Live-In Home Care Offers Advantages, But Financial Barriers Often Make It Unrealistic

One of the most surefire ways to maintain the caregiver-client relationship during the COVID-19 outbreak — without worrying about increased infection risk — is live-in care.

Over the last few months, live-in care has allowed many individuals who need regular, hands-on care in the home to receive those supportive services without interruption. At the same time, it has also reduced coronavirus explosure risks for the live-in caregivers, who only have to care for one patient, in one location.

Despite its perks, live-in care could be in jeopardy moving forward.


“It’s evident that the the safest clients within the whole system are those that are staying in place, those that are at home with limited visitors and one caregiver — and that defines a live-in,” Gary Raymond, managing director of New Jersey’s ComForCare Senior Services, told Home Health Care News.

ComForCare is a home-based care franchise under the Best Life Brands network. The franchise system has over 200 locations nationwide.

In New Jersey, multiple ComForCare locations have had success with the live-in model during the COVID-19 crisis. Generally, clients have been grateful the 24/7 option was available to ease anxieties.


“A number of our clients have families that have expressed the fact that they’re very, very pleased their parents are being cared for by a live-in caregiver,” Raymond said. “We’ve also had new inquiries about it [during COVID-19].”

But live-in care could be at risk in many states, as minimum wage hikes and U.S. Department of Labor (DOL) regulations create a perfect storm to disrupt it. Although it’s a convenient and safe option now, it could be financially unfeasible soon.

If live-in caregivers are treated as per hour employees, then they’re almost impossible to pay. Accruing pay for round-the-clock work, they often become too expensive for normally low-margin home care businesses.

That’s why — when DOL aimed to give more freedom and pay to caregivers — home-based care organizations at the state and federal level were able to fight for a middle ground. The solution: a system that allowed workers to be “on the clock” for 12 or 13 hours per day, non-continuously.

“That actually was fine,” Raymond said. “It worked within the industry. Everybody adjusted and made their payments to the caregivers appropriately.”

Over the course of the last few years, however, some states have mandated higher minimum wages and costly overtime-payment requirements for any worker that puts in more than 40 hours per week. Additionally, some states have been the battlegrounds to abolish the “13 hour rule” entirely.

“Apply, say, $11 per hour [plus relevant overtime bumps], and that live-in caregiver makes $60,000 to $65,000 per year depending on how much time they take off and so forth,” Raymond said. “But when you extrapolate that up to $15 an hour, you will find that a caregiver working as a live-in will make $90,000 a year — and maybe even more than that. So, that will wipe out the possibility of having a live-in caregiver, … and that really is the crux of the issue.”

One solution to avoid per hour issues is to allow an agreed-upon salary to be put in place, exempt from overtime requirements, Raymond argues.

But that would, in turn, raise concerns over whether that proposed solution allows caregivers to be underpaid.

“At first glance, someone might say, ‘Well, you’re going to take advantage of the caregivers.’ That’s not true,” Raymond said. “If a caregiver is making $65,000 right now and you try to pay them, say, $45,000 for a salary, they’re obviously not going to accept or stay on the job. We’ve already established the base on a national level — and that base is in the area of $60,000.”

Finding the workers

The second issue that is threatening to make live-in care unviable in certain states is finding the caregivers willing to do the work. The job pays more, on average, than an out-of-home position, but it’s also usually done by older, experienced caregivers.

But the direct care workforce is getting younger. As of 2017, nearly 60% of all direct care workers were under the age of 44, according to data from PHI National.

“[There’s] more and more caregivers who are on the younger side, and they don’t look to go into live-in care,” Raymond said. “It’s really the more experienced caregivers that choose live-in.”

The entire home care industry is worried about a caregiver shortage. he live-in-specific shortage is just another aspect of that.

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