When should you NOT consider live-in as an option?

Part 1: When should you NOT consider live-in as an option, even when the client wants it?

Note: This post is part of an educational E-Series for Care Managers that outlines the Legal, Financial, and Practical sides of private-hire live-in care. Every other week, a new set of questions will be addressed. 

Let’s start this e-series by going over the main PRACTICAL check-boxes that need to be reviewed in order for private-hire live-in care to even be considered.

1.    Does the family have a spare, furnished guestroom for the live-in to move into? 

2.    Can the live-in be allowed to sleep for five continuous hours most nights?

3.    Can the live-in be allowed time off to take care of their personal needs?

4.    How amiable is the care recipient/family to having a stranger move in and share their space?

5.    Is the care recipient too “high needs” for one, non-medical caregiver? 

Now, let’s answers those questions one by one.

1. Does the family have a spare, furnished guestroom for the live-in to move into?

Everything else is a moot point if the answer to this question is NO.  In our experience, no quality live-in will accept a position where they don’t have their own private space.  I am told that there is a psychological reason for this.  Can you imagine living at work, and when you get off work, you have to stay at work, 24 hrs every day? Most people, me included can’t imagine enduring anything like that. The only thing that makes it possible to the few caregivers that specialize in live-in care, is when they can create their own private space within the family’s residence.

This means, not sleeping on the living room couch, or on an air mattress in the care recipient’s bedroom.  Those are two options that many of our big-city clients ask about, or those in one-bedroom apartments in ALFs. The only exception is if the case is very short-term, say less than 30 days.

Why does the room need to be furnished? Technically it doesn’t, but there is a legal reason why you don’t want them moving in with their own furniture. (More about that later in the series!)

2. Can the live-in be allowed to sleep for five continuous hours most nights?

There is a legal side to this question, a financial side to this question, and a practical side, so we will revisit the Legal and Financial parts later in the series, and just address the Practical side here now.

As for the practical part, there is a lot of wiggle room.  Your client does not have to hit this mark to get and keep a quality live-in. You do want them to get as much undisturbed sleep as possible each night, but if the care recipient needs to be changed or assisted to the commode 2x a night, you are fine, even if it breaks the 5-hour “continuous” target.

The real critical piece to this is that if the care recipient needs help multiple times during most nights, then a live-in will NOT work out. Most caregivers will quit within a month in this situation.  In those cases, you could recommend other options, like bringing in a night-shift person from an agency between 11pm and 7am, or even discussing relocating the care recipient to a nursing home for round-the-clock care.

3. Can the live-in be allowed time off to take care of their personal needs?

This is another one of the check-boxes, that if the answer is NO, then a live-in is NOT a viable option.  Clients understand this, but some struggle with the practical side of it. “So how much time will they need off?”  Generally, the higher the needs, the more time off that they will require. The norm on the private market is one day off each week.  The day off is normally covered by local family or by a home-care agency. If it’s a high needs situation, then some families will provide coverage for an additional four hours mid-week.  That goes a long way in getting someone of quality to stay long-term. We will address this more later in the series when we discuss the best schedules to retain a quality live-in.

4. How amiable is the care recipient/family to having a stranger move in and share their space?

There is a lot of wiggle room here. It is not uncommon for the care recipient to be resistant to having a stranger move into their home and start “taking over” things. Throw in the fact that many live-in cases involve memory-care and things can get even more challenging.  The really good live-ins, will be used to this resistance, and be able to manage the challenges. It’s never perfect, but over time, more often than not, it finds a way of working out. Sometimes, the ones who were the most resistant at first are the ones who become the best of friends.  As with anything, there are always exceptions. When dementia is coupled with racism or xenophobia, a live-in is rarely an option. We will discuss this in more detail later in the series.

Where you are more likely to have problems is when the care recipient lives at their family’s house, and the live-in is supposed to move in with all of them. Generally the family is greatly relieved to have so much help, but positions in these circumstances have a higher turnover rate then when the care recipient lives alone. I’m sure that there are many reasons for this. We each have so many idiosyncrasies; each time you add another person to the mix, it gets more difficult to live together. Throw in there that one person is being paid to live there, and that adds a whole new level of possible resentments.

Bottom line–it is less of a concern if the care recipient is resistant to having a live-in caregiver, than it is in situations where the live-in will be moving in with the care recipient and their family. It can work out, but the second scenario has a higher employee turnover rate.

5. Is the care recipient too “high needs” for one, non-medical caregiver?

Good question. The answer will greatly depend on your care assessment.

Examples of what “high needs” means:

  •   If the live-in has to get up multiple times most nights to assist the care recipient.
  •   If the family cannot provide or hire, weekly scheduled respite help for the live-in.
  •   If the care recipient is a two-person assist transfer.
  •  If the care recipient has chronic medical needs that need attention and are beyond the scope of a non-medical caregiver.
    •  Privately hired aides can do some simple procedures that home-care agency aides or CNAs are not allowed to do under their certification. Many families choose to hire a private aide for this very reason.  The most common is administering medications.
  •   If the care recipient is physically aggressive with caregivers.
  •   If the care recipient cannot be left alone for short periods of time.  
    •   This mainly applies to memory-care recipients who are considered a fall or flight risk. A live-in will need to take some short breaks each day while in the home. They will need to go to their room for 15-60 minutes to recharge. Families may buy a portable “baby cam” for the live-in, so that the live-in can observe/listen to the care recipient while they are taking a break behind closed doors.
  •  If the care recipient is in and out of the hospital every couple of weeks.
    •  The exception is, if the family agrees to keep the live-in on payroll while the care recipient is in the facility. Some families require them to spend their days at the facility with the care recipient, and then go back to the care recipient’s home at night to sleep.

Wow! That’s a lot of information to remember. Now that you have a better idea of when live-in care is an option (and when it is not), we will answer the next set of PRACTICAL questions next week! Stay tuned!

Next Thursday we will learn the answers to:

  1. Which live-in schedules are the most successful with caregiver retention?
  2. Why you shouldn’t trust all of those glowing caregiver references.
  3. Why clients with racism and/ or xenophobia rarely are a good match for live-in care.

If you have a question about any of the above, or would like my opinion on a specific case, please feel free to call or email me.

David Petroski

888-250-2631 x700


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