When my dear FIL became very ill with Parkinson's disease, we had to hire three caregivers for 24 hour care.

It would often require 3 people for 8hr shifts. Although we did have two 24/7 nannies for a number of years. One lived in our home 3.5 days, then she would leave, and the the other lived there 3.5 days. We provided a bedroom for each of them, they shared a kitchen and bath. They each had apartments they went to the other half of the week.

For the elderly, a lot would depend on the care he needs. Does he really need 24/7? Does he need nursing care or help with bathing? That changes the pricing of course. OTOH, he could probably get by with someone who overnights, and then people coming in a few hours each day.

I arranged 24 hour care for an elderly relative who was in another town about 1.5 hours from me. I found a case-manager through Senior Services (she was in private practice, not a part of Senior Services, but they recommended her) who screened and scheduled and managed the caregivers. We found a couple of gems and a couple of not so great folks. One of the gems was a very hard worker who wanted as many hours as she could have, as she needed the $$ (but he didn't have a lot of need, the house was small to keep clean and we were paying very well. She got a yearly raise and vacation pay -so it was kind of a cush job that she coveted. She stayed with him for 4 years, I think, then he needed specialized care and moved to an Adult Family Home. If there are any services like this in your community, I would recommend starting there.

I knew from experience elsewhere that some agencies that hire caregivers and then place them with you, do not get the cream of the crop. Often they are minimum wage workers who are doing the work until they find something better and I've seen lots of problems going that route. And they don't pay their workers very well, usually.

My cousin is a CNA and has done round the clock private duty Mon-Fri for 7 years for an elderly woman. They have another person come in for the weekends. The family is very wealthy so $ is no object for them. When she was hired she was told that “Betty” would probably only live for 2-3 years but Betty has outlived the younger sister who hired my cousin.

I don't understand why the children would object if their father is too frail too manage on his own. Don't want their inheritance spent on a caregiver? He definitely needs care for at least part of the day and he should maybe start out with just a few hours and then increase the time as he feels the need. I hope his kids dont talk him out if it. If he is frail he could easily fall.

ETA.....agree with Oly to look into senior services. You also want someone who has geriatric experience and knows how to lift the elderly and is familiar with geriatric ilnesses, medications, etc.

I know someone who did it. She cared for a woman she knew but she was a nurse. This woman had Alzheimers and at first it was OK but became increasingly difficult but that wouldn't have changed even if the woman had been in a nursing home. My friend finally had to request fewer hours, she just couldn't take it physically and mentally. I think it can work but finding and keeping good people will always be a challenge. My Aunt outlived her wonderful caregiver (the caregiver retired at 72) but her kids found her an assisted care facility that she likes. So it's a process.

I know someone who is an RN and has worked for many years as a one on one skilled 24/7 caregiver and companion for a variety of elderly clients and adjusting her income from what I know it was at one point for inflation it costs about $270,000 a year. However she paid her own benefits and per diem for coverage if she needs time off.

When we looked into 24 7 semi skilled care for my father it was about this out of pocket for a schedule of various providers with no guarantees for alternate coverage if someone called out on short notice. And since the caregiver themselves earned less than half this rate a lot went for administrative costs.

It was off the table for financial reasons but we also determined my father would have better care overall in a facility that is expensive for it's kind but a fraction of $200-300k annually

Be careful of the people who are not associated with a reputable agency. There are many of these people who are true crooks, they lie about their backgrounds, fabricate references, and rob the clients blind.

My parents had a live-in after my mother's stroke.The first woman was lovely, but my mother was not kind, so she left. The second was not as lovely, but merely okay. She definitely knew what was considered her "job" and did no more than that. I didn't blame her b/c my mother was very difficult (grew up with servants in the house and never got over a sense of superiority and haughtiness that my grandparents never had, so don't know why she did). It is a bit of a crap shoot finding someone who meshes well with those he/she is taking care of in the home. Still, it was a godsend for us-I still went up every weekend and holiday for several years. Good luck. I hope you find just the right person!

Years ago I was a bystander when my MIL was trying to arrange this care for her own elderly aunt. As others have said, what it means is that as with other do-it-yourself v hire-it-out situations (remodeling comes to mind) you CAN do it but that doesn't mean you SHOULD do it.

Basically round the clock in home care means someone-not the elderly recipient either-will be a defacto assisted living home/nursing home administrator. One person can't work 24/7 so there will need to be shifts. Either the 'administrator' has to deal with agencies or with independent aides, management of either of which sucks up massive amounts of time and energy . There WILL be snags and problems and difficulties that come along with becoming a facility and HR manager. There WILL be challenges related to an elderly person who is now living with strangers in his/her home who are handling intimate personal tasks and support. Most of all it WILL cost a truly staggering amount of money. The $250-300K figure sounds about right for adequate care at all times in someone's home.

Obviously this is a very personal matter and for those who have the resources and make this choice it can work. However as with most other aspects of elder care it is rarely a choice that doesn't impact others deeply and negatively.

In the long run although nobody wants to be anywhere other than home, once the care needs reach that 24/7 level it's better in most aspects to find a facility. For someone with the financial resources to even consider full time home care there are some lovely, wonderful assisted living or nursing homes that will still cost far less than the home option.

My grandmother suffered from Parkinson's during the last 7 years of her life. My family was so very lucky to find a wonderful caretaker for her (through an agency) who provided 24/7 care. Her caregiver's dedication allowed her to stay in her apartment until her death. As I said about her at my grandmother's funeral, "_______, you provided for mom-mom all that we could not". This woman had an unbelievable amount of patience and compassion. We feel so very blessed to have found her and even after my grandmother's passing we keep in touch with her as we would a family member.

My mom and her sister lived nearby and were able to give her breaks as needed- maybe a few hours, twice a week. They also lived in a very walkable community. She'd bundle my grandmother up and out they'd go with the wheelchair. They had a beautiful relationship and we will be forever grateful.

If one day either of my parents are in a similar situation, this is what I'll want for them.

BTW- my grandmother had terrific long-term care insurance that made this route so much easier.

First of all, your neighbor's children need to be onboard with his desire to remain at home. It is easy to speculate about their perceived resistance, but there are steps to take to ensure a good outcome for all. The first step is typically to call the elder social service agency in town and either speak to a qualified person on the phone, or make an appointment. These agencies deal with this all the time and are prepared to give advice about options available in the area.

There are also private services, "Home Instead Senior Care" in my town is excellent. I had a neighbor who used their services when he wanted to stay in his home.

On a personal level, a good friend whose late mother lived in DC, had what everyone thought was a "good team" of 24/7 live in care. Her mother had virtually unlimited means and was adamant that she stay in her 3000 sq ft condo, even when bedridden. Her mother wanted nothing to do with the "help" at first, but as she declined my friend noticed big checks written out of her mom's bank account. It was not a good outcome. So everyone needs to be on guard.

I guess to some extent we were all "lucky" that neither of my parents really had any choice when it came to the point that they were put into a facility, and with "all" I include my parents as well.

Both of my parents were adamant that they did not want to go into a facility, even though, ironically, they had no qualms making that decision about their own mothers and aunts in their turn. They even made sure that it worked for the best financially for their parents, properly protecting assets and things like that.

At any rate, my parents were in a car accident, and that was the beginning of a cascade of events that started with my mother's long-term hospitalization, after which point she could not possibly go home. (It took two people to properly move her because everything was so fragile--she'd had severe rheumatoid since she was in her 50s). As soon as she moved there she realized she actually had a rather wide circle of acquaintances who lived there or visited other people there who she would have rarely seen otherwise. The thing that bothered me was that her room was hospital like and depressingly ugly.

My dad lived alone until almost ninety-one, drove long distances until almost ninety-two, drove locally until past ninety-three. Two episodes of pneumonia from aspiration followed by a recurrence, followed by a few other medical problems meant hospital followed by a rehabilitation center, at which point they would not release him without a place in a facility or 24-7 semi skilled care. His place is like a Hampton Inn filled with very elderly people, and he seems to like it fine. I think after the hospitalizations and rehabilitation there has been enough displacement that he does not have a clear sense of how long he's actually lived there--he completely lost the entire month he had the pneumonia, and he seems content where he is.

Thanks for all you insights. It will obviously be up to him and his children to decide what to do and I imagine it will be a tough situation. I can tell it's very difficult based on my conversations with them so far. For me personally if/when the time comes, I think I'd be fine with some kind of assisted living situation. I just wouldn't want to be in the nursing home environment where I'm confined to a room with a bed, chair, dresser and a roommate - unless my brain was completely gone.

A dear friend had this for her husband when he was ill and dying. When he died, her children insisted she continue to have the 24/7 help and she did. The day woman was wonderful; the night people, not so much. Their job description required them to stay awake all night and be available if she called for help. They would just go to sleep and when she called them to help her to the bathroom, they didn't come, she would try to get their by herself and a fall inevitably occurred. I can't tell you how many different helpers the agency provide for the night shift and nearly all were not good at all.

My in-laws had always had a live-in cook/housekeeper. When their wonderful woman finally retired after over 40 years with them, they hire another woman, but she would only work M-F - no weekends. They had someone come from an agency for the weekend, but it was not always the same person. They were not required to stay awake all night, but there was a "baby monitor" so my FIL could call if he needed help getting to the bathroom. The weekend help often ignored his calls and multiple falls were the result.

My late mother had many friends who had in-home caregivers, and by the time she had died, they had all managed to steal all her silver and jewelry - and there was a lot of it.

I would strongly advise using an agency where the workers are bonded, and locking up anything valuable and high "portable". Even then, someone needs to keep a close watch to be sure they are actually caring for the person and not also robbing her blind.

Many children object to this kind of care as they don't want to have to be involved with hiring them (one still must be involved, even when using a reputable agency), and it is nearly always far more costly than assisted living in a home. In some cases, it is not - the home may be more. After my MIL died, my FIL announced to his two children that he was going to move to a retirement home in a nearby town. The "walk-in the door" fee was $500,000 and if one dropped dead two hours later, none of this money was returned. There was also a monthly charge. My DH and his sister looked at one another and both thought "That's a LOT of money and we will inherit that much less!" He was nearly 92 at the time. It also meant that my SIL would have a 30-40 minute drive each way to see him on a daily basis. That is how she approached him - it would be a huge inconvenience for her, and she WAS going to visit him daily. She still had two school-age children at home and it would have been very inconvenient.

FIL was a dear, dear man and there was no way he was going to inconvenience his beloved daughter (my DH did not leave nearby). We were very glad he made this decision for innumerable reasons. It gave DH and his sister 13 months to clean out a very large house in which they had lived for over 50 years. My husband would drive down from Maine for the weekend, and they tackled the huge 3rd floor attic, the basement, and all closets with things not in use. It took them all that time to go through all this. And he only lived another 13 months.

Sometimes reality must come into these decisions.

For your neighbor, 3katz, it might be helpful for your DH to help him research care providers, or even bring on a consultant who can help him determine what kind of care and caregiver he needs, hours, and managing the money aspect of it. There are many options available that a consultant would be aware of. Look for a geriatric care specialist, care navigator, social worker. His medical system's home health service should be able to refer him to one of those, too.