How does 24 hour care work? How many caregivers do I need to give days off in a fair manner?

Are you hiring yourself or going through an agency? The agencies in my city all quoted me $6,000 and month for 3 caregivers to work 24/7 and they work out the days off between them. It would be a miracle if 3 caregivers could get along with each other and the person they are caring for. Whenever I had more than 1 caregiver for my mom, they would complain to me about what the other one was not doing. But miracles happen. Ask around in your community what is available. Usually anyone, even live in, will need 2 days off a week.

Caregivers want job security. The best caregivers will hold an in-home job until the person dies or moves to an institution, or their own circumstances change.

My FIL currently has 2 caregivers, each working 8-hour shifts Monday through Friday. If we needed an overnight caregiver, that would be 3 people per day each working 8-hour shifts. Weekends are 2 different caregivers each working 8-hour shifts, and if we needed an overnight caregiver, that would be another person. When someone goes on vacation, we need to find someone to fill-in. Thankfully, these caregivers have a network of people who will work their shifts while they're on vacation.

It's GINORMOUSLY expensive. At $20 per hour, it's over $300 each and every day. Do the math $20 x 16 x 365 = $116,800 which is staggering and why my FIL is burning through his money at an eye-watering rate. If you could find people willing to work for $15 an hour, you're looking at $131,400 a year for 24-hour care. Even if you paid federal minimum wage $7.25 you're still looking at $63,510 for 24-hour care.

If you are looking for 24/7 care, my experience is that a service is a better choice than trying to source for yourself. You would be amazed at how many people don’t show up, personalities clash, etc. The service is your buffer. THEY have to handle the headaches, of which there are many.

Plus, a good agency’s owners will work harder to create a fit between clients and staff. For us, that was unexpected and invaluable.

There are 168 hours in a week, start from there. Best of luck finding people that will show up, on time, not argue like toddlers over assigned duties ( Judy doesn’t like to dust, Pam doesn’t want to haul the garbage to the curb!) The agency we were dealing with was the worst experience! They were fired, but hopefully no other agency is bad as they were. We found caregivers “off the street” that were way better & NEEDED jobs really bad, plus paid them more than would’ve made anywhere else. We let them work out their hours among themselves, kept track with timesheets.

Depending on where you live, you are are looking at around $100,000 per year Just for caregivers, that doesn’t include ANY living expenses for the elder at all.

Don't forget to check on State laws regarding how many hour a caregiver can work per week.

The Agency my Dad used, each caregiver could only work a 40 hour week. Thus, 3 shifts per day, with the 1st shift being the same person M-F. On weekends, 3 shifts, with the 1st shift being the same weekend person. In my area, it was costing $20k per month. I know, yikes!!

This way, the caregivers would go home and come back refreshed. if a caregiver couldn't make his/her shift, the Agency quickly found another person to fill in. Dad was never without someone at his house. And if a caregiver was running behind schedule, the previous shift caregiver would wait. If it was going to a long wait, then someone from the main office would cover until the next caregiver showed up.

NOTE: If you are hiring on your own, and not using an Agency, please note that you would need to contact your homeowner's insurance carrier to purchase a "workman's comp" policy. This policy is needed in case a caregiver should get hurt on the job. The insurance carrier might also suggest what is called an "umbrella policy".

Remember I mentioned that my Dad was paying $20k per month. Dad decided it was time to sell the house, and move to senior living. At senior living the cost was $5k to $7k per month in my area, and Dad felt he was getting good care. With the savings, Dad was able to bring along his 1st shift caregivers to be with him from 7am to 1pm, that help give Dad a routine, and a familiar face when he work up in the morning.

Not sure if you need a caregiver who is awake at night? We did, so we started with an agency that staffed 12 hour shifts (14 shifts per week) at $25/hour. That's $600/day, so ~$18K/month, and the caregivers were only making about $12-13/hour from the agency.

Our weekday caregivers were fantastic, reliable, and my mom was comfortable with them. The weekend caregivers were different nearly every weekend, and didn't seem all that motivated. So, we decided to "buy out" our weekday caregiver from the agency, and she referred us to four other great caregivers with whom she felt she could cover 24/7 as a team.

It worked very well, thanks to the professionalism of the five terrific caregivers. We paid them $16-17/hour, with time and a half for overtime. All on the books, using nanny-payroll software to take care of taxes, SS, medicare, and unemployment insurance. If you hire privately, don't forget to get a workers' comp policy in case someone hurts themselves.

Hugely expensive. We recently moved Mom to a nursing home because she needed services we couldn't provide at home, and it costs less than the caregivers alone, while providing food, activities, medical care, etc.

When you hire from an agency, make certain they are insured; agencies do at least some screening, and covered by workman's compensation if the aid claims to have gotten injured in your home so they cannot sue your estate. Sitters are about $20 an hour. CNAs (hands on) are about $30-$35 an hour. When you get into medications you will need home health nurses to come to your house so you are getting into big bucks. I hope you are wealthy. Agencies are at least insured..and they take care of the taxes.

First off, I have a question. Does your family member have Medicaid/Medicare? Does this person qualify for these benefits? This will significantly reduce how much this person would have to pay a caregiver, If at all! If this person already has these benefits find an agency, and most agencies accept these benefits. He/she could get care coordination, care management service and all the help he would need. I hope this helps. I can assist further if I knew more about the situation. Thank You.

When my dad required this for a few weeks in 2014, the agencies required money upfront. ($2000). Their policy is to assign a worker to dad for 2 1/2 days at which time, another worker would come in to take their place. We were required to provide a bedroom for the caregiver to sleep in. Since money was tight, I did some of the shifts:)

Hi I worked in hone health care as a staff coordinator, assistant admin, administrator and quality assurance/ quality improvement director for over 40 years. I now do senior service care management and senior advocacy so I have knowledge on senior care. 24 hr care can be done 2 ways you can hire teams if caregivers and pay them directly or you go through an agency that had binding in each employee, workers compensation and pay them direct withholding all taxes. The agency’s cost is higher hourly to pay the person and civet overhead and insurance coverage.
shifts of 12 hrs or 8 hrs can be done privately or through the agency on an hourly basis BUT 12 hr shifts through the agency will require you to pay time and a half for the last 4 hrs. This can get costly. If you do 8 hr shifts 7 days a week you’ll have 6 people per week if you do 12 hrs you’ll have 4 people per week M-F and others on the weekend for both or M-Th abs the other shifts Fri-Sun. Or you can hire a live in privately to do 5 days and another for 2 days then you’d only have 2 people a week in the home . And there are some who will do 24/7 live in. Privately the range you’ll pay is $110-145 or more per 24 hr period depending on where you live in the US. Through an agency Exocet to pay $200 and up because most live-ins get $125 -$160 through a reliable agency. Please understand the live in isn’t working non stop the break down especially through an agency is 8 hrs work, 8 hrs sleep, 3 hrs for meals and the other 5 hrs is to be in the home for safety and it’s ok to get up during the night to help the patient but if the caregiver is up all day and all night doing on hands care this is in violation to labor laws. You’ll need to be very clear on the caregivers duties. The patient provides meals and a adequate place to sleep for the live- in. I hope this helps . Screaming, testing and background checks of private caregivers is critical. Agencies do all this.

If this is a family member, you can work as many hours as you want if you are a non paid caregiver.  However, paid care giver, should work no more than 8 hours a day in a 24 hour period.  Overtime for any other hours.  Keep in mind if you want quality care, you can not work the paid care giver the death.  24 hour care will produce 4 people at 8 hours a day.  However, the patient is sleeping at night and doing the day, so you can watch for the 8 plus hours at nights yourself, and split the other 14 hours between 2 to 3 care aid.  Having one person work more than 10 to 12 hours a day will result in poor quality of care.

We did it only once, to get away for 3 days, 2 nights together.  I let the Agency take care of setting up hours.  It was worth the money.  Later, to take a longer trip to see relatives, hubby and I took turns away, and had extra caregiver hours for the one at home.

When my friend for whom I was her P.O.A. started to wander at night, I was told she needed 24 hour care. I hired through an agency and they had two ladies who rotated. One would stay for 5 days and nights straight and then the other would take over. They would sleep on the couch in the living room and the stairs were right there so they knew when my friend would come down in the night and see if she could get out. The door was a double locked door that had a key the care giver would take out so when my friend tried to leave, she could not. The ladies would guide her back upstairs to her bed. The care givers had to be light sleepers who would awaken easily when my friend came downstairs.
I would go grocery shopping for my friends and also for the care giver who would tell me what she wanted to eat, so I provided the food. This system cost over $13,000 a month. I did it for 6 weeks before convincing the husband it was time to go to a memory care apartment I had found for them in order to save money. That cost just under $10,000 a month for the two of them. I have no idea what the care-givers actually were earning, just paid the agency.

Some do a 12-hour night shift (staying awake while patient is asleep and middle of the night toileting assist). Then the 12-hour day nurse comes on duty. Quite costly.

I have been emmersed in caregiving for the past 12 years. This is not something I sought. It started with my MIL who was diagnosed with Alz/VD. We tried keeping her in her home, college age daughter moved in for night coverage and myself, husband and other kids took turns spending the day with her. That lasted a year. We moved her into our home, she was with us for 7 years before she passed, we split that time between an assisted living for one of the years, a group home for two years and the last three back in our home on hospice. I learned more than I wanted to know about dementia and caregiving. After she passed, my husbands work slowed so I took on extra work thru a local caregiving company. This company charged the client 20. an hour and paid me 9. I worked as a contract laborer, I was not impressed with most of what I saw when I filled in or came behind other workers. I have been a teacher, a mother of 9 and now a caregiver. I found myself teaching coworkers and family members how to manage a home with a vulnerable adult. I no longer could continue hours with the company because of all the private hours I had been hired to work. I worked as a private caregiver for 2 years helping 2 families with their spouses on hospice for 20 an hour. I also coordinated a couple of people to assist with 2 elderly neighbors in the mornings. An aunt of my husbands who had Parkinsons and never had married or had children. Had a stroke in her assisted living apartment, after her hospital stay she was moved back but charged double for her care at the AL. Her POA hired us to bring her home, I was paid 5000. A month and she lived with us for nearly 4 Yrs till she died in Dec. While caring for our aunt in our home, I have helped coordinate care, for a few people. Recently, I am assisting one of my neighbors, whose husband I helped care for before he died 4 Yrs ago. Now her children have hired me to help her age in place in her tidy condo she moved to after her husband passed. She has 3 adult children who live from 15min to an hour away, who have young families. This family knows me and trust me. I started with placing 4 different people, 2 I knew and 2 of my kids(21,17) working each evening for 5 hours at 20. An hour. After a few concerns we have added mornings from 9-1 to the eve 4-9.
I also work now and have added another 2 college students. This client has LTCI that covers 10 hours a day for care. Family is able to continue to keep her in her condo because they have done the following as per my suggestion. They have put video cameras in each room and outside each door, this serves for accountability for the caregivers role and also is there eyes on her when no one is there but their mother. All caregivers write about their shifts on a google doc that I review after each shift, I advise and teach from this app, all family members and caregivers can read this doc. Family has put up all supplies that would cause the client to injure herself, cleaning & medicines in a locked area that she can’t get into. The keys to the car are hidden for caregivers use only. All credit cards and checks have been removed. Client has one credit card Costco Visa( her picture on the back) is stored with key. All receipts are kept with a notebook where our daily LTCI logs are placed to record hours and any detail about care for insurance purposes. The children know they eventually we’re gonna have to keep her for hours outside of what her long-term care will cover. Also we have had an incident where a caregiver has needed to stay all night due to some sundowning behavior. I have said a lot more than this OP wanted to know. I believe that I’m well qualified to help families who want to keep their LO home, I enjoy being that resource person/coach better than a caregiver. I’ve been blessed to receive either an hourly pymt, a monthly flat pymt, or an admin salary to coordinate care. I’m glad for what I’ve learned and I’ve been blessed.

I think a reasonable number of work hours depends on the individual. Accordingly, what is “fair” to each person varies.

If you hire someone to live-in, sometimes they will accept lower pay per hour because if the housing benefit. That may be a good way to extend resources.

I am concerned about the person living alone, mentally compromised and supervised (at times) only by cameras. The cameras are no substitute for decision making and caregiving. If there was a fire, she could be in danger. Persons providing the remote supervision, and knowing she is mentally compromised could be held liable.

Agreed, but that is their decision at present. She answers the phone still and can follow verbal ques. So the cameras give them a sense of security and mom a piece of mind knowing her kids are, “there”. This is only one of a dozen ways to care for a loved one helping them to continue aging in place.