9 Signs It Might Be Time for 24-Hour Care

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

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Most older adults say they want to age in place. However, a dramatic shift toward more care may mean that 24-hour care is the only way for someone to stay at home safely. Multiple caregivers come to the home during 24-hour care to cover every hour of the day. Private duty companies tend to be most adept at arranging this particular type of care.

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Despite the additional cost and concern, 24-hour care can bring some peace of mind knowing that your loved one is being cared for at all hours. It also means managing and monitoring several caregivers.

If you are a family caregiver trying to decide if it’s time for 24-hour care, we have some suggestions on what to look for.

How to Tell if Loved One Might Need 24-Hour Care

Deciding if you need 24-hour care can be challenging. You may already have a combination of family caregivers and private duty staff providing several hours of care per day. Caregiver burnout may also necessitate the need for professional help. This patchwork of care may end up being unsustainable due to safety concerns or the inability of the family to continue to provide care.

The cost of 24-hour care can be very expensive. For families who can afford it, keeping someone in their home may be the best option, because that is what the person receiving care wants. If you’re looking for flexibility, you might be able to start with 24-hour care and make adjustments later if your loved one’s condition improves. Keep in mind, most private duty agencies do not have nursing services available. If you need nursing, you will have to arrange for that separately.

If you’re unsure of whether you need 24-hour care for your family member, here are some things to note.

1. Frequent falls

Falls can be devastating for older adults. They can lead to permanent disability, and recovery time from an injury can be long and arduous.

Older adults have falls for a variety of reasons: poor balance, muscle weakness, and dementia. Sometimes a cluttered and disorganized home with lots of stairs increases the risk of falls.

2. Confusion

Confusion can be caused by dementia, urinary tract infections, and other medical conditions. Some adults can confuse daytime and nighttime or are frequently awake in the middle of the night. Others have increased agitation at night, a condition known as “sundowning.” 

Confusion and memory problems can often occur together. Your family member may be quite frightened as they experience these symptoms, and you may also be concerned about their safety and wellbeing.

3. Illness or accident

This could be anything from a recent hospitalization to a stay in a rehabilitation facility following a hip fracture, stroke, heart attack, or other medical event. For someone to return home safely, they will likely need help with bathing, dressing, toileting, and fall prevention.  

4. Wandering

Wandering is a serious and potentially dangerous problem. People wander from their homes at all times of day or night and in all kinds of weather.

Others who are still driving can get lost and are unable to find their way home.

5. Difficulty eating or drinking

For people with dementia or neurological disorders, choking may be a concern. If you have a loved one with swallowing problems, they may be on a special diet that requires supervision throughout the meal. You may also have a loved one that needs help remembering to eat.

6. Meal preparation

Your family member may get to the point that they can’t shop or prepare food. This usually occurs with people who have dementia.

They can’t sequence the steps necessary for meal preparation and can’t do so safely. A caregiver needs to shop and prepare every meal and snack.

7. Mobility issues

It is not unusual these days for someone to be discharged home from the hospital with significant mobility issues. This might mean they are on crutches or in a wheelchair. Caregivers have to help them transfer to the toilet, get in and out of bed, and take a shower. 

8. Nighttime supervision

24-hour care is most often started because nighttime supervision is needed. This could include help getting to the toilet, calming their agitation, and trying to stop wandering. 

9. Companionship

Companionship is often an underrated and underutilized aspect of caregiving.

Although caregiver focus is usually on activities of daily living, companionship offers much-needed socialization and mental stimulation. It can help alleviate loneliness and improve mood. A good caregiver can handle periods of agitation by using distraction and redirection techniques.

ยป MORE: How do you handle your loved one's final affairs? Get your free post-loss checklist.


Tips for Finding the Best 24-Hour Care

Before jumping into finding care, it may be important to define what 24-hour care is and isn’t. Some people may confuse 24-hour care with live-in care, which are not the same.

Here are the requirements for live-in care according to the U.S. Department of Labor:

  • A caregiver must have a place to sleep for 8 hours during a 24 hour period. They are not considered to be a resident of the home.
  • The same caregiver can only be booked for four to five days in one period. Then another caregiver would need to take the other two shifts.
  • A four-hour break must be given to the caregiver during that 24 hour period. That being the case, someone needs to be available to cover the four hours when the caregiver is on break.
  • Private sleeping quarters in a homelike environment must be provided.

Some states don’t allow live-in caregivers, and in those states, people rely on 24-hour care. With 24-hour care in these states, it can be more flexible.

Some things that differ are the following:

  • Since the shifts are 12 hours or less, no breaks are required. This eliminates the need to fill in that extra four hours of care.
  • Sleeping quarters do not have to be provided. That doesn’t mean the caregiver doesn’t sleep on duty at night, but it is not a necessity.
  • There is lots of flexibility on how and when you want to schedule caregivers. As a family member of your loved one, you can decide how to best structure shifts.
  • With no sleep requirement, this allows a caregiver to actively monitor someone at night. This can be especially helpful for people who tend to sundown and are more agitated during night hours.

If you’re looking to start 24-hour care for your loved one, here are some tips for finding a good agency and managing caregivers.

Get recommendations

Talk to friends, family, and healthcare providers to get recommendations of licensed, bonded, and insured companies.

Even though you may not be hiring a geriatric care manager, you could try calling one in hopes of receiving recommendations of trusted companies they have worked with.

Interview companies

After you have selected your top three picks, interview the owner or manager. Let them know that you are considering 24-hour care and ask if they have the staffing to meet that need.

Ask for references and make sure they are licensed, bonded, and insured. Find out the cost of 24-hour care. Are there any options to help defray costs if that is an issue? If your family member has long term care insurance, will the company help you apply for that?


The more caregivers coming in during a 24-hour period, the harder it can be to manage a consistent schedule.

Multiple caregivers might also be upsetting for your loved one. Ask about the possibility of two or three caregivers to cover the 24-hours and how likely is it that you can expect the same caregivers each week? If you or your family member is unhappy with a caregiver, what is the process of having that person replaced?


If you are considering 24-hour care, you may also be looking for trained caregivers to help with multiple, complex tasks. In a 24-hour period, your family member might need help going to the bathroom, assistance with meal prep and cooking, and management of agitation.

Once the agency has a care team in place, ask about their current and ongoing training. Your family member might have care needs that require a Certified Nursing Assistant (CNA). What is the ratio of non-licensed staff to licensed staff? What are the agency requirements for ongoing training?  


Due to the high turnover of caregivers in the in-home care industry, staffing can change from week to week.

Ask about staffing levels and the availability of people to fill in during someone’s absence. How quickly can you expect a replacement if someone is unable to make their shift?


One of the most important questions you might want to consider asking is who is the person to communicate with regarding complaints or changes. Having one point of contact will simplify things. 

Some agencies have a physical book in the client’s home where caregivers can leave daily notes about what they did and any problems that have come up. Others have an online version of this same thing and family members have access to a portal. Ask about what method the company uses for caregiver documentation and how often you can view notes.

24-Hour Care Can Be a Lifeline

If your loved one wants to stay at home, 24-hour care can help make that possible. As you go through the steps of determining care and selecting an agency, approaching the situation with an attitude of flexibility will help things go more smoothly.

In-home care can feel like an unstable situation, but it is in response to evolving needs and managing the change of caregivers. 


  1. “Fact Sheet #79-B: Live-in Domestic Service Workers Under the Fair Labor Standards Act (FLSA).’ U.S. Department of Labor. www.dol.gov/agencies/whd/fact-sheets/79b-flsa-live-in-domestic-workers 

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