or renter’s insurance agent. Learn if your policy covers liabilities for domestic workers.
  5. Check your state’s minimum wage and overtime pay requirements.
  6. Some states do not allow “live-in” caregivers, or exchanging domestic parts of wages for “room and board.”
About The Author

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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