Live-in home care is a time-honored and cost-effective home care solution that Ready Hands continues to offer, despite a general retreat in the industry at large. The dwindling availability of this service is largely the consequence of new federal wage and hour regulations, about which much has been previously written in this blog.
Live-in care works best for individuals who live alone and are reasonably independent with respect to mobility and self-care, but who are unsafe to leave completely unattended at home. In a live-in situation, a home care aide remains in the home for extended periods and is available during the waking hours for whatever assistance the care recipient might need. The aide sleeps in a private bedroom at night and generally is not expected to provide care during that time, but is available to respond in an emergency.
The key determinant of whether a client is a candidate for live-in is the level of need for nighttime assistance. It is not appropriate for clients with mobility impairment who might fall without help, those who need nighttime toileting help or people requiring close safety monitoring. However, it is perfect arrangement for, say, someone with dementia whose cognitive impairment poses a risk, but who can walk and perform other self-care tasks independently.
The historical reason families so often seek out live-in care is that it has typically been priced at a flat daily rate that is well below what 24-hour care on an hourly basis would cost. For example, at the typical $22-$24 per hour charge in our area, round-the-clock care would cost well over $500 per day. Live-in care has generally been charged at half that amount or less.
Now all of that has been upended by new federal regulations that place stringent conditions on how live-in aides must be paid. They boil down to the following key provisions: 1) The requirement that home care workers be paid overtime wages for all hours in excess of 40 per week (an exemption for home care had prevailed since the 1970’s until October, 2015); 2) New record-keeping standards for tracking all work hours; and, 3) Explicit designation of compensable work time as including both active task performance and idle periods when the aide is “engaged to wait.”
The regulations do permit agencies to enter into agreements with employees waiving compensation for sleep and meal times, but only if a new narrower definition of live-in care is met. The new rules have forced home care agencies to incur considerable additional administrative burdens and increased payroll costs, and to pass on these costs to consumers. But many companies are just giving up and no longer offering live-in care at all. Those that do are frequently sending up to three aides to work parts of each week, in order to avert the overtime costs. This completely upsets the continuity of care from one primary aide which is so essential to a good home care experience.
Ready Hands has long prepared for these changes and has been able to retain the basic live-in model, while continuing to offer clients and home care aides the benefits both have been accustomed to in the past. Clients receive continuity from one primary aide at a moderately increased price that is about half what 24-hour care would cost on an hourly basis. Aides are compensated at competitive rates that meet their income needs without forcing them to seek second jobs. We have instituted new record-keeping and payroll procedures that are fully compliant with the regulations. And, we feel some pride in that, unlike many competitors, we have managed to retain this valuable service for the many vulnerable elderly clients for whom it is a good fit.