Just the other day we got an uncommon call from someone at The Four Seasons in Lakewood asking for 24-hour care. My first question is, why do you need 24-hour care? The reason I ask is that based on the needs and the situation, the cost can vary greatly. A live-in is more than half the cost and can work in most situations.
The 30-Second Answer
Live-in home care is one caregiver who lives in the home with your loved one for weeks at a time. The same person, week after week. She is on duty during the day with breaks built in, and she sleeps in the home at night. It is a fit when your loved one needs help with daily routines and the reassurance of someone in the house, but does not need somebody covering them every minute. Around-the-clock 24-hour shift care is a different service. Most families looking at live-in are weighing it against a move into assisted living or against an hourly shift schedule. The answer depends on the senior's safety at night, the family's role, and what the daily routine actually looks like.
What "live-in" actually means
A live-in caregiver moves into the home and stays for weeks at a time. The same person, week after week. She has her own room and her own bed. She is with your loved one through the day with scheduled breaks, and she sleeps in the home at night. New Jersey requires that a live-in caregiver get an uninterrupted sleep period and breaks during the day, and that is built into the arrangement.
When your regular caregiver takes vacation time, usually about a week, we replace her with another caregiver. Your regular caregiver returns when she comes back. The point of live-in is consistency: one person who knows your loved one's routine, mood, and quirks, week after week.
That is different from what most families picture when they say "24-hour care." True 24-hour care uses two or three caregivers in awake shifts so that someone is awake and covering at all times, including the overnight. It costs more because the overnight is paid as awake hours. We will come back to the difference later in this article, because it is the most common question we get.
The short version: live-in is the right answer when your loved one sleeps through the night most nights and the bigger risks are during the day. Falls in the kitchen. Forgetting to take medications. Wandering toward the front door. Getting in the car when she should not be driving. Live-in puts a trained set of eyes and hands in the home for those hours.
When families start asking about live-in care
We hear from families at a handful of moments. After a hospital stay at Monmouth Medical Center Southern Campus, when the discharge team has said it is not safe for Mom to go home alone. After a fall on the porch steps on a winter morning, when the daughter who lives in Wall realizes the once-a-week visit is not enough. After a daughter in Brick spends a long weekend with her parents and notices that Dad is opening the mail twice and forgetting which day is which.
The question that comes next is usually some version of: do we move her to assisted living, or can she stay home? For many seniors, the answer is that home care can carry her safely for years longer than the family thought. The trick is matching the level of care to the level of risk. Live-in is one of three options. The other two are hourly shift care (caregivers coming in and out of the home, often one to three different people a day, seven days a week) and around-the-clock 24-hour care (two or three caregivers on awake shifts).
Choosing among the three is not always obvious from outside the house. That is why a no-cost consultation is the first step. The consultation can be a phone conversation. Or we can come to the home and walk through it in person. Whichever the family prefers, we listen, ask questions, and give you a recommendation. Sometimes the answer is live-in. Sometimes it is something lighter to start, with a plan to step up when things change.
How a live-in arrangement actually works, day to day
Here is a typical day. Our compassionate live-in caregiver wakes around 7. She helps your loved one with getting up, bathing, and getting dressed. She makes breakfast, sets out the morning medications (she does not administer prescriptions but she sets them out and reminds), and sits with your loved one through the morning. She does the light housework that keeps the home livable: a load of laundry, the breakfast dishes, a wipe-down of the kitchen.
Mid-morning is often a quiet hour. She might read aloud or play cards. She might walk to the mailbox with your loved one. On a nice day, the two of them might take a slow walk around the block. Lunch around noon. An afternoon rest for both of them. An afternoon activity, a visitor, a phone call from the family. Dinner around 5 or 6, then quiet evening time. Around 9 or 10, she helps with the bedtime routine, sets the night-light, and goes to her own room.
Overnight, she is in the home. If your loved one gets up to go to the bathroom and needs help, the caregiver hears her and is there in seconds. If your loved one wakes up confused at 3 a.m., there is a familiar face and a calm voice instead of an empty house.
We recently had a circumstance where a client was unusually confused. My experienced caregiver had seen this before and called our Client Care Coordinator. In conjunction with my nurse, they arranged for the client to go to the James & Sharon Maida Geriatrics Institute at Monmouth Medical Center Southern Campus to have it checked out. That visit avoided a possible progression that could have caused sepsis, hospitalization, or a bad fall.
This is also where your Client Care Coordinator comes in. Every Comfort Keepers family in Northern Ocean is assigned a dedicated Client Care Coordinator who handles the day-to-day. She is the person you call when the caregiver is going to be late. She is the person who hears that your loved one has started refusing the morning shower and quietly arranges for a different caregiver to try a different approach. She works closely with our Director of Nursing, the experienced Brittany Minervini, RN, who builds and updates the written Plan of Care and runs the 60-day reviews.
The triangle is the family, the Client Care Coordinator, and the Director of Nursing. The caregiver in the home is the fourth point. Most agencies have families calling a general office line. We do not work that way.
Live-in care vs. 24-hour care: the question Lakewood families ask most
Here is the cleanest way to think about it.
Live-in care is one caregiver who stays in the home for weeks at a time, with breaks during the day and sleep at night. It is appropriate when the senior sleeps reasonably well through the night and the bigger risks are during the day. The price reflects that the overnight is paid as sleep hours, not awake hours. The same caregiver, week after week, gives families the consistency that hourly shift work cannot.
Around-the-clock 24-hour care is two or three caregivers on awake shifts so that someone is awake and covering every minute of every hour. It is appropriate when the senior wakes frequently at night, wanders, needs help to the bathroom multiple times, or has to be watched at all times. The price is higher because the overnight is paid as full awake hours.
Hourly shift care is a different rhythm entirely. Caregivers come in and out of the home, sometimes one, two, or three different people a day, seven days a week. It works for families who need part-time coverage, but it means a steady stream of new faces in the house, which some seniors find harder to tolerate as memory issues progress.
A useful rule of thumb. If your loved one slept through most nights last month, live-in is probably the right starting point. If she was up three or four times a night, or if she got out of bed and the family woke up to find her in the kitchen at 4 a.m., 24-hour care is the safer answer.
That rule of thumb is not a hard line. Our experienced staff have strategies that can reduce nighttime waking even when it has been a concern. Restricting fluids in the few hours before bedtime. Working with the family doctor on medication timing. Adjusting the bedtime routine. This is the kind of thing that comes out of the in-home Assessment. After reading this article you may think live-in will not fit your situation. Our staff sometimes see it differently once they understand the whole picture.
Our Director of Nursing makes the live-in vs 24-hour recommendation as part of the written Plan of Care, after the in-home Assessment. The Plan is reviewed every 60 days. It is normal for a family to start at one level and move to the other as the senior's needs change. The National Institute on Aging notes that family caregivers often underestimate how much care is needed at night until they have spent a full week observing it, which is one reason the 60-day review matters.
What live-in care costs
After the consultation, we will give you a cost over the phone. Live-in care can be considerably cheaper than hourly care. But for the sake of the client and the caregiver, we want to make sure live-in is the right fit.
The client needs to have proper space for the live-in. And the client should not need hands on them at all times. A live-in caregiver needs breaks. She needs to shower. She needs her own down time.
If the client is a fall risk or wanders when not watched, a live-in may not be the best option.
In about 90 percent of the cases a live-in can work. That saves a considerable amount of money over hourly care. The consistent care of just one individual is a huge benefit on top of the cost savings.
Most Lakewood families looking at live-in care are also looking at the cost of assisted living. Family Caregiver Alliance national data shows the comparison is closer than most families expect when the senior has a paid-off home and the live-in arrangement avoids the move.
The hospital-to-home piece for Lakewood and Brick families
A live-in arrangement is often the right answer in the first few weeks after a hospital discharge. The Agency for Healthcare Research and Quality's Re-Engineered Discharge (RED) toolkit identifies the days right after a hospital discharge as the highest-risk window for a readmission. A trained caregiver in the home through that window does several things at once. She manages the medication list. She watches for warning signs. She gets your loved one safely from the bed to the bathroom. That is one of the most effective ways to keep her out of the hospital again.
We have worked with the discharge planners at Monmouth Medical Center Southern Campus on Lakewood and Jackson cases for many years. They know our caregivers. They know what a transition from hospital to home looks like when we run it. We can often start within a few days of a discharge, and sometimes faster when the case is urgent and a caregiver is available.
The other thing worth knowing: a live-in arrangement after a discharge is often the bridge to something lighter. After three or four weeks, when the senior is steadier, the Plan of Care often steps down from live-in to part-time hourly. That is the right outcome.
What live-in care does not solve
Live-in care is not a nursing-level service. Our caregivers do not administer prescriptions, do not change sterile dressings, and do not do skilled medical tasks. Those are the work of a visiting nurse or a home health agency, and we coordinate with them when they are involved.
Live-in care also is not always the right answer. If your loved one is up most of the night, around-the-clock 24-hour care is safer. If she is in the late stages of dementia and needs two people for transfers, two caregivers on awake shifts is the right call. If she needs IV antibiotics or daily wound care, a skilled-nursing arrangement belongs alongside the live-in.
We say this out loud because most families have called other agencies before they call us, and the conversation often goes, "we can start tomorrow with live-in." Sometimes that is true. Sometimes it is not. We would rather tell you the harder answer if it is the right one.
Frequently Asked Questions
How quickly can live-in care start in Lakewood?
Most Lakewood families have care in place within a week of the first call. Some are faster when the case is urgent and a trained caregiver is available. A few are slower when the case is complex and we need to match a specific skill set. Our team will tell you on the first call where the timeline is likely to land for your situation.
Does Medicare or Medicaid pay for live-in care?
Medicare does not pay for non-medical home care, including live-in care. Medicaid in New Jersey covers some home care through the MLTSS program, but Comfort Keepers does not accept MLTSS or other Medicaid waivers. Private pay, long-term care insurance, and VA Aid and Attendance benefits are the most common ways Lakewood families pay for our services.
What is the difference between live-in care and 24-hour care?
Live-in is one caregiver who lives in the home for weeks at a time, with breaks during the day and required sleep at night. 24-hour care is two or three caregivers on awake shifts so someone is awake and covering every minute. Live-in is appropriate when the senior sleeps reasonably well at night. 24-hour care is appropriate when the senior is up frequently at night, wanders, or needs to be watched at all times.
What counties and towns does the Shrewsbury office cover?
Comfort Keepers of Monmouth and Northern Ocean Counties covers Red Bank, Shrewsbury, Tinton Falls, Middletown, Holmdel, Colts Neck, Long Branch, Freehold, Manalapan, Marlboro, Howell, Wall Township, Brick, Jackson, and Lakewood. Our caregivers live in these towns.
Can the same caregiver stay with my loved one the whole time?
Yes. The whole point of live-in care is consistency. The same caregiver lives in the home with your loved one for weeks at a time, with daily breaks and required nighttime sleep built in. When she takes vacation time, usually about a week, we replace her with another caregiver. Your regular caregiver returns when she comes back. If a caregiver is not the right fit, your Client Care Coordinator swaps her.
Is your office NIHCA-accredited?
Yes. The Shrewsbury office is NIHCA-accredited, has been serving Monmouth and Northern Ocean families since 2001, and uses our Interactive Caregiving approach along with our Alzheimer's Association-recognized Positive Pathways™ training in every case.
Talk it through with us
I can't say enough about live-in care. I used it for my own father, and there is nothing like a caregiver who knows your every need and is invested in your health. Live-in care is really a wonderful thing, and it is a wonderful long-term plan. My staff and I are always willing to have a consultation in order to determine the best plan for you and your family. Feel free to call us at (732) 530-3636. We have these conversations all day long, and there is no obligation to use us.
