In-home care services come in many forms. They can range from simple Companion Care to Skilled Nursing. They can also be requested for a couple of hours a week up to live-ins or 24-hour shifts.
When it comes to 24-hour home care for a loved one, there are several things to consider.
The first step is to understand the definitions associated among hourly in-home care, live-ins and 24-hour shifts.
Hourly in-home care
Hourly in-home care is fairly straightforward. We provide coverage for the days and number of hours of in-home assistance you need, such as Monday and Thursday from 11 to 3, or seven days a week from 8 to 5, or 24/7 support in extensive-care cases. Home care agencies typically charge hourly rates for these services.
Live-ins are a service arrangement through which a caregiver resides at the client’s home for the duration of the home-care assignment. They are useful for clients who need extensive care or company, but do not require constant attention.
From a cost perspective, live-ins can be significantly less expensive than continuous 24-hour care, because wages do not need to be paid for agreed time off.
For a work arrangement to legally qualify as a live-in, caregivers must get a minimum of 8 hours of sleep time per night, with a guaranteed minimum of 5 hours of uninterrupted sleep.
Home care agencies typically charge a flat fee per day for live-ins. They help you determine how many “working hours” you are entitled to per day, which is then formalized in documents signed by the agency, the client and the caregiver in order to strictly comply with labor regulations.
Most companies assume a daily amount of working time between 10 and 14 hours. Hourly charges may apply for any work performed within a given day in excess of the assumed amounts established in a service plan.
Important: live-ins are not a universal solution for all clients who need extensive in-home care. For clients who need constant support and cannot be left alone, the only safe option is continuous care performed round the clock by teams of caregivers, each of them covering individual shifts of 8 or 12 hours.
Live-ins are governed by relatively complex labor regulations that must be carefully observed by employers and employees. If you are considering a live-in, please schedule a call with or visit by one of our specialists, and request our Live-In Fact Sheet prior to that conversation. It is a useful document that summarizes relevant regulations, clarifies a few myths commonly assumed about live-in norms, and offers links to important norms published by the Department of Labor.
24-hour shifts are commonly used when extensive care is necessary only for a few days a week, or to cover weekly breaks of a live-in caregiver. They follow a logic and regulatory framework that are similar to a live-in’s.
Caregivers working in 24-hour shifts must be assured a private space to sleep for up to eight hours during their shifts, and those hours may be discounted from the total fees due. Agencies may charge either a flat fee for the shift or hourly rates.
24-hour shifts only are recommended under a few circumstances, the most common of which being the temporary replacement of live-in caregivers.
Some users of extensive home care services, after considering the total costs involved, decide to hire caregivers directly or through a registry. This is a legitimate and common concern, since in-home care costs may quickly add up to a family’s total healthcare expenditures and represent a significant financial burden.
If you hire a caregiver directly, you are responsible for all direct and indirect hiring costs, taxes and applicable insurances, in addition to selecting your aide, establishing a contract and defining a care plan. If you choose not to acquire insurance policies related to the caregiver’s work, then you may be liable in a case of injury or accident.
A registry is another kind of company providing home care services. As with an agency, it must be licensed by the state’s Department of Health. But there are important differences.
Under the agency legal framework, caregivers are employees (W-2 employment model), are bonded and insured, and must follow several mandatory legal requirements. Very importantly, an agency must hold liability and workers’ compensation insurances, among others, and check its employees’ criminal backgrounds, provide training and comply with a long list of legal requirements. Please check the pertinent sections of our website to learn more about caregiver-selection and training standards within Assisting Hands.
In a registry, legal requirements are less strict, and it essentially operates as a staffing firm. A registry’s caregivers are contractors (1099 employment model), and the client is ultimately responsible for t payment of taxes and insurance costs. It is a very different business model from an agency’s. Additionally, a registry is not responsible to replace an underperforming or missing caregiver.
Consumers should take several process- and regulation-related aspects of service provision into account, as well as potential risks, when choosing across these different service options.
We understand this is a lot of information and legal details to consider. If you are seeking In Home Care in Philadelphia or In Home Care in Montgomery County please call for a no cost or obligation consultation at 215-882-8234.