Live-in care or 24-hour care: when one carer sleeping in is not enough

Live-in care is one self-employed carer who moves into your relative's home for a placement. They have a bedroom of their own, they are there through the day, and at night they go to bed like anybody else in the house. If your relative calls out, needs the bathroom or wakes confused, the carer gets up, sorts it out and goes back to bed. That is included in the weekly rate.

What is not included is a night the carer spends awake. A live-in week is priced on the assumption that the carer sleeps in the house most nights, and once that stops being true the arrangement has to change.

24-hour carers, in the sense of somebody awake at every hour, are always more than one person. A search for 24-hour live-in carers can lead to either of two arrangements: a single live-in carer who sleeps at night, or a live-in carer with a second carer for the nights. Both are set out below. 24-hour care at home is the guide to every way of covering the whole day and night, including two live-in carers taking turns.

The line between a sleeping night and a waking one is a convention among carers rather than a rule anybody wrote down, and it is worth understanding before you negotiate anything. Waking night or sleeping night explains where carers draw it. For what a live-in carer's night looks like from the inside, do live-in carers stay overnight? walks through one.

Two or three ticks in the first group is a practical answer on its own. If the question in your family is whether the live-in carer could simply stay up as well, can one carer work 24 hours a day? explains why that does not last. Before acting on it, keep a short note of the nights for a fortnight: when your relative woke, what they needed, and how long it took to settle them. Two weeks of real nights settles the argument better than anyone's memory, and a night carer will ask you for it.

If most of the ticks are about confusion rather than physical need, the answer may be a change in the evening routine rather than a second carer. What is sundowning? covers why late afternoons and evenings unravel for some people with dementia, and night care for dementia covers what an overnight carer does about it.

The first arrangement is ordinary live-in care, and where the nights are quiet it is enough. One carer knows your relative and knows the house, and is there for the evening and the early morning as well as the middle of the day. The nights are covered in the sense that somebody is there and will get up. What it does not give you is somebody awake. Where a progressive condition such as MS is what has outgrown the visits, when visits stop covering the day works through the same arrangements from that starting point.

The second keeps that continuity and adds a waking night carer alongside it. The live-in carer holds the days and gets a proper night's sleep, and a second carer comes in for the nights that need somebody up. This tends to suit a household where the days are going well and only the nights have changed, and it does not have to be every night. Paying for the three hardest nights of the week is one way to start.

The third drops the live-in carer altogether. A day carer works a 13-hour shift and a night carer the remaining 11 hours, handing over twice a day, so somebody is awake and working at every hour. It suits a household with no spare bedroom, or one where the help needed is heavy enough that nobody could do it across a whole week alone. It is the most expensive of the three and it means two faces rather than one, which matters if your relative finds new people unsettling. Who provides 24-hour care at home? lists providers of each arrangement.

What makes round-the-clock cover expensive is the requirement that somebody be awake, rather than the number of hours. Buying the same 168 hours as ordinary hourly visits at £19.47 an hour would come to £3,271 a week, more than any of the arrangements above. The cost of live-in care breaks the weekly figure down, what 24-hour care costs prices each route over a month and a year, with an estimator for your own mix of nights, and how our pricing works explains what sits inside the rate.

If round-the-clock care at home is beyond what you can fund, that is an answer rather than a failure, and a nursing home is the comparison to make next. 24-hour care or a care home weighs the two for somebody who needs a person awake at night, and how to get 24-hour care funded sets out who might pay towards it.

1. 1

   Write down a fortnight of nights first

   Two weeks

   Note the time of each waking, what your relative needed and how long it took to settle them. This decides whether you are asking for a sleeping night or a waking one, and a night carer will want to see it.
2. 2

   Search for night cover as its own booking

   Free

   Overnight carers and live-in carers are searched for separately, and they may well be different people. Every carer on PrimeCarers has had an ID check, a right to work check and an enhanced DBS check issued within the last 2 years (PVG in Scotland, Access NI in Northern Ireland), and an online interview. We do not check qualifications, training or references, and the reviews and references on a profile are not verified by us, so go through these with the carer. Separately, carers are covered by the insurance we arrange for visits booked through PrimeCarers, within its terms (no clinical procedures).
3. 3

   Agree the handover and the rates in writing

   Before the first night

   Settle what time the night carer arrives and leaves, what the live-in carer hands over, and where the night carer will sit. Confirm the rate in writing too: bank holidays are charged at one and a half times the carer's normal rate and Christmas Day at twice, and travel costs are only payable if you and the carer agree them in advance in writing.
4. 4

   Review it after a month

   Week 4

   Nights change in both directions. Somebody settling after a hospital stay may need fewer of them; somebody declining will need more. Ending a live-in arrangement takes 48 hours' notice in the first week, and once 168 hours have been worked it takes a week's notice on either side.

If you have not hired a live-in carer before, how do I hire a live-in carer? covers the job description, the questions to ask and how the first fortnight normally goes, whether you are hiring one carer or two. For the rest of what overnight cover involves, overnight care is the pillar guide.