Everyone wants Alice to come to their house. Remember Alice, the live-in housekeeper who managed the Brady Bunch? Alice had a handle on everything, she never lost her cool, and there was nothing she couldn't handle. Alice is who we all want to move in and help care for our aging loved ones.

We've often wondered what it was about Alice that she didn't want her own home to retreat to in the evening and on her days off. Why was she willing to be cook, cleaning lady, nanny, therapist and general factotum to someone else's family, rather than her own? After all, she did have her boyfriend, Sam. Didn't she ever want her own kitchen? Didn't she ever want some privacy to wander around in her robe (or less) on a Sunday morning?

Whatever Alice's motivation, there aren't many dedicated, honest people like her willing to literally move in and care for someone who's elderly, frail, sometimes cranky and almost always exhausting. Caregivers are human, and much to our sometimes regret, they have families, homes and lives outside caregiving, too. A well-qualified caregiver with a good work history won't want to give up her home, her family, and her life to move permanently into your elder's home.

If she were willing, I would have some pretty serious questions about why she didn't have a home and why she was willing to give up so much.

Twice in my career as a geriatric care manager I ran into this situation, and both times they did not end well.

A few months after his wife passed away Jack met a "lovely" woman who checked groceries at the local market. They dated a few times, and then "Lola" moved in to "share expenses." By the time distant family discovered what was going on, Lola was firmly ensconced in the guest bedroom and was recognized by his doctor as Jack's "caregiver." Tens of thousands of dollars and a new car later, Lola moved on to greener pastures.

Audrey never married and had no family except a nephew several hours away. After a stroke Audrey needed daily help. She rejected the idea of moving to assisted living, and instead hired someone recommended by her hairdresser to move in and provide care. Although she had years earlier given her nephew her powers of attorney and made him executor of her will, approximately 18 months later it came to light that the caregiver now held these powers, as well as check-writing authority on Audrey's account. Time hadn't done anything to improve Audrey's cognitive abilities, and she couldn't recognize that there might be a problem.

The nephew was obligated to hire expensive legal counsel for Audrey, and things eventually culminated in a very costly guardianship proceeding. The live-in was never prosecuted, because Audrey had willingly participated.

24-Hour live-in caregiving offering room, board, and a few dollars a day attracts dubious people who know that being alone with a senior, without oversight or supervision, is an open opportunity to take advantage. People without homes or the resources to rent are also attracted to these jobs. It can be a recipe for disaster.

Professional caregivers who value their skills and experience will not work 24 hours every day in someone else's home for room, board, and a pittance in wages.

So, how does real, quality live-in senior care really work?

Whether you are planning to hire a caregiver through a professional agency or privately, if your senior needs someone there 24 hours every day, count on having a minimum of two regular caregivers.

If your senior sleeps through the night, without needing night care that would make it impossible for a caregiver to sleep, then the most common system would allow for one caregiver to "live in" for several days. At the end of the scheduled live in period this caregiver is replaced by a second caregiver, who will do the same. Each caregiver will return to her own home during her off days.

The senior client provides all meals and a room where the caregiver can sleep.

"Live-in" caregivers are often paid a flat salary for a 24-hour period, which is usually somewhat less than if they were paid an hourly rate.

If the caregiver must be up with the client during the night, then regular sleep is impossible and more caregivers will be necessary. In this case, caregivers usually work 12-hour shifts, so there is always someone awake and available. Shift caregivers are usually paid by the hour.

Shift caregivers often rotate duties among three or four workers, so that each will have the opportunity for a 24 to 48 hour "off" period.

Finding Live-In Caregivers

You may be able to find groups of caregivers who work together to provide 24-hour live in care in weekly blocks. These groups are often informal mother-daughter or collegial teams that have worked together for years. Word of mouth and referrals from other care professionals in your area are usually how they find work.

If you employ this kind of a team you should be prepared to supervise carefully. These teams often bond very closely with their elderly charges and, whether intentionally or unintentionally, they  sometimes take over more than they should. They sometimes resist other caregivers coming in to the home, which can be worrisome.

You can also find 24-hour live-in care through a licensed home care agency. They will handle recruitment, scheduling, taxes, insurance and paychecks, but you should still supervise the care.

If you find that you need 24-hour awake care, it will be extremely difficult to set this up without the help of an agency with several qualified employees. Replacing a caregiver who does not show up will be impossible for you to manage on short notice if you are trying to schedule this kind of caregiving arrangement yourself. Using an agency will definitely be worth the few dollars more they will charge per hour.

A professional home care agency will ask you to commit to a regular schedule so they can send you the same caregivers consistently. Most will ask for a deposit to cover 14 to 30 days of care, and most will invoice you weekly or bi-weekly.

In-Home care is not covered by Medicare. However, many caregivers use long-term care insurance, VA "Aid and Attendance" benefits, or the proceeds of a reverse mortgage to cover the costs.