What’s an Overnight Caregiver? Duties, Costs & FAQs

Updated

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

Caregiving is an urgent topic due to several factors. The population is aging, people are living longer, and no national caregiver support program exists. Family caregivers are the backbone of caregiving in the US, with over 50 million unpaid caregivers providing care to a loved one. Another factor is the lack of workers filling paid caregiver positions. This puts enormous pressure on family caregivers, and many turn to caregiver agencies to help out.

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Most older adults state they want to remain at home for as long as possible. Falls, chronic medical conditions, and dementia are a few of the circumstances that, over time, require more help than you may be able to provide. Overnight care, in particular, can be a challenge for family members to offer, so they look for professional caregivers to fill that gap. 

What Is an Overnight Caregiver?

An overnight caregiver is a person who stays the night to help a client. The caregiver may need to be awake all night, or they sleep and respond as necessary to the client's needs. An overnight caregiver is usually someone different from a daytime caregiver to avoid overtime and other federal and state regulations that specify the number of hours a caregiver can work.

What Does an Overnight Caregiver Do?

First, let’s talk about what caregivers can and can’t do, whether they are overnight or not. Each state dictates the legal caregiver duties for professional caregivers. In some states, a professional caregiver can give injections, catheter care, dispense medications, etc.

In other states, caregivers can only assist with activities of daily living such as dressing, bathing, grooming, and medication reminders. These caregivers can also shop, cook and do light housekeeping. In general, these are the tasks overnight caregivers will do: if you are hiring through an agency, they will inform you upfront about whether they can meet your loved one’s overnight needs.

Preparing the client for bed

The caregiver can help the client get dressed in the morning. Part of nighttime duties could be preparing the client for bed. These duties include oral care, changing into nighttime clothes, and assisting to bed.

Dementia care

Dementia in all its forms can be a safety hazard for those who suffer from it. One common symptom is sundowning, which causes people to become agitated and confused at night. In other words, someone with dementia could be wide awake at night.

An overnight caregiver can ensure that a person with dementia doesn’t wander or otherwise become agitated. The caregiver can use distraction techniques like engaging the client in activities to keep them calm. For example, calming music, watching a movie, and sorting laundry are just a few techniques caregivers use.

Going to the bathroom

Going to the bathroom at night is dangerous due to the risk of falling. When an older person needs to urinate, they can be groggy, or perhaps they are recovering from surgery and have limited mobility. A caregiver accompanies the client to the bathroom as many times a night as needed. 

Companionship

Companionship is more than keeping someone company overnight. Nighttime can be frightening for older adults who struggle with depression, dementia, or other mental health problems. Knowing someone is there to comfort them can provide reassurance. Or, even for seniors who are suddenly alone due to the death of a spouse or partner, knowing someone is in the home at night is a relief. 

Emergencies

Emergencies can occur at any time of day or night, but your loved one may be anxious and afraid at night due to frailty or dementia. A caregiver can follow safety emergency protocols to assist the client during any crisis by calling 911.

Who Typically Hires an Overnight Caregiver?

Families typically hire an overnight caregiver when they cannot provide the needed care. Or, the family may not live in the same area, so sleeping overnight with a loved one is not possible. Some of the reasons to hire an overnight caregiver:

Post-surgery

After surgery, your loved one may have gone to skilled nursing rehab but continues to require assistance to get up at night to use the bathroom safely. Or they may also need help getting ready for bed.

Worsening dementia

Typically, people with mild cognitive impairment may do fine with minimal assistance. But if you have a loved one whose dementia is progressively worsening, safety at night can become a concern. Wandering and getting up in the middle of the night to try and cook food or leave the house could trigger the need for overnight care.

Hospice care

Most people think of hospice care as round-the-clock care at the end of life. Hospice is a tremendous support to families and their loved ones, but the patient’s needs often exceed what hospice can provide.

Unless there is an urgent crisis that calls for limited ongoing intervention to manage symptoms, hospice does not offer overnight care. Your loved one may need help with going to the bathroom or, if they are bed-bound, assistance keeping warm, drinking, and eating. An overnight caregiver can tend to these needs whenever they occur.

Chronic medical problems

Many older adults have chronic medical problems like congestive heart failure, kidney failure, neurological conditions such as multiple sclerosis, Parkinson’s, and ALS. As these diseases progress, they can cause mobility, breathing, and other issues. People might require overnight oxygen, turning during the night,  or assistance with transferring from bed and walking.

How Much Does an Overnight Caregiver Cost?

Overnight care costs depend on several factors. Overnight care can be a stand-alone service where the caregiver comes in only for nighttime care. 24-hour care is round-the-clock care where several caregivers work different shifts. Then there is live-in caregiving, where the caregiver is in the client’s home for 24-hour periods for 3-4 days at a time.

The United States Department of Labor determines the hours a caregiver can work. For example, live-in caregivers must live at the client’s home full time and spend at least 120 hours or five consecutive days for nights in the client’s home. If a caregiver comes to the house for 24-hour shifts but is not present for at least 120 hours each week, they are not considered a live-in worker.

An agency may exclude sleep time or meal breaks from the hours worked. If the caregiver is awake at night, they must be paid for the time worked. And all hours worked must comply with the Fair Labor Standards Act (FLSA ) minimum wage requirement. Overtime pay (at one and a half times the hourly rate) is required for every hour worked over 40 hours a week. Now let’s look at all the other factors that affect how much you will pay for an overnight caregiver.

Agency vs. private hire

If you contract with an agency for an overnight caregiver, you will probably pay more per hour regardless of whether it is 24-hour or live-in. According to Genworth, the national hourly median cost for homemaker services is $26.78. When you contract with a caregiver outside an agency, the two of you negotiate the price of overnight care but keep in mind payroll and liability insurance costs.

Sleep time vs. awake

The cost of overnight caregiving will also depend on whether the caregiver is sleeping most of the night or required to be awake. An agency will likely charge a flat rate for overnight if the caregiver is sleeping most of the night and only responding intermittently to the client's needs.

There is a sleep time deduction under the Fair Labor Standards Act (FLSA). The agency may exclude sleep time from an employee's hours worked hours under these conditions: 

  • The caregiver has consistently scheduled interrupted sleeping periods of up to eight hours.
  • The client must provide adequate and separate sleeping space. 
  • The employee can get at least 5 hours of uninterrupted sleep during the 8 hour time period that is being deducted.

Live-in caregivers

Live-in caregivers are exempt from overtime laws except for a few states that have their own overtime laws for live-in caregivers. A live-in caregiver can be more cost-effective since they are paid for 16 hours during 24 hours.

Location

Location significantly affects the hourly rate you will pay for caregivers. For example, according to Genworth, if you live in California, your hourly median cost will be about $32.96. In Kansas, the hourly median price is $24.72, and there will be variability within each state as well.

Caregiver credentials

A caregiver who has additional training and credentials may cost more whether they work for an agency. Some caregivers are certified nursing assistants (CNAs) or have other specialized dementia training.

How Can You Pay for an Overnight Caregiver?

Overnight care can get expensive, and the costs can soar if your loved one continues to need increasing care. Medicare does not pay for in-home care, so you will want to look at other potential funding sources.

Veteran’s benefits

There are several VA programs that can assist in paying for caregivers or reimburse a family caregiver. If your loved one is a veteran, applying for any programs you think they might be eligible for is worth it.

Medicaid

Medicaid is a federal program for low-income individuals. There could be some home services for people who have Medicaid, including overnight caregiving, that your loved one could qualify for. Most programs have waiting lists and strict criteria.

Long-term care insurance

Long-term care insurance will provide a daily cash payout depending on your policy. Many policies have a 90-day waiting period but will count caregiver hours towards the elimination period.

Savings and home equity

Savings from retirement accounts or accessing home equity could be a possibility. Meet with a financial advisor to assess these options.

How to Find a Local Overnight Caregiver

Finding a local overnight caregiver in a large metropolitan area shouldn’t be a problem. But if you live in a more rural area, you could have limited options. The reality of the caregiving industry is that there is a high turnover, so plan on being flexible since you may have to change caregivers midstream. As with choosing any caregiver, take your time and do your best to make a good selection.

Identify tasks

Knowing your loved one’s needs, personality style, and willingness to accept a caregiver will give you a solid start. It can be helpful to write down everything you expect overnight so you can get the best caregiver and have an idea of the cost.

Ask for referrals

Talk with friends and healthcare providers about agencies they recommend. Personal experience with a particular company can be valuable.

Search online

A search online should give you most of the in-home agencies in your area. Many larger franchise companies cover a wide geographical area.

Use caution when hiring outside an agency

Hiring outside an agency, either through a direct consumer to caregiver platform or a recommended neighbor, has some risks. You will be responsible for background and drug screenings, liability insurance, and replacing a sick caregiver.

Are There Any Good Alternatives to an Overnight Caregiver?

Good alternatives to an overnight caregiver depend on how much and the type of care your loved one requires. The cost and complexity of managing several caregivers can be challenging. 

Assisted living

Assisted living is the most logical alternative to an overnight caregiver. The peace of mind could be worth the move. Most assisted living communities offer round-the-clock caregiver checks and emergency call pendants.

Family

If several family members live close by, splitting overnight caregiving among several people. This arrangement works best if there is a separate bedroom for the family to sleep in. An emergency response system along with a baby monitor can help augment care.

An Overnight Caregiver for Comfort and Care

An overnight caregiver can be just the reassurance you and your loved one need. Stay flexible and accept that you may need to adjust overnight caregiving hours or choose an alternative to overnight care over time.

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