Whether your older loved one needs more assistance through the night than you can provide or they need a caregiver to look out for their safety, you might be considering overnight care. While those are two of the main reasons to hire an overnight caregiver, according to Hillary Wootton, business operations manager at Homewatch CareGivers, LLC, the roles and responsibilities of this provider may depend on the client’s needs. For that reason, you might be wondering what to budget for this kind of care.
Here, the basics on overnight caregiver services and what you can may pay for them.
What is overnight care?
Overnight care is as individualized as any other type of care, and therefore, there is not one specific way to describe it, explains Quincie Novella, case manager with Salus Homecare. “In most cases, it entails a 12-hour shift,” she says. “Some agencies provide sleep care where the caregiver sleeps for up to eight hours during their shift.”
Like daytime care services, overnight caregiving responsibilities generally depend on a senior’s needs. “We see clients needing assistance with medications or visiting the bathroom during the night,” says Wootton. “Sometimes, clients with dementia will suffer from sundown syndrome, which often manifests itself in wakefulness and wandering at night.”
Types of overnight care: hourly overnight caregivers vs. live-in caregivers
Overnight care typically falls into two categories, which will impact roles as well as pay:
- Hourly overnight caregivers.
- Live-in caregivers.
With both overnight care and live-in care, activities are personalized in collaboration with family members, the case manager, any medical professionals involved in care and the client as appropriate, adds Novella. However, it bears noting that tasks included in the plan of care are often quite specific and always non-medical in nature, says Novella, as the caregiver is not licensed to provide medical support.
“Caregivers are expected to remain awake during the night shift in case the care recipient might wake up and require assistance.”
— Kevin Tagarao, chief operating officer of 1Heart Caregivers Services
1. Hourly overnight caregivers
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The most common overnight caregiver responsibilities, according to Kevin Tagarao, chief operating officer of 1Heart Caregivers Services:
- Preparing the care recipient for bed: going to the bathroom or using a bedside commode.
- Assisting in reminding them to take medications.
- Changing clothes when needed.
- Oral care.
- Tucking them into bed.
- Assisting with any of these needs throughout the night.
“The caregiver would also be responsible for being alert during the entire duration of the shift, making sure the client does not develop bed sores or fall during the night,” he adds. “Caregivers are expected to remain awake during the night shift in case the care recipient might wake up and require assistance.”
Although a caregiver that’s “on the night shift” needs to be awake through the night, there’s some flexibility as far as sitting in a chair in the same room or in a nearby room where they are awake and available for what the client needs overnight, adds Glenn Lane, CEO of Westchester Family Care. But overall, a caregiver working by the hour on a night case needs to be awake, as they are paid by the hour, he explains.
2. Live-in caregivers
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On the other hand, live-in care is different from overnight care in that the caregiver remains in the patient’s home for 24-hour shifts, three to four days a week. These caregivers typically sleep at night along with the client but still provide assistance.
The Department of Labor defines live-in care as having a single caregiver who spends at least 120 hours (five consecutive days) in the client’s home per week, explains Wootton. “In this situation, the client’s needs might be the same as with a 24-hour client, but care must be taken that, in those five days, that caregiver is given an opportunity to sleep,” she notes.
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What you can expect to pay for overnight care
Typically, overnight caregivers are paid either an hourly, weekly or monthly rate. However, the set amount will vary based on a range of factors, including:
- Your location.
- The senior’s needs.
- Whether you are going through any agency or an independent caregiver.
- Whether you are hiring a live-in or an overnight hourly shift caregiver.
Depending on a caregiver’s prior experience and whether or not they carry other certifications, their services can cost anywhere between $12 and $15 per hour or $120- $200 per night, says Elliana Rose, a medical doctor who specializes in pharmacology, immunology and internal medicine.
According to the most recent Genworth’s most recent Cost of Care survey, the median national hourly cost for homemaker services or a home health aid (defined as someone typically with a high school diploma who can help with a patient’s daily activities including cleaning and bathing, toileting, dressing and potentially, check vitals), is about $33. However, this drastically changes depending on location, ranging from $22 to $42 per hour.
The cost to the client for live-in care will vary depending on the type of provider they are working with, adds Wootton. “When working through an agency, prices will tend to be higher because of the accrual of overtime costs,” she says. “An independent provider sets their own rates.” (However, it bears noting that in certain states, overtime is required for live-in caregivers in some capacity. More on that in a moment.)
How to find out the customary rates for your location
Glenn explains that the hourly rates and live-in rates vary by both region and agency. However, to help give you a general idea, here are the states with the most and least expensive median hourly rates for a home health aide in 2023, according to Genworth:
States with most expensive median hourly rate for home health aide
- Maine: $42
- South Dakota: $42
- Missouri: $40
- New Hampshire: $40
- Rhode Island: $40
- Vermont: $40
- Washington: $40
- Colorado: $38
- Hawaii: $38
- Iowa: $38
States with lowest median hourly rate for home health aide
- Oklahoma: $28
- Texas: $28
- Georgia: $27
- Oregon: $27
- District of Columbia: $26
- Kentucky: $25
- Louisiana: $25
- West Virginia: $25
- Alabama: $23
- Mississippi: $22
There are additional resources in each community where you can determine the rates for your area, says Glenn. These include:
- Referral sites that list agencies.
- Your insurance company.
- Local home health and nursing agencies or assisted living facilities.
- Looking at caregiver listings on Care.com and ZipRecruiter. This can also give you an idea of how much live-in caregivers make in your area. “If you offer too little, you will either find no one to fill the position or find poor candidates,” adds Melanie Musson, a senior care provider and a senior life insurance expert at Life Insurance Post. “The better you pay, the better your candidates.”
- Word of mouth.
How overtime, sleep time deduction and taxes can impact cost
Although you can take the above averages into consideration, what you’ll ultimately pay for an overnight caregiver will vastly vary depending on the precise type of overnight care you are looking for and any related built-in overtime, sleep time deduction and taxes, explains Lane.
Live-in assistance with overnight care
The Department of Labor Wage and Hour laws require caregivers to be paid for all hours worked, including any applicable overtime, she adds. “Most states allow for 24-hour caregivers to have up to eight hours of unpaid time, known as the sleep time deduction,” she says. “There are rules that govern how many hours can be deducted on any given night, depending on how much assistance a client will need.”
Under the Fair Labor Standards Act (FLSA), the sleep time deduction works like this: An employer may exclude sleep time from an employee’s hours worked hours, meaning they can only bill for up to 16 hours a day, if certain conditions are met:
- If both employee and employer agree to “regularly scheduled” interrupted sleeping periods of up to eight hours.
- The employee provides “adequate” sleeping accommodations.
- The employee is able to get at least 5 hours of uninterrupted sleep during the 8 hour time period that is being deducted.
The pay to the caregiver — if they work for an agency and are not a private caregiver — is always based on hours worked and is subject to overtime laws. “This is true whether the caregiver is performing an eight-hour overnight shift, a 24-hour shift or is live-in,” says Wootton. “Again, only in states where the sleep time deduction is legal can a caregiver not be paid for hours spent in the client’s home.”
Hourly overnight care
This role is paid by the hour but any time over the 40-hour work week will be paid overtime.
Caregivers hired privately to work in someone’s home are categorized as non-exempt workers under the Fair Labor Standards Act, Desiree Leung, VP of operations for Care HomePay, previously shared. “This means they must be paid overtime for all hours worked over 40 in a seven-day work week,” she says.
Although live-caregivers are exempt from overtime pay, according to federal law, certain states have special overtime laws for live-in employees. These include: CA, HI, MA, MD, ME, MN, NJ, NV, NY and OR. Specific requirements in these states can be found here.
Families also need to be aware of the nanny tax when hiring a senior caregiver. This is a combination of state and federal taxes outlined in IRS Publication 926. It impacts those who pay a household employee $2,700 or more in a calendar year and it’s important to note that these caregivers can not be classified as independent contractors.
The bottom line
Opting for a live-in caregiver can be “very price-efficient” if your older loved one can’t be left alone, points out Lane. “A client has someone with them who is available 24/7 but is only being paid 16 hours of 24 hours,” he explains, adding that this might result in an expense that is less than hourly care.
Ultimately, figuring out which type of overnight caregiver is right for you, your senior loved one and your budget is a highly personal decision that’s worth researching before making a final call.
