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My mother, age 88 has lived alone for 10 years and wants to keep it that way, despite her unsteady gait and uneasiness about driving.  She enjoys spending time with my brother, and me and with friends as long as someone provides the transportation.

She has agreed to have companion care for 15 hours a week and that has worked well for the past six months. But we're concerned about her being alone at night. She says she doesn’t want someone "hanging around" while she’s sleeping and quite frankly, the added expense is more than we can afford. Any suggestions?  Maria G., Fort Lauderdale, FL

Your mother sounds like she is at a turning point: she is still active and values her privacy, but without some support, her unsteadiness puts her at a high risk for a fall. Considering her immediate needs and the cost of additional hours of care, I suggest that your mother consider a live-in companion. That’s because, generally speaking, once you exceed 12 hours per day, it becomes more cost efficient to have companion care around the clock.

There are many benefits to live-in companion care that most people overlook, instead focusing on the lack of privacy and expense. However, I think the idea will appeal to your mother when she considers the following;

First, a live-in companion can increase, rather than diminish, your mother’s independence. Unlike an hourly day-time companion, when someone lives with you, they have their own space and don’t hover when you want to be alone. When your mother wants companionship and assistance, someone will be there for her.

Second, having a live-in companion who drives will allow your mother to maintain her social activities on her own schedule and not rely solely on those who can provide transportation. It also means that you and your brother can enjoy more quality time with your mother.

Third, when she is not needed, the live-in companion can work “behind the scenes” doing errands, making meals and keeping the home running smoothly.

Of course, there are a few requirements for a live- in arrangement to be successful. It’s important that your mother is able to sleep through the night; that is, not require help throughout the night on a regular basis. Otherwise, the caregiver will be too exhausted to do her “day” job properly and your mother might not be in safe hands.

There also should be sufficient space for the caregiver to sleep, and meals must be provided for her.

A live-in helper also needs some time off. There are different types of arrangements to consider. Many families hire an additional person for just weekends. Alternatively, there can be two companions - one for four days, and a second caregiver for three days.  It depends on your mother’s individual needs and desires.

It’s worth mentioning to your mother that caregivers who choose to live with a client tend to be a little older and more mature than hourly day-time workers. So there’s a very good chance that your mother would enjoy the company of a companion and the added freedom that her presence makes possible for a good many years ahead.