By Austin Senior Advisor Care Team · October 26, 2026
Live-in care means a caregiver lives in your parent's Austin home. It is not the same as 24-hour shift care, and federal overtime and sleep-time rules change the price depending on who employs the caregiver.
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Marcus: Welcome to the Austin Senior Advisor podcast. I'm Marcus.
Dana: And I'm Dana. Today we're talking about live-in home care, and the overtime rule that changes what it costs.
Marcus: This comes up a lot. Dad shouldn't be alone at night anymore, and somebody says, "Let's just get a live-in."
Dana: Right, and it can be a good fit. But families often think they're buying one thing and get quoted for another.
Marcus: So start simple. What is live-in home care in Austin?
Dana: One caregiver lives in your parent's house and helps with daily life. Bathing, dressing, meals, getting to the bathroom at night. It's non-medical care.
Marcus: Does the agency need a license for that?
Dana: Yes. In Texas, an agency that sends caregivers into a home needs a Home and Community Support Services Agency license from Texas Health and Human Services, usually in the personal assistance services category.
Marcus: And "live-in" has a legal meaning too?
Dana: It does. The U.S. Department of Labor counts a worker as live-in only if they live, work and sleep in the home seven days a week, or five days and at least 120 hours a week.
Marcus: So a caregiver who covers two weeks after a hospital stay?
Dana: Not live-in. And neither is someone who works 24-hour shifts but goes home between them.
Marcus: Okay. What's the difference between live-in care and 24-hour shift care?
Dana: Live-in is one person, living in. Most "24/7 care" quotes in Austin are shift care, where two or three caregivers rotate so someone is always there.
Marcus: And this is where the overtime rule comes in.
Dana: Exactly. Since January 2015, a family that directly employs a live-in caregiver doesn't owe overtime. A home care agency can't use that exemption, even if the family also directs the work.
Marcus: So an agency's live-in price has to cover time and a half past 40 hours.
Dana: For every hour the caregiver actually works, yes.
Marcus: What about sleep? Is the caregiver paid all night?
Dana: With a true live-in, the family and the caregiver can agree in writing that real sleep, meal and off-duty time is unpaid. But if Dad wakes them at 2 a.m., that's work, and it's paid.
Marcus: And for shift workers?
Dana: On shifts of 24 hours or more, up to eight hours of sleep can be excluded. If they can't get at least five hours of real sleep, the whole night is paid.
Marcus: How much does live-in or round-the-clock home care cost in Austin?
Dana: No source publishes an Austin price for live-in care. CareScout's 2025 survey puts the Texas median for a non-medical caregiver at $30 an hour, and Austin generally runs above that.
Marcus: So what does round-the-clock hourly care come to?
Dana: At $30, a 30-day month is 720 hours, or $21,600, before any overtime. That's why live-in exists. If your parent sleeps through the night, you pay for the hours someone is working.
Marcus: What should families ask for in a quote?
Dana: The live-in day rate in writing, how many hours a day it assumes, how overtime works, and what happens to the price when nights get interrupted.
Marcus: Does Medicare or Texas Medicaid pay for live-in care?
Dana: Medicare doesn't. Its home health benefit excludes 24-hour care at home and care that's only housekeeping, laundry or meals.
Marcus: And Medicaid?
Dana: STAR+PLUS can pay for personal attendant hours if your parent meets the financial test and a nursing-facility level of care. The hours come from an assessment, and the waiver has an interest list.
Marcus: Anything else if Mom already has full Medicaid?
Dana: Ask about Community First Choice, a Texas attendant-care benefit. And for free benefits counseling, call the Area Agency on Aging of the Capital Area at 512-916-6062.
Marcus: Last one. How do you hire a live-in caregiver in Austin without breaking the rules?
Dana: With an agency, check its license in the Texas Long-term Care Provider Search first. Hiring privately makes you the employer.
Marcus: Which is what lets you skip overtime.
Dana: Right, but you still owe at least $7.25 an hour for every hour worked, a written agreement on sleep and off-duty time, and records of the real hours.
Marcus: And taxes?
Dana: The IRS says Social Security and Medicare taxes apply if you pay one household employee $3,000 or more in cash wages in 2026. Talk to a tax preparer before the first paycheck.
Marcus: The full guide, with the comparison table, is in the description.
Dana: And if you'd like to talk it through, an Austin Senior Advisor is free. See you next time.
What is live-in home care in Austin, and what is it not?
Live-in home care means one caregiver lives in your parent's house and helps with daily life: bathing, dressing, meals, medications reminders, getting to the bathroom at night. It is non-medical care. In Texas, an agency that sends paid caregivers into a home to help with daily living has to hold a Home and Community Support Services Agency license from Texas Health and Human Services, usually in the personal assistance services category, which HHSC describes as "routine ongoing care or service required by a person in a residence."
"Live-in" also has a legal meaning, and it is narrower than most Austin families expect. The U.S. Department of Labor counts a domestic worker as live-in only if they live, work and sleep in the home seven days a week with no other home, or for five days a week (120 hours or more). A caregiver who stays two weeks to cover a rough patch, or who works 24-hour shifts but goes home between them, is not a live-in worker under federal rules.
That definition matters because it decides overtime, and overtime decides the bill. Before you compare quotes, ask every agency or private caregiver one question: is this a true live-in arrangement, or 24-hour coverage with rotating shifts? For the basics of home care in the area, see our in-home care guide.
Live-in care vs. 24-hour shift care in Austin: which one are you actually buying?
Most agency quotes for "24/7 care" in Austin are shift care: two or three caregivers rotate so someone is always there. True live-in care is one person, living in. The table shows the difference.
| Live-in caregiver | 24-hour shift care | |
|---|---|---|
| Where the caregiver lives | In your parent's home, 7 days a week, or at least 5 days (120+ hours) a week | Their own home; they come for a shift, often two 12-hour shifts a day |
| Overtime | No overtime when the family is the employer; an agency must pay time and a half over 40 hours | Time and a half over 40 hours a week |
| Sleep time | Unpaid only under a written agreement, and any wake-up call to duty is paid | On shifts of 24 hours or more, up to 8 hours of sleep may be excluded; under 5 hours of real sleep means the whole night is paid |
| Who is awake at 3 a.m. | Usually no one, unless your parent needs help | Often an awake caregiver, if you pay for overnight shifts |
| Best fit | A parent who sleeps through most nights but should not be alone | A parent who wanders, falls, or needs help several times a night |
The overtime line is the one families miss. Under rules in effect since January 1, 2015, a family that directly employs a live-in caregiver does not owe overtime. A home care agency cannot use that exemption, even if your family also directs the caregiver's work. So an agency's live-in price has to cover time and a half for every hour past 40 that the caregiver actually works.
Sleep is the other line. The Labor Department lets a family and a live-in worker agree in writing to leave real sleep, meal and off-duty time unpaid. If your parent wakes the caregiver at 2 a.m., that time is work and must be paid. If the nights keep getting broken, the agreement has to change to match the real hours.
How much does live-in or round-the-clock home care cost in Austin?
No primary source publishes an Austin price for live-in care, and no survey publishes a Texas live-in median. What does exist is CareScout's 2025 Cost of Care Survey, released March 2, 2026: the Texas statewide median for a non-medical in-home caregiver is $30 an hour, or $5,720 a month at 44 hours a week. Austin generally runs above the Texas median, so treat these as a floor, not a quote. Our in-home care cost page has the full figures.
Here is the arithmetic families should do before a tour. Round-the-clock hourly care at that $30 median is 720 hours in a 30-day month, or $21,600, before any overtime. That number is why live-in arrangements exist: if your parent sleeps through the night, you are paying for the hours someone is working, not every hour on the clock.
Ask each agency for its live-in day rate in writing, how many hours a day it assumes the caregiver works, how it handles overtime, and what happens to the price when nights are interrupted. If a quote cannot answer those four questions, it is not a quote yet.
Does Medicare or Texas Medicaid pay for live-in care in Austin?
Medicare does not. According to the Medicare Rights Center, Medicare's home health benefit excludes 24-hour-a-day care at home and custodial care such as light housekeeping, laundry and meal preparation, and aides cannot visit only to do custodial tasks. Medicare home health is short, skilled and intermittent.
Texas Medicaid can help, but not as a blank check for a live-in caregiver. STAR+PLUS, the Texas Medicaid managed care program for adults who need long-term services, covers personal attendant services and respite for people who meet the financial test and a nursing-facility level of care. The hours are set by an assessment, and the STAR+PLUS waiver has an interest list. Read our STAR+PLUS guide before you count on it.
If your parent already has full Medicaid, look at Community First Choice, a Texas Medicaid state plan attendant-care benefit rather than a waiver. For free benefits counseling, call the Area Agency on Aging of the Capital Area at 512-916-6062.
How do you hire a live-in caregiver in Austin without breaking the rules?
Through an agency, check the license first. Search the agency in the HHSC Long-term Care Provider Search and confirm it holds an active Home and Community Support Services Agency license with personal assistance services. Our guide to Texas home care license categories walks through the search.
Hiring privately makes you the employer. That is what lets you use the live-in overtime exemption, but you still owe at least the federal minimum wage of $7.25 an hour for every hour worked, a written agreement on sleep, meal and off-duty time, and records of actual hours. The Labor Department warns that without accurate records a family can owe back wages.
Taxes follow too. IRS Publication 926 for 2026 says Social Security and Medicare taxes apply if you pay one household employee $3,000 or more in cash wages in the year, and it lists caretakers, health aides and private nurses among household workers. Talk to a tax preparer before the first paycheck, not after.
Last verified: October 2026.
