Caring for a Spouse While Working Full Time in Massachusetts

You are doing two full time jobs and only one of them pays. The question is not whether to get help. It is which hours to buy, because buying the wrong ones is expensive and does not fix the problem.

Do I need somebody there all day?

Usually not, and this is where most working spouses overspend. Eight hours a day at our rate runs about $10,900 a month. Three hours a day runs about $4,095. For most couples the three hour version solves the same problem, because the day does not break evenly. It breaks in specific windows.

Which windows actually break?

Listen to your own week and you will usually find three.

• The morning rush. Getting him up, showered, dressed and fed before you leave, which is why you are late twice a week and arrive at work already exhausted. An aide covering 7 to 10 in the morning is the single highest value block most working spouses buy.
• The middle of the day. Lunch, the bathroom, and the knowledge that nobody will find him for nine hours if something happens. This is the block that makes you check your phone in meetings.
• The five to seven crash. You walk in the door and immediately start a second shift of cooking, cleaning and personal care with nothing left in the tank. An aide who cooks and does the evening routine before you get home changes the whole evening.

Pick one. Run it for a month. Add a second only if the first one did not do the job. Families who buy all three on day one usually discover that fixing the morning quietly fixed the evening too, because they stopped starting the day depleted.

What does it cost?

Our home health aide rate is $45 an hour , from one to eight hours a day, no minimum contract and no assessment fee. There is no four hour minimum per visit, which matters here, because a working spouse often needs a tight three hour block and nothing else.

• Three hours a day, weekdays only: about $2,925 a month
• Two hours a day, every day: about $2,730 a month
• Three hours a day, every day: about $4,095 a month
• Four hours a day, every day: about $5,460 a month
• An overnight: $540 for a twelve hour night

Weigh that against what the current arrangement is costing you. Working spouses in this position cut hours, turn down promotions, burn vacation days on medical appointments, and some leave the workforce entirely. If you are considering dropping to part time, run the numbers both ways, because paid help three hours a day is often cheaper than the income you are about to give up, and it does not cost you your pension contributions or your health insurance.

I am not sleeping. Is that the real problem?

Probably, and it is the thing people are slowest to buy help for. If you are up two or three times a night helping him to the bathroom and then going to work at eight, nothing else on this page will hold. You cannot sustain it and the first thing to break is usually your own health.

Two overnights a week is about $4,320 a month, which is real money. But two nights of actual sleep a week is often what keeps a spouse working at all. Some families use overnights only on Sunday and Wednesday so there is never more than three bad nights in a row. We wrote about the night side of this in how family caregivers can get better sleep.

Can I get paid for the care I am already giving?

Not as his PCA. MassHealth regulations treat a spouse as a legally responsible relative, and legally responsible relatives cannot be paid as personal care attendants. Adult Foster Care excludes spouses from pay as well. It is the first thing working spouses hope for and the answer is no.

What can happen is that somebody else gets paid for hours you are currently doing unpaid. An adult child, a sibling, a neighbor, or a hired PCA can be paid, and that frees up your morning. If your husband may qualify for MassHealth, that route is worth starting now because it takes time. Email pcm@careremedy.com and that team will tell you straight whether it is worth applying.

Also check two other things this week. Whether there is a long term care policy in the filing cabinet, since those policies pay for a home aide and people forget they bought one. And whether your employer offers any caregiver leave or benefit, because more do now than did five years ago and almost nobody asks.

What will an aide actually do while I am at work?

Bathing, dressing, grooming, toileting, meals cooked and portioned, light housekeeping, laundry, a walk, company, and a text to you if something changed. The practical gift is that you stop being the only person who knows how he is doing at two in the afternoon.

What an aide will not do: our aides are trained, background checked and insured, and they are not nurses. They do not administer medication, change a dressing, or make a clinical judgment. They can remind him that the pills are on the counter at two o'clock, which is allowed and is usually what families actually need.

He does not want a stranger in the house

Expect that, and do not start with the personal care. Start with an aide who cooks and keeps him company for two hours while you are out, and let bathing come three weeks later once he knows her. Ask for the same aide every visit, and say up front whether you want a man or a woman.

The framing that works is usually about you, not him. Help in the house so that you can keep your job and the two of you can stay in this house is an easier thing for a proud person to agree to than help because he cannot manage. Our page on when a parent says no to in home care works the same way for a spouse.

Start with one block

Call 781 957 8076 or email info@careremedyinc.com. Tell us which window is breaking and what time you leave for work, and we will build around that. There is nothing to sign and nothing to cancel if you only need it for a season.

We serve Greater Boston from Woburn, Western Massachusetts from Springfield, and the South Shore from Brockton.