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Short-Term Pilot Service Request
Thank you for your interest in Grandma Joan’s Short-Term Pilot Program. This program connects families with experienced professional live-in caregivers who travel nationwide to provide temporary 24-hour support, typically lasting one to four weeks. Families can opt to use this service following a hospital discharge, when a regular caregiver is away, or while a longer-term care plan is being arranged.

Please complete the form below with as much detail as possible. Your answers will help us determine whether your situation is a good fit for the program and allow us to identify caregivers who may be appropriate for your needs. After reviewing your request, a member of our team will follow up to discuss availability and next steps.

Program Expectations

Professional short-term live-in caregivers in this pilot typically cost $425–$850 per 24-hour day ($2,975–$5,950 per week). A live-in’s workday usually includes 13–16 hours of intermittent daytime assistance, followed by an 8-hour sleep break, during which they remain on call for emergencies or help to the bathroom.

Families are responsible for round-trip travel costs when caregivers travel from another location, as well as any payroll-related expenses. This program is designed for individuals who require intermittent daytime assistance and typically sleep through most of the night, and may not be suitable for cases requiring constant supervision, frequent overnight assistance, or two-person transfers.
*

I understand and acknowledge the program expectations.
Urgency (best guess if not known)*

We need someone to start within 7 daysWe need someone to start in 8-14 daysWe need someone to start in 15-30 daysWe need someone to start in 30+ days
Who is the request for?*

Myself or a family member.A client of mine.Other
Point of Contact*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
Contact's time zone*
Relation to care recipient*
E-mail*
example@example.com
Desired location*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
What is the main reason that a short-term live-in is needed?*

Upcoming discharge from hospital/rehabRespite coverage for current caregiverStability while we consider our optionsRecovering from acute injury/illnessOther
Tentative term*
Service start date (if known)

MonthDayYear
Date
Service start time (if known)
Time that the candidate is expected to start working on their first day.
Service end date (if known)

MonthDayYear
Date
Service end time (if known)
Time that the candidate can leave work to go home on their last day of service.
Service is needed for:*

Single person who lives aloneSingle person who lives with someone else who does not need any services.Couple who both need some services, either hands-on, or hands-off help.Other
Care recipient's gender*

FemaleMale
Care recipient's age
Age
Current living situation*

Level of Assistance Needed with ADLs (Best guess if you aren't sure).*

Rows	None	Stand-by assistance	Hands-on assistance	Total assistance
Toileting
Bathing
Grooming
Dressing
Feeding

Mobility / Transfers*
Approx height
Approx weight
Taking medications*
Memory issues*
Memory diagnosis
Combative or wandering?
2nd care recipient's age
Age
2nd care recipient's gender

FemaleMale
Current living situation

Mobility / Transfers
Approx height
Approx weight
Taking medications
Memory issues
Memory diagnosis
Combative or wandering?
Driving Preference*

No driving required, but willing to use Uber/Lyft for errands, appts, shopping, etc.Driver's license required.We are open to either of the above.Not sure
Does anyone smoke in the home?*

No , non-smokers onlyYesNot sure
Are there any pets in the home?*

NoDog(s)Cat(s)BothOther
Housing Situation*

HouseCondo / ApartmentAssisted LivingOther
Live-in's private space will include:*
Tell the candidate(s) about the care recipient(s) and anything else of importance that has not been covered by your previous answers.
Choose a Care Tier

Please use the descriptions below to select the closest care level that matches your service request's needs.

All three Tiers include: Up to 16 hours of intermittent help with both hands-on and hands-off assistance, as needed in a 24 hour day. Includes an 8-hour sleep shift in the home. On-call during sleep shift in case of night-time emergency or help to use bathroom.

Tier 1 : Low to medium needs. Example: Single care-recipient who lives alone who has memory-care needs.

Tier 2 : Medium to high needs. Example: Single care-recipient who has demetia, and needs a one-person assist transfer.

Tier 3 : High needs. Example: Two care-recipients who both have some hands-on or hands-off needs, or total care for a bedbound patient.
Tier Level (Best guess if uncertain)*
Worker Classification

Families may choose to hire the caregiver as a W-2 household employee or engage them as a 1099 independent contractor. The key difference is control: employees work under the direction of the family, while independent contractors operate independently and determine how they perform their services.
Worker Classification Preference*

W2 household employee. (We can refer you to a household payroll service to take care of all of your payroll obligations.)1099 Independent Contractor. (They will invoice you and you can pay them directly.)I am open to either worker classificationI am unsure at this time
If you need someone to start in seven (7) or fewer days, please include your phone interview availability for the next 3 days.
You/your family's availability to phone interview interested candidates
For example: Tues 7pm-9pm EST , Wed Anytime. Thurs 9am-12pm. EST
How did you hear about us?*
How did you hear about us..other
What Happens Next

After you click “Submit,” a pop-up box will appear prompting you to schedule a time to speak with a live-in care specialist. During that call, we’ll discuss how the pilot works and answer any questions you may have. There is absolutely no obligation to proceed with services. The consultation is completely free.
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Short-Term Pilot Service Request

What Happens Next