Caring for a loved one with Alzheimer's disease is a difficult, energy-sapping job that can trigger a lot of stress and anxiety. It's such a demanding role, in fact, that eventually, you'll need outside help. If you're thinking of hiring a live-in caregiver, here are some factors to consider.

1. It's expensive. And live-in care, besides being costly, is probably not covered by insurance. Medicare, the primary source of health care coverage for those

65 or older, isn't going to cover a live-in nurse. You'll need to take a look at the patient's financial picture to see if you can even afford live-in help.

2. For a live-in caregiver situation to work out, it helps when the patient is on board with having someone in the house. If you decide to proceed with a search for live-in help, consider how willing the patient is to accept this, says Debra Greenberg, Ph.D., director of geriatric social work at Montefiore Medical Center in the Bronx, New York. "If the patient is cooperative with the idea that they need help, it can make finding someone easier," Greenberg says. If the individual refuses to admit they need help, it's a trickier situation.

3. Assess the level of care that the patient needs. "If it's a matter of preparing meals and cleaning the house, that's very different from dealing with the patient's personal hygiene and giving medications," Greenberg says.

4. Assuming that the person needs assistance with personal hygiene because of dementia, you will want to look for a well-trained home health care aide who understands dementia care, says Maria Torroella Carney, MD, director of community-based geriatrics at the North Shore-LIJ Health System in Great Neck, NY. "You need an aide who can orient the patient and get them started on their day," Carney says.  "The patient may need help to shower, dress, and use the toilet." And, she adds,  "Otherwise, we find that if you put someone in the home and the patient gets agitated, the aide may not know the strategies to reduce the agitation."

5. While trying to find the right person, be pro-active in your search. Ask around. Find out whether anyone you know hired a home health aide to care for a relative with Alzheimer's, and whether they were happy with the person. Ask your primary care physician or the doctor caring for the person with Alzheimer's for recommendations.

You can also call the local chapter of the Alzheimer's Association for help. Or take advantage of Medicare's online tool that lets you find and compare home health agencies in your area.

6. Once you've chosen a potential aide, make sure that the two of you see eye to eye on your goals for treatment. "Make sure to spell out both short-term and long-term goals," Carney says. "Some people may complain about the aide if the patient just sits for part of the day. Be patient, because remember, even with an aide, the person is just not going to be busy every second."

Maria Torroella Carney, MD reviewed this article.


In-Home Health Care. Caregiver Center. Alzheimer's Association.

"Paying for Care." Caregiver Center. Alzheimer's Association.