Live-in Home Care - FAQ

Questions from Salt Lake Area Families

 

Q: What are the advantages of live-in home care, compared to an assisted living facility?

The major advantage, and the one most important to most people, is being able to stay in your own home rather than relocate to a facility.  Cost is also a factor. Depending on the facility, you can spend upwards of $10,000 a month for higher end services.  Another huge advantage with live-in care is that you have an individual caregiver paying attention to YOU 24-hours a day, rather than having to care for multiple occupants.  
 
You may also feel that you have more independence and control over your life at home.  You can bathe, eat, and move through your daily activities when you want, not at the time scheduled by the facility.  This is also a good option if you prefer more privacy and maybe aren't as intrigued by the activities at an assisted living facility.  With live-in care, you have someone devoted to do the activities you enjoy, such as going to parks versus arts and crafts if that may not be your interest.  Lastly, staff at the facility may vary greatly throughout the week/month.  With live-in care, you are able to have 1 or 2 caregivers who are always with you and can learn your habits.

Another advantage of live-in care is the ability to keep your cherished pets. And your live-in caregiver will help take care of them. Also, interactions with family and friends feel more natural and relaxed in the familiar home environment, where everyone can visit while sitting around the kitchen table if they wish to. In larger community settings, visitors may feel more like “outsiders.”

A live-in caregiver becomes a true companion, with bonds of friendship and empathy that are less likely to happen in a facility or community with rotating staff. There really is no substitute for one-on-one care where your smallest needs are quickly responded to, and the smallest changes in health or mental alertness are quickly noticed and reported. It provides great comfort to family members who witness the lively interactions and attentive care provided by your personal assistant. We often hear family members remark that the loved one seems to be in a better mood or less withdrawn since starting live-in care. In fact, our live-in caregivers often develop deep friendships with an entire extended family.  

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Q: What are some life circumstance examples where live-in home care is especially useful?

Live-in home care is especially useful for anyone with Alzheimer’s disease or memory conditions that may cause them to wander.  It is also beneficial for a person who is a fall risk at night when getting up to use the restroom, or is generally frail when moving about.  If someone is not able to respond to an emergency and would need assistance, then the presence of a live-in caregiver is needed for both safety as well as comfort. Live-in care is obviously needed for any bedbound person who needs total assistance.  It is also useful for people who feel anxious or get lonely easily, or who have incontinence and cannot do all of their personal care on their own.  Another determining factor for implementing live-in home care is when someone does not remember to take medications or isn’t eating properly.

Q: What are the exact services that are provided?

A wide range of services are provided, generally relating to the activities of daily living, and personal lifestyle circumstances. These include meal planning and cooking, cleaning, personal care, transportation, medication reminders, help getting up during the night, stand by and assist, companionship, and  taking care of errands. A live-in caregiver functions as a personal assistant in any way that is needed, such as pet feeding and walking, grocery shopping, bill paying, letter writing, reading out loud, laundry, toileting assistance, driving to appointments or events, and coordination of care with medical professionals.

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Q: What types of services are not provided?

A live-in caregiver does not dispense medications, or provide any medical services such as wound care, tracheostomy (suction), gtube feedings, IV care, bowel programs, or anything that involves skilled nursing care.

Q: What are some of the unusual things that clients have asked for with their live-in care arrangements?

The requests are usually pretty standard in terms of care.  Most of the unusual requests have to do with a client's interests -- singing, conversation in German, gardening, etc.  These requests are usually more common with hourly caregivers, and they come into play with situations that are largely companionship and supervision.

Q: What if my mom occasionally needs in-home medical care?

We will fill this need typically within 24 hours. This is a major advantage of contracting with a full-service home healthcare and personal care agency. We have a medical division, and if in-home skilled care is needed, we can make all of the arrangements with the client's primary physician.  We also use our clinicians to provide quarterly training to our caregivers.  One of the more recent trainings was focused on patients’ health and identifying "red flags" that indicate when our clients might need medical attention.  Obviously, if it is an emergency, they will call 911 but we do training more on recognizing the flu, pneumonia, indications that a wound is starting, etc.

Q: Does a private bedroom need to be available to the caregiver?

A live-in caregiver needs to have adequate living space. This is not necessarily a private bedroom but is somewhere where they can store a few items (clothes) while they are on their shift as well as a comfortable place to sleep.

Q: Is the same caregiver there at all times, or do several rotate through shifts?

Our goal is to have one caregiver for five days and another for two days.

Q: If mom has to go into the hospital for several days, will the same live-in caregiver be available when she returns home?

Depending on our caregiver’s schedule, this is ideal. Typically, if it is a short stay, the caregiver will usually remain available.  Caregivers almost always want to stay with their client, and will usually not accept other work to remain ready when the client comes home.  When a client has an extended stay, or discontinues and comes back on service at a much later date, we will do our best to get the same caregiver. But if the caregiver is now with another live-in client, we won't compromise a situation that is working well.

Q: Do we get to interview several caregivers, and choose the one we like best?

Yes, but you will need to pay for multiple interviews at an agency’s normal hourly rate. This also isn't always the best way to find the best caregiver.  Usually an interview will give you an idea of someone's experience and their personality, and while we encourage families to interview, we also recommend that they allow us to choose someone for them and have them begin service to see how it works out.  We know our caregivers (personality and skill) well and we generally do a good job of matching people with their caregivers.  If the client and family don't like the caregiver, they can always change and we can have a new candidate on the next shift.

Q: Can we request a caregiver who speaks a certain language?

Absolutely. This is a common request.

Q: How does your agency select its caregivers?

We contact occupational schools, participate in job fairs, place advertisements, and attract applicants through the Internet. We have a rigorous screening process that includes background checks and verification of qualifications.

Q: How do I know the level of the caregiver’s qualifications?

All of our caregivers have at least one year of experience.  All background information is available upon request. Our caregivers also have varied experience.  For this reason, we meet with the family to get detailed information in order to put together a plan of care.  By doing this, we can insure that each employee that we send out has all of the skills to address the needs of each client.  If a client’s health status deteriorates and requires more skill, we will make arrangements to staff as necessary.

Q: Are caregivers trained in CPR and basic first aid?

Many of our caregivers are already trained in CPR and first aid before we hire them. If a client specifically requests this skill level, we can make it happen.

Q: What happens if my mom has some sort of medical emergency?

911 is immediately called in the event of a medical emergency. There is an emergency preparedness procedure that every caregiver is trained on when hired, with annual training updates. We also ask the family to post a list of emergency numbers by the phone and put them in the order that they should be called.  911 would usually be the first call if it is a true emergency.

Q: It will probably seem odd to have a stranger around. How long before most people get comfortable with a live-in caregiver?

It usually takes a week or two to get comfortable with a new caregiver. We also reassure families that while this is new for them, it is not new for our professional caregivers.  They are accustomed to the situation and know how to make the transition to having someone in a private home as easy as possible.  We want our clients to remain as independent as they can for as long as possible, so the caregivers will give as much space as a client needs.

Q: What is the typical length of service for live-in care?

This varies greatly.  Service might last for only a few days, or in some cases, extend for years.  It is unfortunate that people do not consider live-in care sooner than they sometimes do. The benefits are especially significant for anyone with aging-related declining health or mobility problems, and impacts their sense of well-being, security, mood, and quality of life.

Q: What if my dad decides he doesn’t like the caregiver, or something about his/her behavior?

The advantage of working with a reputable agency is that you may switch caregivers at any time. Always feel free to switch with no questions asked.  Also we don’t expect the clients to manage the caregivers at all; that is our job.  If a client really likes the caregiver, but doesn't like the way he/she makes the bed, we can instruct the caregiver so that he/she does things to the client's satisfaction.

Q: Do caregivers sometimes decide they don’t like the clients, or it just isn’t “clicking”?

Caregivers do have the right to refuse servicing the clients, and we will replace them. Yes, it is a mutual relationship and the caregivers are free to say they don't want to work with a particular client. If things aren’t “clicking,” it’s best to find a better match for everyone involved.

Q: How is the caregiver’s time-off arranged?

Each caregiver gives his or her schedule to the Staffing Manager, and then it is conveyed to each client and the client’s family.  When time-off is needed, a replacement will be made. Typically, we even try to make replacements consistent.  If a caregiver is asking for time-off, we do our best to first contact caregivers who a client has had (and liked) in the past.

Q: What are the guidelines when the caregiver gets sick?

We use a time and attendance software that notifies us if someone is a no-show, and we then can staff immediately.  Caregivers must give eight hours of notice if they need to change a schedule. Concerning unexpected illness, it is the same protocol as with any job.  If they are to report to a shift, they are to call us as soon as they know that they will not be able to make it.  We have an on-call staffer who is available 24 hours/day, 7 days/week for this reason.  We will do our best to find a replacement as quickly as possible.  For a live-in care, we will ask the person who is already there to stay while we find a replacement.  If a live-in caregiver becomes ill during a shift, he/she can call the office and we will find a replacement as soon as possible.

Q: Are we compensated if the caregiver accidentally breaks something of value in the home?

Yes.

Q: What happens if the caregiver is accidentally injured?

We have workers compensation insurance, and professional and general liability insurance.

Q: How can I monitor the care that my dad is receiving?

All caregivers make daily log notes and the binder is left at the house.  Also, they will be periodically called by the Staffing Manager and/or Certified Senior Advisor. Much of this involves just observing during visits.  Food in the fridge, a clean house, and a clean and happy client are all indications that the care is good.

Q: What happens if a caregiver is given conflicting instructions from family members?

We abide by the person who is in charge or has power of attorney for healthcare.  This person would sign the contract. We also ask that all communication be facilitated through the office.  This way our staffing supervisors can help work through the conflict and make sure the family is all on the same page.  Also, we need to know any changes to the plan of care so that we can follow up with the caregivers.

Q: What are some of the other challenges that can happen with family dynamics?

Siblings have different ideas about care or may also have problems regarding financial matters.

Q: Do you have social workers available if unusual situations need attention?

Yes. This service may be covered by Medicare.

Q: Do caregivers report suspicious behavior by a client’s acquaintances or family members?

Yes. They log all daily activities, along with a procedure to make management aware of any misdoings.

Q: What are the situations where live-in care is no longer a viable option for someone in declining health?

It is possible for live-in care to evolve to 24-hour live-in skilled nursing care, but it's usually limited by the amount of specialized medical equipment/services that may be required, along with the associated costs. A skilled nursing facility is more fully equipped than a private home can generally be, or for the family to afford. The patient’s doctor is involved in this type of decision.

The good news is that studies have shown that attentive companionship can actually prolong a person’s life. With live-in care, a person is less likely to suffer the negative physical effects that loneliness has on the body’s cardiovascular system and overall health.

Q: What are some of the disadvantages of live-in home care, compared to an assisted living facility?

Depending on the arrangements, live-in care can be more costly.  Also, you may decide that you feel too isolated at home, depending on your social network and family interactions. You may personally enjoy the daily interactions offered in a larger community setting.

Q: What are the main reasons that people don’t choose live-in home care as an option?

Cost is the most common factor, since it is possible to find assisted living facilities that are less expensive than live-in care.  Also, some families don't feel comfortable having someone stay with them all of the time.  What they often don’t realize is that professional live-in assistants are very sensitive to families’ emotional reactions to their presence, and will be as unobtrusive as possible. The agency can also schedule someone on an hourly basis to start with, moving to live-in care later on, if requested.

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