Ask anyone caring for a parent at home what finally became unsustainable and they will usually say the nights.
Days can be managed. You can work around them, share them, get through them. Six months of broken sleep is what ends people, and it is the point at which most families conclude that residential care is the only remaining option.
Often it is not, and the reason families do not know that is simply that nobody tells them.
What night sitting is
Overnight care in the person’s own home. Depending on need it might be a waking night, where a carer stays awake and provides support through the night, or a sleeping night, where a carer sleeps in the house and is available if needed.
It exists to cover night-time needs: help to the toilet, repositioning, medication, reassurance and the risk management that comes with dementia and night-time wandering.
Why families never hear about it
There is no conspiracy here, but there is a pattern. Assessments tend to focus on daytime tasks: washing, dressing, meals, medication. If the assessment does not ask about nights, night needs do not get recorded, and support nobody records is support nobody funds.
Meanwhile the family carer treats their own broken sleep as a personal problem rather than an unmet care need, so they do not raise it either. Both sides of the conversation quietly leave it out.
How to ask
Two separate routes, and it is worth using both.
A care needs assessment for the person being cared for. Anyone who appears to need care and support is entitled to one under the Care Act 2014, regardless of their finances. Contact adult social care at the council and request it. Say explicitly that you are asking for night-time needs to be assessed.
A useful form of words: “I am requesting an assessment of care and support needs under the Care Act 2014, and I want night-time needs specifically included in that assessment.”
A carer’s assessment for you. This is the route families most often miss. If you provide regular care, you have your own right to an assessment of your needs as a carer, entirely separately, and again regardless of your finances or the person’s.
A carer’s assessment looks at the effect caring has on your health, your work, your sleep and your ability to keep going. Night support can be funded as a result of it. If you are up three times a night, say so in those terms rather than saying you are managing.
What happens at the assessment
The council assesses needs first and money second. The needs assessment establishes what support is required. A separate financial assessment then determines what, if anything, the person contributes.
Eligibility turns on whether the needs arise from a physical or mental impairment, whether they prevent the person achieving specified outcomes and whether there is a significant impact on wellbeing. Night-time needs can meet that test comfortably when they are properly recorded.
Keep a diary for a fortnight before the assessment. How many times a night, what was needed, how long it took, what happened on the bad nights. Assessors work from evidence, and a diary is far more persuasive than a general account of being tired.
If the answer is no
Ask for the decision in writing with reasons, and ask what would need to change for the answer to be different. Councils must have a complaints procedure, and you can escalate to the Local Government and Social Care Ombudsman if it is not resolved.
Age UK and Carers UK both offer free advice and have seen every version of this. A phone call to either before you accept a refusal is worth the time.
The wider point
Residential care frequently arrives as a default rather than a decision, chosen because the family has run out of capacity rather than because it is what anyone wanted. Support at home costs the state less and is usually what the person would have chosen if asked.
Which is a reason to have the conversation about care preferences early, while the person can say what they want rather than having it decided for them at three in the morning.
If you are not in England
Care funding is devolved and the differences are substantial rather than cosmetic. Scotland provides free personal and nursing care as flat weekly payments regardless of income or assets, and its capital limits are more generous than England’s. Wales uses a single capital limit and caps the weekly charge for care at home. Northern Ireland runs its care system through Health and Social Care Trusts rather than councils. Everything below describes England. If you are elsewhere, start with Care Information Scotland, the Welsh Government social care pages or nidirect, because the thresholds quoted here will not apply to you.
Where FamilySafe fits
Care assessments involve a lot of paperwork and usually one exhausted person holding all of it. FamilySafe keeps the assessments, care plans, contact names and your own diary notes in one place, shared with the rest of the family, so requesting a review does not mean starting the evidence from scratch.
Sources
- Care Act 2014, sections 9 and 10 on needs assessments and carer’s assessments
- Care and support statutory guidance, chapter 6 on assessment and eligibility
- Carers UK and Age UK guidance on carer’s assessments
This is general information about how care assessments work, not medical or care advice. Contact your local council’s adult social care team about your own circumstances.
