Night care for someone who falls or is up all night

Two of these are jobs for the GP rather than for you. Ask specifically whether any of the tablets could be making your relative dizzy on standing, and whether a water tablet could be taken earlier in the day so that the bladder fills before bedtime rather than after it. A pharmacist will do a free medicines review and is often quicker to get an appointment with. The other three are jobs for a screwdriver and an afternoon. Our guide to dealing with elderly falls covers what to do when somebody is already on the floor, and the mobility and falls care pillar covers the daytime side: strength, balance and the equipment that helps.

The one thing that is not on the list is carelessness. People do not fall at night because they were not being careful. They fall because they are doing a difficult thing in the dark, in a hurry, half asleep, at the age at which balance recovers slowly. Everything below is about removing one of those four conditions at a time.

Do the whole route in one evening rather than one item at a time. Wait until it is dark, turn everything off, and walk it the way your relative walks it: slowly, half asleep, in a hurry. You will find the two or three things that a daytime look never shows, usually a dark stretch of landing, a door that swings shut, or a rug that has been there so long nobody sees it any more. Most of the list costs less than a single night of care, and the sensor lights and a non-slip mat can be bought in an afternoon.

The harder part is often the person rather than the house. People who have lived somewhere for forty years do not want their hall rearranged, and being handed a walking frame feels like a verdict. Two things help. The first is to frame every change as being about the dark rather than about them: the lights are so nobody trips, the rail is so the corner is easier at night. The second is to change one thing at a time and leave it a week. A route that has been altered all at once is its own hazard, because the map in somebody's head no longer matches the house they are walking through at three in the morning.

Two things in that night are worth pulling out. The first is the drink at half past nine. Families often decide, on their own, to stop their relative drinking after six in the evening. That is the wrong fix: dehydration causes confusion, dizziness and falls of its own, and it makes urine infections more likely. What a carer does instead is shift the fluid earlier in the day so the total stays the same and the last drink is a small one. The second is the pace at 4am. A carer does the second trip exactly as slowly as the first, because the second trip is the one where a person is deepest asleep, least steady and most in a hurry. Ten unhurried minutes at four in the morning is most of what the job comes down to.

Most families end up with a combination: the route lit and railed for the first trip, a commode or a bottle for the small hours, and pads on the nights when they are needed. What tips it into needing a carer is not the equipment but the changing. A pad that needs changing at 3am, or a bed that needs stripping, is a two-person job in practice and it is the thing that wakes a spouse up properly and keeps them up. If that is happening most nights, read managing incontinence and bathing and toileting an elderly parent, and then look at cover for two or three nights a week rather than seven.

The last point in each column is the one to be clear about. Nobody can promise a fall-free night. What a carer changes is what happens next: somebody is there in seconds rather than in hours, they know not to haul a person up by the arms, they can check for a head injury or an obvious break, and they can call 999 and stay on the floor with them until the ambulance arrives. The long lie on a cold floor until the morning is the thing that turns a fall into a hospital admission, and it is the risk that having somebody in the house takes away.

Two of these are worth buying before anything else. Sensor night lights along the route cost a few pounds each and need no wiring, no monitoring fee and no decision from anybody. A key safe costs very little and turns a fall behind a locked front door into a ten-minute problem rather than a broken door and a long wait. Everything else on the list is worth asking the council about first, because many areas will supply and fit it at no charge, and a telecare package with a monthly fee is not always better value than the same kit bought once.

The gap in all of it is the same: an alarm brings somebody eventually, and a carer is already there. For a person who lives alone and is broadly steady, a fall detector and lit route may be the right answer and much cheaper than care. For somebody who is up three times a night, unsteady, or confused when they wake, a mat that chimes in an empty house does nothing at all. Home technology for the elderly goes through the kit in more detail, and if the falls are recent and the confidence has gone, building strength at 80 is the other half of the answer: the strength to get up off a chair is the strength that stops the next fall.

Most families who ring us after a fall book three nights a week for a month or two, not seven nights forever. Confidence is the thing that goes after a fall, and it comes back. A run of covered nights while somebody is unsteady, on new medication, or just home from hospital is often all that is needed, and then it tapers. If the fall put your relative in hospital, short-term night care after hospital covers the first few weeks back specifically, and how long is a night shift explains what you are buying by the hour. If you find you need every night, live-in care from £1,050 a week covers the days as well and usually costs less than seven separate nights. The night-time carer cost guide has the full breakdown, and the cost of care puts every option side by side.