How wealthy are those elderly people who hire someone to be with them at all times, instead of moving into a nursing home?

Depends on where you live, and exactly what services you're shopping for.

I used to be a nurse's assistant, which has a certification for a limited scope of medical things rather than only non medical jobs. The pay is pretty shit here, and doesn't ever get good in most of the U.S.

That being said, some services are covered under various insurance options, or convenient government programs. So a given individual may not be paying out of pocket for all of the services during a shift.

So, if someone is contracting a home health agency for a certified nurse's assistant, in my area, the company is going to charge at least 20 bucks an hour. That's the least any company around here charges for personal care, period. 20×24 is 480 a day, for a 175,200 bucks a year.

That ain't chump change, and it doesn't include anything but somebody coming in and providing basic services. That's not including any RN visits, etc.

Basic services like I used to provide would involve any direct patient care like baths, incontinence care, assistance walking, that type of thing. It would include bare minimum cleaning duties that are for the patient. This means I'd wash dishes, sweep, mop, vacuum, but only within limits because a CNA is not a housekeeper. Normally, it would be limited to spaces the patient uses only, but most of us that did the job were fine doing a bit more as long as it didn't interfere with the actual job. If the patient lives alone, I didn't know anyone that minded basic housekeeping like that, but we "don't do windows", so to speak. It's kinda bare minimum cleaning.

Supplies are not included, except PPE. If the patient needs wound care, as an example, they'd have to have those supplies paid for extra. Soaps, lotions, and such are their responsibility to provide. We would have access to gloves, hand sanitizer, and often hand soap freely, provided by the company. Other PPE, we were provided with limits to how much we would have at once. That's part of what the hourly charge covers, the overhead of that.

Now, you don't have to have a CNA to provide some care. There are caregivers that have to state certification, or oversight, and insurance won't cover that at all unless it's insurance specifically for that type of service. Which is pretty damn expensive anyway.

Thing is, any of the companies providing that level of service charge the same basic hourly rate, they just pay less to the employees since they aren't certified.

Now, I did do some private care, where I was directly hired to provide care. That's always going to be purely out of pocket, anywhere in the U.S., since we can't bill insurance without way more hassle than it's worth. Again, location matters, and I've been out of the field for a while now.

That being said, I wouldn't show up for anything under 15 an hour, and even that would only be for a shift basis. Well, typically. There were a few people I charged less than that, because sometimes it's about making sure someone is covered, so you do what you have to to make sure of that. But for some random person I didn't know, 15 was the base, and didn't include any cleaning outside of the patient's messes at all. They wanted me to do the work of two people, they could damn well pay for it.

But, 15 wasn't what it usually ended up being, because I would be assuming a shit ton of risk. That's why I rarely did private work away from a company. You need insurance if you're going to be providing medical care. You drop a patient because they decide it's time to box, you're on the hook if things go badly. Through a company, you're covered. So, that 15 was pretty much only when all I would be doing is "safety" sitting. You're just there to make sure the person doesn't get into accidents, plus some bathing and cleaning.

If it included lifts, transfers, transportation, more involved wound care, etc, the price went up a lot because of the liability involved. That would shift the risk/reward some, and/or allow me to get coverage (which isn't all that easy to do individually, and it's absurdly expensive). There were times I charged 30 an hour, but I was also covering all my own expenses for PPE, etc.

Since my area is pretty much rock bottom for pricing of that kind of services, you can tell that someone wanting a live-in, full service caregiver isn't going to be anything but wealthy to some degree. The people I knew that were dumb enough to do that kind of thing (really, you have no fucking life whatsoever) were charging a decent salary, 50k a year or so, but they also had to pay their own taxes, so that wasn't net. I knew a few people that would charge more, but the kind of wealth to pay that out isn't common out here in the boonies, so they were limited, and had to compete with each other.

One of my private patients essentially owned a bank, and that's the kind of rich you need to be to be able to pay out of pocket for that kind of services. But they had two maids, a driver, and other staff in house.

Truth though? You gotta be a masochist. Working for people like that, they tend to be nice, but they treat you like some kind of lower being that they're nice to because they have to be. It's very rare to be treated with the same kind of respect and decency you'll get from other patients. Mind you, I'm a big guy, and was very in demand back in those days because I was very good at the job. So I was actually treated better than average by those wealthy clients. Some of them treated women like dirt, when they wouldn't do so to the six foot tall, bearded power lifter. And you really don't want to know how they would treat black caregivers.

So, yeah, what with the cost increases, and variances by location, you aren't getting out without paying at least 30k a year, and you'd be getting someone with zero skill or training at that rate, so you'd have to be rich enough to have 30k a year to give to someone. And, realistically, it's a lot higher.