Fain's Private Duty
Fain's Private Duty Home Care is a nationwide private duty operator built on 17 years of New Jersey home care operating experience. New Jersey is our first launch market.
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24-hour home care

24-hour home care at FAINS is a split-shift hourly staffing structure where two or three Certified Home Health Aides cover the full 24-hour cycle, all awake and working through their shifts, under a single plan of care. Every 24-hour case has a Registered Nurse Supervisor of record and chemistry-matched caregivers introduced to the family before the first shift. The methodology draws from seventeen years of Irina Fain operating home care in New Jersey, since 2009.

Minimum credential: NJ-certified CHHA on every shift
Starting rate: $46 per hour (CHHA tier) times 24 hours per day
Shift minimum: Four hours (per The Fain Standard pillar 3)

What 24-hour home care means in practice

24-hour home care at FAINS is a full-day, seven-day-a-week staffing structure where CHHAs are on shift and awake for every hour of the 24-hour cycle. Two or three caregivers rotate through their scheduled shifts. The client is never without a CHHA in the home. The plan of care is one document, held across all shifts, so the client experiences a single coherent care plan even though the caregivers change through the day.

The structure exists because it is the right fit for a specific category of case: an acuity picture that needs active caregiver presence around the clock, a cognitive or fall-risk picture that cannot safely have unattended hours, a family whose composition or geography does not include a live-in bedroom for a live-in caregiver, or a household that specifically prefers the awake-through-the-night model over the sleep-eligible live-in model. Getting the choice right matters because 24-hour hourly and live-in produce very different economics and very different in-home experiences.

Most FAINS 24-hour cases run on a three-shift structure: an eight-hour morning shift (typically 7 AM to 3 PM), an eight-hour afternoon-evening shift (typically 3 PM to 11 PM), and an eight-hour overnight shift (typically 11 PM to 7 AM). Some cases run on a two-shift structure: twelve-hour day and twelve-hour night. The specific split is set at intake with the family and reflects both the family's preference and the roster of caregivers whose schedules and skills fit the case.

Every shift is CHHA-tier. Every caregiver is license-verified against the NJ Board of Nursing registry before her first shift and re-verified monthly. Every caregiver is chemistry-matched to the family before her first shift. The RN Supervisor writes the plan of care that all shifts follow, and the plan is a single document, not three separate shift plans that risk drifting apart.

Who calls FAINS for 24-hour home care

Three family situations account for most of the 24-hour caseload.

A client with substantial acuity across the full day. This is often a client with advanced dementia and unmanaged behaviors, an ALS or Parkinson's case at a stage where continuous supervision is warranted, or a bed-bound client requiring frequent repositioning around the clock. Live-in staffing is not the fit here because the caregiver cannot safely have a sleep window; the case needs awake caregivers on every shift.

A high-risk post-hospital or post-procedure window. After a significant hospitalization, an initial period of 24-hour hourly coverage is often the intervention that prevents rehospitalization. The structure typically tapers to fewer hours per day as the client stabilizes. Two to eight weeks of continuous coverage is common in this window, then a step-down.

A household without a live-in bedroom or a family preference for awake overnight coverage. Some homes simply do not have a spare bedroom that meets the live-in requirements. Other families prefer knowing an awake caregiver is with the client through the night rather than a sleep-eligible arrangement. Both are legitimate reasons for the 24-hour hourly model.

Other cases include end-of-life vigil coverage, complex neurological cases with unpredictable overnight needs, and clients whose insurance benefits or long-term care policies structure better for hourly than for per-day billing.

How pricing works for 24-hour home care

24-hour home care is billed at the CHHA hourly rate published on the pricing page, multiplied by hours in the shift, multiplied by shifts in the week. No coordination fee, no shift-change fee, no per-shift premium. The invoice line for each shift names the caregiver on shift and the hours worked, and it matches the shift log the caregiver completed.

For most cases, 24-hour hourly runs at a higher weekly cost than a live-in arrangement covering the same seven days. That difference is intentional and reflects the different staffing model. The caregiver on an awake overnight is working; the caregiver in a live-in sleep window is present but sleeping. Families whose case fits the live-in model often prefer the pricing that comes with it. Families whose case does not fit live-in accept the higher hourly cost because their case requires it.

Weekly invoicing runs Monday through Sunday under weekly transparent invoicing. ACH is free; card is available with a three percent surcharge disclosed at invoice time.

The four-hour minimum shift applies in the sense that no shift on a 24-hour case is under four hours; most are eight or twelve.

What FAINS commits to for 24-hour cases

Every FAINS 24-hour case is governed by all seven pillars of The Fain Standard. The pillars carry particular weight when the household is running on continuous staffing.

Every 24-hour case has a Registered Nurse Supervisor of record. She wrote the plan of care after the in-home assessment, credentialed the assigned CHHAs against the plan, and returns at least every 60 days for a supervisory visit. In 24-hour cases the RN's visit reviews shift log continuity across all shifts, checks for drift between how different shifts are executing the plan of care, and adjusts the structure when the acuity picture changes. The RN is also the family's clinical phone line between visits and the coordination point when the case involves outside clinicians (hospice, home health, PCP, specialists).

Every CHHA on a FAINS 24-hour case is license-verified against the NJ Board of Nursing registry before the first shift and re-verified monthly.

The chemistry-matched commitment applies to every caregiver on the case, not just the primary. The family interviews every caregiver assigned to the case before her first shift. If the fit is wrong with any caregiver inside the first week, the swap happens without penalty for that caregiver, and the case continues with the caregivers who fit.

The 24-hour cancellation window applies to shift-change scheduling. When a scheduled caregiver cannot make a shift, the RN Supervisor personally coordinates coverage from the on-call CHHA roster and notifies the family. The family never learns at a shift change that no one is coming.

24-hour care at FAINS is private pay and private insurance only, including long-term care insurance policies that cover continuous home-based care. Families whose primary payer needs to be Medicaid are referred to a fit-for-purpose provider with specifics named.

Two composite case examples

Robert, 84, advanced Parkinson's with dysphagia and cognitive changes, Basking Ridge (Somerset County). After twelve years of the disease Robert had reached a stage where his wife Diane could no longer safely manage him even with substantial daytime CHHA coverage. Fall risk was high through the night, medication windows fell inside the sleep hours, and Robert's cognitive fluctuation had begun waking Diane repeatedly. The FAINS RN scoped the case for 24-hour hourly staffing on a three-shift structure, seven days a week. Three chemistry-matched CHHAs covered the shifts. The RN visited every 45 days rather than the standard 60 because the acuity was high. Diane returned to sleeping through the night in her own bed. The structure held Robert at home for another ten months before end-of-life planning transitioned to a different setting.

James's mother, 82, dense hemiplegia after a large stroke, first six weeks home, Cranford (Union County). After acute hospitalization and three weeks of inpatient rehab, James's mother came home with substantial dependency and a heavy medication regimen. The FAINS RN and the discharging team both saw a high rehospitalization risk in the first six weeks. The plan of care landed on 24-hour hourly staffing for six weeks with a two-shift twelve-hour structure. The Medicare home health team ran therapies on their visit schedule. The FAINS CHHAs held personal care, meals, transfers, medication supervision, and continuous fall prevention. At week six the RN Supervisor stepped the structure down to daytime-only twelve-hour shifts. The stepped taper worked; James's mother never rehospitalized.

How 24-hour hourly care differs from FAINS's other hour models

The 24-hour hourly structure is one of several FAINS hour models. Naming the differences openly helps families pick the right one.

24-hour hourly versus live-in care. 24-hour hourly has awake caregivers on every shift, priced at the hourly CHHA rate, typically staffed by two or three rotating caregivers. Live-in has one caregiver in the home for a multi-day rotation with a defined sleep window, priced at a daily rate. 24-hour hourly costs more per week than live-in for a comparable case; the difference reflects the awake overnight model. Live-in fits when the client sleeps a solid overnight; 24-hour hourly fits when the client does not.

24-hour hourly versus daytime-plus-overnight caregiver split. Both cover the full day with hourly staffing. A daytime-plus-overnight split typically uses two shifts (a long daytime shift and an overnight shift) with the same overnight caregiver arriving after the daytime one leaves. 24-hour hourly typically uses three eight-hour shifts. The choice is often about which structure the family prefers and which fits the caregiver roster better; the pricing works out similarly.

24-hour hourly versus hourly short shifts. Hourly short-shift coverage (four to eight hours a day, some days per week) is the entry-level structure and fits many clients well. 24-hour hourly is a specific escalation for cases that need continuous coverage. The RN Supervisor recommends the structure that fits the current acuity, and the family can request a change at any 60-day review.

The right structure is the one the RN's assessment recommends and the family agrees to. FAINS does not push a family into a higher-cost structure than the case actually needs. Naming honest fit is part of the operating discipline.

Common questions

How is 24-hour hourly care different from live-in care?
24-hour hourly care is two or three CHHA shifts covering the full 24-hour cycle, all awake and working, at the hourly CHHA rate. Live-in is one caregiver in the home for a multi-day rotation, with a defined sleep window each night, priced at a per-day rate. The two are different staffing models, priced differently, and matched to different clinical situations. The FAINS RN Supervisor helps the family choose at the intake assessment.
When does 24-hour hourly fit better than live-in?
24-hour hourly fits when the client's overnight needs are substantial enough to require an awake caregiver, when medication windows fall during the sleep hours, when fall risk during the night is high enough to need active supervision, when acuity is elevated (recent hospitalization, unstable clinical picture), or when the client's cognitive state at night warrants continuous active presence. Live-in fits when overnight needs are minimal and the client sleeps a solid overnight window.
How many caregivers does a 24-hour case involve?
Most FAINS 24-hour cases run on three CHHAs with an eight-hour shift structure: 7 AM to 3 PM, 3 PM to 11 PM, 11 PM to 7 AM. Some cases run on two CHHAs with twelve-hour shifts: 7 AM to 7 PM and 7 PM to 7 AM. The specific structure is set at intake based on the family's preference and the roster fit. All caregivers on the case are chemistry-matched and introduced to the family before the case starts.
How is a 24-hour case priced?
The CHHA hourly rate applies for every hour on shift. The published rate multiplied by 24 hours a day, multiplied by days per week, produces the weekly cost. The pricing page publishes the rate. There is no per-shift-change fee, no coordination charge, and no premium beyond the standard hourly rate. Weekly invoicing runs Monday through Sunday at the published rate.
Are all three caregivers on shift the same each week?
The goal is stable assignments so the client sees the same three faces on the same shifts each week. Vacation, illness, and life events sometimes require a covering caregiver from the FAINS on-call roster. When that happens, the RN Supervisor notifies the family in advance where possible, and the covering CHHA is introduced before her first shift when time allows.
Can a 24-hour case scale up or down over time?
Yes, and this happens frequently. A case that starts at 24-hour hourly during a recovery window often steps down to 16 hours a day (two shifts) or to overnight-only or to daytime-only as the client's needs change. A case that starts at daytime-only often scales up to 24-hour hourly as the clinical picture progresses. The RN Supervisor reevaluates at the 60-day visit and any time the family or caregivers report the current structure is not fitting.
What is the shift handoff protocol?
The outgoing caregiver walks the incoming caregiver through the shift log, notes anything the family should know that came up during the shift, and hands off keys, phones, and the plan-of-care binder. Handoffs typically take ten to fifteen minutes and happen in the home. The family is welcome to be present for handoffs and often finds it useful to hear the previous shift's report.