Should We Be Looking for a Live-In Nurse, or Nursing Home Care?
Q: A family member who lives alone told me that she had stage IV colon cancer. Recently, she had to go to the emergency room and was hospitalized for several days until it could be determined whether she was well enough to go home — or — to a nursing home. While she wrote a will, she never discussed a plan of care. Her brother is thinking about hiring a live - in nurse since the family lives a good distance away. What should we consider?
A: The idea of live - in caregiving is appealing to many families when round – the – clock care is needed, and increasingly hospitals are releasing terminally ill patients to receive late stage healthcare, hospice or palliative care in their homes. There are a number of factors that affect the decision. Here are some considerations:
- Who is the primary caregiver? If there is no family member or friend who can provide live - in care for extended periods of the day, then a live - in caregiver may need to be hired. There may also be a need for additional home care aides to help part of the day or during the night. A main caregiver would expect to work between 4 and 5 days each week providing 24 - hour care. The caregiver is given a bed and typically allowed an 8 - hour period to sleep at night, although his or her sleep may be disrupted to care for the patient. In addition, the caregiver is given breaks during the daytime hours, often 4 hours or more. During the breaks, another caregiver may take over. Another option is to have three caregivers working 8 hour shifts. With this type of care the caregiver sleeps in their own home.
- What are the costs? When paid caregiving is required for 40 hours or more per week, then a nursing home may be a better option. According to a national survey conducted in 2019 by Genworth a company that sells long term care insurance, the national median monthly cost of a home health aide is $23.00 per hour ($552.00 per 24 hr. period), but that varies considerably based on where you live. The Genworth survey found that the national median monthly cost of nursing home facilities was $8,517 for a private room in 2019.
- What does Medicare cover? Medicare doesn’t cover the cost of live-in caregivers, or longm- term nursing home care. There are a number of conditions which must be met to qualify for short - term nursing home stays. If the patient has a three - day qualifying stay in the hospital as an inpatient, requires the assistance of skilled care workers, and has been admitted to a Medicare certified facility, Medicare covers stays for up to 100 days. Qualifying for Medicare coverage for short nursing home stays has become difficult, as more hospitals hold patients as outpatients, instead of inpatients. Medicaid does cover long term care services for low- income patients who qualify.
- Medicare covers hospice care. Medicare covers end - of - life hospice care for people who are terminally ill and who are not expected to live more than 6 months. The focus is on comfort (palliative care) because the patient is no longer responding to treatment. Services typically include physical care, counseling, drugs, equipment and supplies for the illness and related conditions. The care is generally given in the home, and family caregivers can also get support.
Both in home caregiving and nursing home care can be expensive, and costs continue to rise every year. TSCL strongly recommends that families contact local Agencies on Aging to learn about caregiving options and services in the area where your loved one is located. To find services visit the Eldercare Locator 1-800-677-1116.