24/7 Home Care: A Guide to Around-the-Clock Care

Many families include someone in their golden years who lives at home alone, and family members may notice how these seniors struggle with common tasks, such as getting dressed and preparing meals. It’s only natural to worry about their physical abilities deteriorating, which raises the question of what can be done to help. It might mean becoming a caregiver or seeking out a professional caregiving agency.

The scenario is all too common. A 2020 National Alliance of Caregiving and AARP report found that 53 million Americans provide unpaid care to family members, while an independent AARP report revealed the value of the care they delivered in 2021 to be worth $600 billion. Both reports show that families across the country are shouldering an enormous burden that’s likely to grow as the country’s median age continues to increase.

If you’re caring for a loved one, you already know it’s stressful. As with many unpaid caregivers, you may feel ill-equipped and worry about unintended consequences as you juggle care and your own life. 

For these reasons and many others, you may be thinking of employing a professional care provider. This guide can help you understand your options. It provides an overview of 24/7 in-home care, reveals its costs, and discusses various ways to pay. It also covers choosing the right in-home caregiver and lists some resources that can ease your burden.

Professional caregivers provide 24/7 in-home care to seniors who need someone on site round the clock. They specialize in helping people struggling with activities of daily living, such as toileting, bathing and dressing. There are several benefits to 24/7 in-home care, including:

• Aging in place
• Developing personal relationships with professional caregivers
• Providing personalized care services
• Assisting with preparing meals, housekeeping and laundry
• Managing medications and reducing the chances of incorrect dosage or forgetting to take them
• Reducing the chance of loneliness due to around-the-clock companionship
• Providing peace of mind for families knowing their loved one is receiving skilled, professional care

Although they’re similar, 24-hour home care and live-in care are not the same. In some instances, a rotation of caregivers deliver a total of 24 hours of home care, typically working 8 to 12 hour shifts to ensure continuity. Live-in care is a single caregiver who lives with the senior full-time, delivering care when required. Let’s look at 24/7 in-home care to see if it’s the right option for your loved one.

You could consider 24-hour in-home care if your loved one needs around-the-clock care and monitoring. It can be a safe, comfortable alternative to an institution. Everyone’s a stranger at first in a residential facility, and you might find visiting times restrictive. 24/7 in-home care can be an especially appealing option if your loved one has any of the following condition: 

• Dementia: Confusion, disorientation and memory loss can make it harder for seniors to perform activities of daily living and monitor their medications.
• Rehabilitation: Individuals recovering from surgery or illness may require frequent monitoring, changes to wound dressings and mobility assistance.
• Physical Disabilities: People who need help transferring, such as from their bed to a wheelchair. Also, those who need positioning to avoid getting pressure sores.
• Chronic Health Conditions: Seniors who require medication management and monitoring of their vital signs. Examples include patients with diabetes, heart disease or respiratory problems. 

As you’re probably already aware, no type of care solves every problem. Here are some of the pros and cons of 24/7 in-home care.

The last point addresses something important for most families considering in-home care services — the cost. Let’s look at this in more detail.

The national average for in-home care is almost $1,239 per week (or $4,957 per month). This is the average cost, so you may find local agencies costlier or more affordable. Also, some agencies reduce their hourly rate if the contract is for 24-hour care.

An array of factors can affect in-home care costs, including:

• The type and volume of care required
• The caregiver’s level of experience and qualifications
• Your location
• The hours of care provided
• Additional services, such as medical equipment and supplies
• The level of insurance coverage because not all plans cover all costs
• Agency fees if not paying the caregiver directly

In-home care fees can stretch people’s budgets, so let’s consider some programs that can make it more affordable.

There is financial assistance available for 24/7 in-home care, but the availability and coverage of the options vary.  Learn more about Medicaid, Medicare, Veterans Benefits, and Long-Term Care Insurance options for 24/7 in-home care. 

Medicare doesn’t pay costs for 24/7 in-home care, but it can help — albeit for a limited period. The program will pay costs deemed reasonable and necessary for eligible seniors recovering from an illness or injury.

To be eligible, the senior’s doctor or allowed practitioner (such as a clinical nurse) must certify that the treatment is necessary or your loved one is homebound. Additionally, the home health care agency you appoint must be Medicare-certified. Only seniors requiring intermittent care are eligible. Medicare defines intermittent care as:

• Fewer than 7 days of skilled nursing per week.
• Up to 8 hours of skilled nursing care per day for up to 21 days — the 21-day limit can be extended in exceptional circumstances

The federal government allows Medicaid to cover 24/7 in-home care costs (known as “Private Duty Nursing”). However, not all 50 states offer this provision, so your location will determine availability.

To be eligible, your loved one must need continuous skilled nursing care similar to what they would receive in a hospital or nursing home. For example, their care may require the use of technology and regular medical interventions, such as intravenous medications and tube feedings. The senior will also need to satisfy the Medicaid qualifying criteria for their state, which will include their income and assets as well as the type of medical care required.

If your loved one has served the country, they can receive 24/7 nursing and medical care in their homes if they’ve signed up for VA health care. The program will pay for pain management and comfort care services, as well as physical therapies and assistance with activities of daily living. It can also cover intermittent care costs if you or another family member provide occasional care for your loved one.

Assuming the service is available in your loved one’s area, other eligibility requirements include them being deemed in need of ongoing treatments and personal care. VA may also consider other factors, such as insurance coverage and disabilities linked to military service.

You should know that your loved one may not qualify if they have an existing condition. However, this isn’t guaranteed, so it’s worth asking an insurance agent, financial planner or broker.

Choosing an in-home caregiver needs careful consideration. A caregiver’s qualifications and experience cover their skills and how they’ve applied them in real-world situations, but they don’t reveal the person. Therefore, it’s prudent to consider the traits that make a good caregiver. You may want to think about the following points.

• Patient: Some seniors have conditions, such as dementia, that make communication difficult, so the caregiver must be patient.
• Empathetic: They must empathize with their patient’s circumstances and provide emotional support when needed.
• Dependable: They have to be consistent and reliable, so dependability is vital.
• Flexible: The ability to adapt to changing situations and adjust their approach accordingly is crucial.
• Meticulous: They should be detail-oriented and a keen observer who methodically follows care plans and is sensitive to subtle changes in their patient.
• Articulate: They must be able to articulate their thoughts clearly and be equally adept at listening.
• Fit: The role needs someone with stamina, so they should be physically fit. They’ll also need strength because transferring or positioning your loved one will be an everyday occurrence.

In-home care isn’t the only option for seniors requiring around-the-clock care. Let’s take a look at some common alternatives.

Live-in care is when one caregiver resides with the senior, often for continuous days (although also taking some days off). They help with activities of daily living (ADL) and managing medications. Live-in caregivers are a good fit for people with disabilities or who are too frail to perform ADLs without assistance. Unlike 24/7 in-home care, it can’t guarantee an awake caregiver, as the live-in person will need to sleep (they have an 8-hour sleeping break), whereas a caregiving team can ensure awake staff always.

Standard home care and home health care services provide the same care as 24/7 in-home caregivers but don’t offer it around the clock. They’re a good fit for seniors who don’t always need someone nearby but do need help with ADLs and/or the provision of basic medical care. 

Advances in technology and communication make it easier to remotely monitor conditions such as diabetes, heart problems and chronic obstructive pulmonary disease. This option can be a good fit for people comfortable with using appropriate devices, such as blood pressure monitors and breathing apparatus, or those with a caregiver who is comfortable using them. However, unlike tried and tested 24/7 in-home care, there are concerns about the accuracy of some devices.

Assisted living is a good fit for seniors who need help with ADLs or are at risk due to memory loss. These facilities typically have awake staff on site 24/7 and emergency call buttons in residents’ rooms. Staffing levels and the size of the facility will determine the speed at which an emergency call is answered, so there could be a longer delay than there might be from a 24/7 in-home caregiver.

Nursing homes provide near-hospital levels of care 24/7 for patients with complex medical needs. The staff-to-resident ratio is narrower than assisted living, and there will be at least one registered nurse (RN) available (i.e., not all states follow the same guidelines, so your location will factor in the RN-to-resident ratio). It’s a more comprehensive service than 24/7 in-home care, which is reflected in the typically higher costs. 

Seeking help from the right sources is important if you’re considering 24/7 care for a loved one. The following list includes some of the most useful.