A live-in caregiver stays in the home for an agreed stretch of days, helps through the day and sleeps there at night. One person lives in the home and is not on duty every hour, which is the main difference from 24-hour care with a team. Medicare does not pay for it, so most families pay privately or use Medicaid, VA or insurance where they qualify.
This guide explains how live-in care works, what the labor rules mean for a household, who it suits, how it is paid for and how to choose an agency. Carevo is a directory. It does not provide care, place caregivers or vouch for any agency.
What live-in care is
Live-in care means one caregiver lives in the home during their working period. The caregiver helps with the daily routine, sleeps in the home overnight and is available if something happens. They are not meant to be awake all night. The U.S. Department of Labor says sleep time and meal periods can be excluded from paid hours only under set conditions, and that is why live-in arrangements include a schedule, a private place to sleep and breaks.
A caregiver cannot reasonably work every day with no relief, so a live-in arrangement needs a plan for days off and sick days. Ask any agency how relief is covered, who the relief caregiver is, and how hand-over works.
Live-in care sits between hourly home care and 24-hour home care. It provides someone in the house at all times, but not someone awake at all times.
Who live-in care suits
Live-in care tends to suit:
- An older adult who needs help in the morning and evening, company during the day and someone nearby at night, but who sleeps through the night.
- A person recovering after a hospital stay who should not be alone.
- A couple where one spouse cares for the other and needs regular relief. See respite care.
- A person with early to moderate memory loss who is calmer with one familiar caregiver. See dementia care at home.
- A person who wants to stay home rather than move to assisted living or a nursing home.
It is a weaker fit if the person is awake and active at night, needs help every few hours overnight, or needs two people to move safely. In that case, 24-hour home care with an awake overnight caregiver may be needed. It also needs a private place in the home for the caregiver to sleep, and the household has to be comfortable having someone live there.
What a live-in caregiver does and does not do
A live-in caregiver typically helps with:
- Bathing, dressing, toileting and moving safely
- Meals, drinks and shopping
- Light housekeeping and laundry
- Medication reminders for medications the person manages themselves
- Company, outings and rides to appointments
- Being available at night if the person needs help, within the agreed arrangement
A live-in caregiver is not a nurse. Skilled tasks such as wound care or injections are done by a nurse. Ask the agency whether a nurse or manager supervises the caregiver and visits the home. Be clear about the schedule too. Live-in does not mean the caregiver is on duty for 24 hours with no break. Agree in advance which tasks the caregiver will do, and what happens if the person's needs change.
How the labor rules affect a live-in arrangement
The Department of Labor's home care guidance is the reason live-in care is priced and set up the way it is. In summary:
- A live-in worker employed solely by an individual, family or household is exempt from overtime but must receive at least the federal minimum wage for all hours worked.
- Third-party employers such as home care agencies cannot claim the companionship or live-in exemptions. They must pay minimum wage and overtime for covered hours.
- A worker counts as living on the premises if the home is their permanent residence or they stay for extended periods.
- For live-in workers, excluding sleep time also requires a reasonable agreement, ideally in writing, and private quarters in a homelike environment. Workers on 24-hour shifts who are not live-in must receive minimum wage and overtime unless otherwise exempt.
- An individual or household that receives services from a direct care worker typically acts as that worker's employer.
This is a summary of federal guidance, not legal advice. State law may also apply. If you plan to hire a caregiver directly, talk to a payroll service or an employment lawyer before the first day.
Setting up the home and the first week
Live-in care changes how a household runs, so prepare before the caregiver arrives.
- A proper bedroom. The Department of Labor's guidance on sleep time for live-in workers refers to private quarters in a homelike environment. Provide a real bed in a private room, with somewhere to keep belongings.
- Bathroom and kitchen access. Agree which rooms, what food, and whether the caregiver cooks for themselves.
- House rules. Visitors, phone use, smoking, pets, and quiet hours are best settled in writing before the first day.
- A written routine. The person's daily schedule, medications they manage, doctors' numbers, emergency contacts and the preferred hospital.
- A first-week check-in. Talk to the caregiver and the person after a few days. A small problem is easier to fix early.
Think also about the family's own privacy. Some people find it hard to have a stranger in the house at all hours. If that is a worry, say so when you talk to agencies, and consider whether hourly home care with a shorter day would suit better.
How live-in care compares
- 24-hour home care has a team on shifts and someone awake all night.
- Hourly home care covers only the hours you book.
- Companion care and personal care describe tasks, which a live-in caregiver may provide.
- Assisted living and memory care are residential options. Use the care cost comparison to weigh them.
How live-in care is paid for
Medicare. Medicare.gov says Medicare does not pay for 24-hour-a-day care at home, homemaker services unrelated to your care plan, or custodial or personal care when it is the only care you need. Part-time skilled home health care ordered by a doctor can be covered. See the Medicare guide.
Medicaid. Medicaid home and community-based services can include personal care, homemaker, home health aide and respite. Medicaid.gov says states choose the maximum number of people a waiver serves, and that the services follow an individualized plan of care. Each state sets its own rules for who qualifies and how many hours are approved, and whether a program allows a live-in arrangement is a question for your state agency. Some states let participants self-direct, choosing and supervising their own workers. See Medicaid and long-term care, the state programs and paid family caregiver.
VA. VA's Veteran-Directed Care lets enrolled Veterans use a flexible monthly budget to choose their own workers, including relatives, friends or neighbors. VA lists the eligibility, which includes needing substantial help with daily activities. VA also lists Homemaker and Home Health Aide care and respite. Ask a VA social worker. See VA benefits and VA Aid and Attendance.
Long-term care insurance. Oregon's insurance regulator says policies usually pay a fixed amount per day, week or month, and most set a lifetime maximum. Whether your policy pays for a live-in caregiver depends on the policy. See long-term care insurance.
Private pay. Many families pay from income and savings. See private pay.
What drives the cost
Carevo does not publish a price for live-in care. What moves the bill:
- Who the employer is. Agency or household. See the labor rules above.
- Number of caregivers. Relief caregivers for days off add staff.
- Night needs. If the caregiver is regularly woken, the arrangement changes.
- Level of care. Hands-on personal care, lifting, and dementia care can all affect the rate.
- Room and board. The household supplies a private room and food. Plan for that cost.
- Location and demand. Wages differ across states. The Bureau of Labor Statistics reports a national median wage of $17.21 an hour for home health and personal care aides in May 2025. That is what aides are paid, not what an agency charges.
How to choose a live-in caregiver or agency
- Decide the nights. How often does the person need help overnight? If often, ask about 24-hour care instead.
- Prepare the home. A private room and bed for the caregiver, bathroom access, and agreed meal arrangements.
- Ask how rotation works. Days on and off, the relief caregiver, who they are, and what hand-over looks like.
- Interview at home. The Alzheimer's Association suggests interviewing in the home with a third person present, checking references and asking about background checks.
- Write the arrangement down. Duties, schedule, sleep and break arrangements, rate, notice period and what happens if either side wants to end it.
- Review after the first two weeks. Fit matters more with live-in care than any other type, because the caregiver is in your home.
Browse home care agencies on Carevo by state and city. These listings show home care agencies, and we have not yet confirmed which of them place live-in caregivers, so ask each one.
Questions to ask
- Is the live-in caregiver your employee? Do you handle payroll, taxes and insurance?
- How long is each placement, and who relieves the caregiver?
- How many hours is the caregiver expected to be on duty, and what rest do they get?
- What do you expect the household to provide for the caregiver's room, meals and breaks?
- How do you handle night needs? Is there an awake overnight option?
- How do you screen caregivers, and are they trained in first aid, CPR and dementia care?
- What happens if the caregiver is sick, quits or is not a good match?
- Who supervises, and how often does someone visit?
Red flags
- The agency cannot say who employs the caregiver.
- A caregiver is expected to work every day with no relief.
- A promise that the caregiver will be awake all night when only one caregiver lives in.
- No written agreement, or terms that change after you sign.
- A request to pay the caregiver in cash outside the agency.
- The caregiver does not have a proper place to sleep.
Next steps
- Work out the nights with the person's doctor or a social worker.
- Compare schedules in the home care hours cost calculator.
- Check your coverage before booking.
- Tell us what you need and we will show agencies in your area. You decide who to call.