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Recently considering hiring outside home healthcare assistance for elderly in-laws (97 and 93 years old).
Mother-in-law recently released from ICU (was diagnosed with double pneumonia, UTI, congestive heart failure, Zenkers Diverticulitis, and sepsis. On oxygen, bedridden, unable to eat much (pureed food) or drink. Sleeps 90% of day, needs turning every 2 hours. On hospice now while in our home.
Father-in-law, needs assistance with hygiene and dress and grooming, has dementia, wheelchair.
Their son, my husband, works full-time and I, his wife, have been basically the in-law's primary caregiver. Due to shoulder injury and ongoing back pain, I need more help now.
Hubby and I have discussed possibly hiring 24 hour private duty nurses to come to help. Anyone have any experience using in-home private duty care and if so, what are pros and cons?

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Imho, although some private duty nurses can be great, the one who cared for my late mother until I could arrive from out of state to live with her was only adequate, not stellar. However, she worked pro bono for me as she was a friend of my mother's.
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Yes, I do...for my mom; mostly privately hired CNAs, some agency for night shift, no "family" caregivers due to mom's needs that required professional, but we visited frequently. Better than facilities. More attention, better care, food, mom happier in her home with all her stuff, pets, pictures, etc.
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Home health care depends on the type of person you hire. Nurses (LPN or RN) are more expensive and can do all tasks: toileting, bathing, feeding, medications... Aides can take care of non-medication tasks: toileting, bathing, feeding, light housework... but it seems that your in-laws primarily need a person to help with their personal needs and clean up your in-laws space, Usually, an aide is hired for certain days and times of the week. If you need somebody 24/7, then you will need at least 3 people to manage their care (everybody needs days and times off).

Home care agency personnel have already been screened and made sure they have training. They do cost more than private hire. However, there are people to cover if a worker is sick for a shift.

Private hire personnel may cost less - usually minimum wage. They are screened by you and may or may not have training as a CNA. Please require a drug screen and do a check for a police record. Ask for references and call those people.
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We hired 24 hour help for my mom after she came home from hospital from bacterial pneumonia. We tried to send her to skilled nursing but no place to go due to COVID.

She lives alone and everyone works or lives far away. She was not capable of caring for herself. Can’t walk or stand and needs sponge bath.

We decided on 3 8 hour shifts so as not to pay overtime. We could not hire live-in help due horrid condition of the house and mom is so demanding and requires lots of attention I did not see how a live in would be able to keep up or when they would rest.

The 24 hour help is very expensive. $25 per hour. She had the cash but it is going fast. I have to say the agency we hired is very good. All the women are excellent with her. This is the second agency we hired and have been the best.

if you try an agency and they don’t work out you can try another. You have no obligation to stay with any agency.
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Bravo for you being able to see the need before the next crisis and protecting your own well-being. Also glad you have the financial resources. You will save yourself lots of grief by going through an agency if you find a good one, otherwise you'll need to track and take care of taxes and want to check on your homeowners for liability issues. Please please be sure to lock up any valuables prior to someone coming in...locking file cabinet, or lock on a room....Agency or not, prior to someone considering or starting have a care plan and make clear what is expected or not. My experience was not positive and in fact added to my stress particularly when I said NOTHING was to be done in the kitchen because I knew it would agitate me to have things moved or not cleaned to my standards. The aide we had, supposedly a retired nurse was totally inept and clueless. She was totally incapable of getting mom in the shower/bath which was a primary goal. So she'd sit on her you know what, make small talk or read her magazine....BUT we were paying for THIS! SO I left a note (being at work) for light housekeeping tasks to be done which WERE listed in the plan and acceptable for her to do. She clearly didn't want to do that. The one day she showed ANY initiative (WOW! she emptied the crumb tray of the toaster oven! and used an abrasive paper towel with glass cleaner on the stainless fridge) was the last straw for me and I got rid of her early. The agency never took responsibility or made the slightest apology. Make the ground rules and duties clear private hire or agency, expect to do a bit of orientation, have adequate supplies available, and provide some guidance. See how it goes and consider revising if you find you don't need someone 24/7 as it gets very costly. But protect your sleep. From your description there is plenty to keep someone busy.
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Sounds like they do need alot of help. I found that hiring caregivers privately and 1099 them was better than home care agencies. You can do your own background checks and pick your caregivers. Also, they will get paid more this way and you will have a better pool of applicants. More experienced.
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G
gdaughter Apr 2021
OH yes, I totally forgot to mention the most important thing...references you will check on if hiring privately and doing a background check. DO BCI and FBI (your local police dept may be able to refer you to a source for that). BCI will be limited in scope to your state probably, but FBI is National or more. You'd be surprised who you might let into your home. Some agencies say they do them and don't. One agency I ALMOST used did it only because I asked! My own googling around found multiple local court appearances for driving violations. Do you want THAT person driving YOUR family around? I didn't. The owner of the agency had no issue with that. I told her that her standards were far lower than mine, and to get out of my life. :-) SHE even found the person had been to court for trashing an apartment so badly the landlord took her to court! The agency owner was so stupid as to make it sound like the aide took the rap for her sister!
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I brought my husband home from a nursing home due to Covid restrictions. At first he had 24 hour care through an agency. The cost was the same..about 12,000 a month. or $400 a day. Since you have 2 people who need looking after, it would be worth it, unless they qualify for Medicaid. I’m glad I used an agency, though I had to be very proactive that they would send qualified people..he needed Hoyer lift transfer, bed baths, and brief changes. They would sometimes send 3 or 4 different people a week, so I was constantly training people. I am living at home too, so it was like having houseguests. I made all the meals, had to provide a separate room for sleeping, and had no privacy. They would sit in a corner and look at their phone for hours. This was before vaccines, and it’s hard to require a caregiver to have a mask on all day, so it’s a miracle no one got Covid.

If I didn’t like someone, they would send a different caregiver, but many times not qualified to provide the heavy care, and I had to help. You can let someone else take care of taxes, SS, insurance, etc. after a few months I asked the caregivers who were here to train me to use the Hoyer lift and do the personal care, and now I have a caregiver for 4 hours 3 days a week, so I can get out for walks, see friends, and shop. I do a better job with his personal care than any of the caregivers did.

I can see your dilemma, since no family member lives there to supervise. I think it’s hard to find qualified people. You might start out at home and see how it goes. Good luck. Let us know how it goes.
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Recently started 24 hour live in care for my 99 year old mother who suffers with early stage demencia, is unable to walk due to arthritis so basically wheelchair bound, and other problems that come along with being 99 years old. Arranging for 24 hour live in home care was the best thing we ever did... We have 2 wonderful ladies 1 stays 3 nights the other stays 4 nights... They take such good care of her and all her needs which gives me such peace of mind and I am able to have some time to breath. I would recommend it highly ....you will be a much happier person!
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Scheduling is very difficult here. COVID has made safety issues very complicated and agencies have not been able to keep workers.
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I agree with others who have suggested a care facility. Hiring full time in home care is cost prohibitive ( not to say disruptive ) and some facilities offer shared rooms where husband and wife can live together.
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For my Daddy we had agency help during the day and private caregivers for the evenings. My mom was able to comfort him during the night. At the last weeks of his life he was bedridden and the morning agency person came in at 7:00.

The last two weeks we had hospice at his home.

It was expensive but he qualified for VA assistance which paid for some and then he had some savings. It was well worth it and he was happy to be home and see his wife everyday. Family got to visit.

I created a daily log that each person filked out to have good communication about care. I also had responsibility for finances, medications, grocery shopping supervising the caregivers and any other needs. It was exhausting.

I do not regret keeping him home. This was at the start of Covid and staffing was low at facilities. He had several hospital stays and rehab so I had a good look at the services that were provided.

I also have my husband's aunt with more advanced dementia @ 92. She is in her home with caregivers 7a-7p everyday. Family members have assigned evenings. We use a Nest camera to monitor after bedtime. She stays in bed the entire night. If needed a caregiver stays the night.

My advice, keep them home if you can manage with help and have the finances.

They deserve all we are able to give if possible. Every situation is different and each family has the givers and takers. I tried to accept and be thankful for what each person could do.
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We had a CNA (friend of the family) for the day shift and the agency for nights. Agency was tough because they would send different people and I had to explain the routine: blood pressure, blood sugar, my dad’s condition, etc. Eventually we were able to request regular shifts with the same people.

The CNA was immensely helpful and more proactive in the care. She was able to instruct the agency and the PT personnel as to his condition and ability for the day. She also was able to handle the medications and administer insulin.

We also made worksheets with specific tasks for them to fill out so we could monitor the trends with his blood sugar and blood pressure, e.g:
7:00am Wake up, dress, walk to kitchen
7:30am Record blood pressure and blood sugar
7:45am Eat breakfast

MargaretMcKen: Our costs were the same. 20$ an hour for agency, a bit less for the less experienced, around 17$ an hour, and a bit more for the CNA.
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I am a caregiver. 20 years experience experience, I have worked as a c.n.a. in several environments, private duty is good to keep I ng them home! Usually in home care does light house keeping,care giving and ao much more
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For me 24/7 care would mean placement in a facility.

Unless you are wealthy, you won’t be able to to hire but one person.

A facility provides an entire staff for less money, plus all of the medical equipment needed.
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My first reaction, unfortunately, is that what you can expect is the bill. You will be paying 3 by 5 full time wages to cover the 3 by 8-hour shifts every week day, and 3 full time wages by 2 to cover the weekend days. That’s 21 shifts a week. At $20 an hour, it’s over $3000 a week, about $14,500 a month. If 2 people are required any of the time, or if the skills you require mean more than $20 an hour, the cost can go up dramatically. Work out the sums for what you need, as well as the tasks. It’s a hard hard road.
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I was hoping someone else would offer suggestions. Maybe this will bring this post up again....
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What you expect is that what is needed is done. (sounds flippant and I do not mean it to be so)
When you hire in home care you specify what needs to be done and if you are using an agency they will provide a person that is qualified to do what you need done.
The more that is required the more the cost.
If medications need to be administered you will have to have a nurse. (only a nurse can administer medications but if your in laws can take medications on their own if they are reminded then a nurse is not needed)
Most of the tasks that you mentioned can be done by a good caregiver or a CNA. Again a CNA will cost a bit more than a caregiver.
IF you hire privately you can hire anyone you want and can instruct them do do what needs to be done. In a private house a private hire caregiver CAN give medications to a patient. But you will have to do back ground checks, I would hire at least 2 people so that they work shifts and can cover for each other if one is off. AND you need to follow the "rules" and take out taxes, file the paperwork so that it is all legal and there will be no problems with IRS. In some cases it is easier to pay a bit more and go through an agency. (less/fewer headaches in the long run)
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