Hiring Live-In Caregivers for Alzheimer’s / Dementia & How They Differ from 24-Hour Care

Last Updated: August 18, 2020


Live-in caregivers allow persons with dementia to continue to live at home throughout the course of their disease, rather than moving into an assisted living facility, memory care unit, or nursing home facility. For elderly people with Alzheimer’s disease who want to age in their homes, this can be hugely important. People with dementia in the early stages need less help to remain in their homes, but in the middle and late stages independence is unfortunately impossible. This is when live-in caregivers make all the difference.


What Do Live-In Caregivers Do?

Live-in caregivers provide an alternative to residential living. In mid-stage dementia, persons generally require some assistance with activities of daily living (ADLs), such as bathing, personal hygiene, and dressing, and instrumental activities of daily living (IADLs), like light house cleaning, laundry, and shopping for groceries. In late-stage / end-stage dementia, persons need extensive help because mobility and speaking ability are eventually lost altogether.

Other services live-in caregivers might provide include companionship, meal preparation and clean up, transportation to / from doctor’s appointments and social outings, medication management, payment of bills, and monitoring one’s health as symptoms of dementia become worse.

There are also live-in caregivers that specialize in Alzheimer’s and dementia care, sometimes referred to as memory caregivers. These caregivers have very specific training in order to understand how to approach and communicate with persons with dementia, how to handle specific behaviors commonly seen in persons with the disease, such as sundowning, wandering, and mood swings, and techniques to provide hands-on care while still allowing persons to maintain some autonomy (as long as they are able).


Benefits of Live-In Care

For persons with dementia, and their families, there are many benefits to having a live-in caregiver:

Familiarity: Unfamiliar settings and routines can create confusion, anxiety, fear, and stress for persons with dementia. These emotions often result in disruptive behavior. With live-in caregivers, persons with dementia can continue to live at home, or the home of a family member, and remain in a familiar place with the same daily routine.

Peace of Mind: Having a live-in caregiver gives family members peace of mind knowing their loved one with dementia is supervised and getting help from a professional. In other words, you know your loved one is safe and that their needs are met.

Caregiver Relief: Live-in caregivers can also take the pressure off family caregivers, allowing them to work full-time and take time to properly care for themselves.

One-on-One Care: The person with dementia receives one-on-one care, which would not be possible in a residential facility, where staffing ratios are typically more like one employee for every five or eight residents.

  For those who do not yet require the extensive care of a live-in caregiver, there are also in-home caregivers that offer flexible days and hours. Learn more here. If residential care might be more suitable for your loved one’s needs and situation, learn more about assisted living and memory care units here.  


How Live-In Caregivers Differ From 24-Hour Care?

It is easy to confuse live-in caregivers with 24-hour care. While the same services are generally provided with both types of care, there are differences between them.

Live-in caregivers work 24-hours, but the caregiver is able to sleep during the night (the caregiver must be provided with a place to sleep). He / she also gets lunch breaks and personal breaks. With 24-hour care, shifts are generally 8 to 12 hours long and the caregiver does not sleep during his / her shift. Said another way, supervision and assistance is available 24-hours / day. Generally, with 24-hour care, there is a minimum of two regular caregivers that provide care for the person with dementia.

With live-in caregivers, there is generally just one caregiver. However, a second caregiver may need to be hired, or friends or family may have to step in and help provide care, if the person with dementia cannot be left unattended.

Live-in caregivers often accept reduced compensation in exchange for room and board, while 24-home care workers would not.


Cost of Live-In Care

The cost for live-in caregivers is generally a flat rate per day, rather than an hourly rate. On average, live-in caregivers cost about $3,000 per month. However, this rate will vary based on the state where you live, and even the geographic location within the state. In addition, live-in caregivers that specialize in dementia care may charge more for their experience and knowledge.

Please note, for 24-hour care (mentioned above), caregivers are generally paid an hourly rate, making it a more expensive care option. In addition, the cost of live-in caregivers is much more cost effective than assisted living, memory care units, and nursing home facilities.

There may be Medicaid programs in your state that provide funds to pay for services that keep a person out of expensive nursing homes, including money to pay live-in caregivers. To find out if your state helps pay to keep a person with dementia in their home, look under “Financial Assistance” on your state’s page.


Finding a Live-In Caregiver

Finding live-in caregivers can be challenging. Many home care agencies do not staff for live-in caregivers, and because of the shared residence, a caregiver and care recipient must have a good personality match. Dementia Care Central has partnered to provide a service that helps to match caregivers with care recipients. Start your search here.

Questions to Ask
When interviewing live-in caregivers to find a good match, it’s important that you have already written out the specific needs of your loved one, to be sure the person you hire knows exactly what the job requires. Interview the person in your home, and be sure to check references.

The following are good questions to ask in the interview:
– Do you have experience working with dementia?
– What medical training have you had?
– Do you know CPR and first aid?
– Are there days or times you are NOT available?
– Do you have references?
– Do you have another professional who can fill in if you are sick or away?
– How do you handle aggressive behavior?