Waking night or sleeping night? The rule of thumb

The convention has two halves and you only need one of them to be true. Three or more wakings makes it a waking night because the getting back to sleep is what wrecks a night, not the waking itself: a carer up at midnight, two and four is awake in every meaningful sense by dawn. And a single waking that runs past twenty minutes makes it a waking night because at that length it is a piece of care, not a check. Helping someone to the commode, changing a bed, turning somebody who cannot turn themselves, or talking a frightened person back to bed all take longer than twenty minutes once you count the settling.

Both halves are about the same thing. A sleeping night is priced on the assumption that the carer gets a broadly normal night's sleep in your house and is available if something happens. When that assumption stops being true, the price stops being right, and the carer either asks to move to the waking rate or stops taking the booking. Getting this straight before the first shift is better for everyone.

Families sometimes assume a waking night means constant activity, and it does not. Much of a waking night is a carer sitting with a book and a soft light, getting up to look every hour or so, and that watching is what you are paying for. If your mother gets out of bed at 3am and is on the landing before anyone hears her, a sleeping carer arrives after the fall and a waking carer arrives before it. Do night carers sleep? goes through what each kind of carer does with the quiet hours.

Three sleeping nights a week is £390 to £435, or about £1,690 to £1,885 a month. The same three nights awake is £450 to £480 a week. The gap of £45 to £60 a week is roughly what a fourth sleeping night would cost, which is the trade families most often face: one more night with someone in the house, or the same three nights with someone awake.

The opposite case matters just as much. If your father is up once for the toilet and back asleep in five minutes, and the reason you want somebody there is that he fell in March and neither of you has slept properly since, that is a sleeping night. So is a stretch of nights after a hospital discharge while confidence comes back, and so is the very common case of a person who needs nothing in particular and is frightened alone in the house. Short-term night care after hospital covers the first sort, and overnight care so the family carer can sleep the second.

1. 1

   Put a sheet of paper by the bed

   Tonight

   Six columns: the date, the time they went to bed, each time they woke, how long you were up, what they needed, and how you slept. Keep it on paper by the bed, rather than on a phone you have to unlock at 2am.
2. 2

   Write the clock time, not the feeling

   Every night

   Note 1.15am and 1.40am rather than "twice, for a while". Length is the number that decides the kind of night, and it is the number people misjudge most. If you are up more than twenty minutes, say so plainly.
3. 3

   Keep it for fourteen nights

   Two weeks

   One week is not enough, because a single bad week can happen to anybody. Two weeks shows you whether the bad nights cluster, whether they follow a difficult day, and whether the weekend is different from the week.
4. 4

   Show it to the GP as well as the carer

   Week 3

   A pattern of night waking sometimes has a medical cause: a urine infection, pain, a diuretic taken too late in the day, sleep apnoea, or medication that is due a review. A fortnight of dated entries is exactly what a GP needs. Some families find the nights improve before they book anything.
5. 5

   Send the summary to two or three carers

   Week 3

   Send a summary rather than the whole diary. Three lines will do: usually up twice, about ten minutes each, and worse on the nights she has been out. A carer can price from that, and it is the fastest way to a proper quote rather than a guess.

The diary is also the thing that stops a disagreement six weeks in. If a carer arrives expecting a sleeping night and is up four times, they are within their rights to ask to move to the waking rate, and you have no way to say whether the night was typical. With a diary you both do. Keep it going for the first fortnight of care as well; the carer will usually keep their own notes, and the two together tell you whether to step up, step down, or leave it alone.

Nights change, and usually in one direction. Dementia gets worse, a chest infection turns a quiet fortnight into a hard one, and a new tablet can move everything around. Build the review in rather than waiting for somebody to complain: a short conversation every couple of months about what the nights are like, with the diary in front of you. If the nights are getting steadily busier and you are already booking most nights of the week, look at seven nights a week and what a rota costs, and at live-in care, which from £1,050 a week covers the days too and includes one or two disturbances a night.