Overnight and 24-Hour Care in Brisbane: How It Works and All You Need to Know

Taking care of your aged parents is a rollercoaster; at first, you are being obliged to take care of them because you care. As days go by, you experience exhaustion, confusion and you start asking a lot of questions. Most family members consider providing care to their loved ones themselves, but over time they realise they suffer carer burnout more than ever. The constant caregiving round the clock, changing positions, catheter care, having to sleep by the bedside of the aged residents- all of these aren’t sustainable. After trying all options, they start asking the question, “Can we get an overnight worker?” This question isn’t from a place of hate or lack of love, but exhaustion.

Overnight or 24-hour care is considered one of the most expensive support-at-home services, and many people are wondering why it costs so much. This guide covers all you need to know about overnight shifts, the price cap in Brisbane, if the funding covers it adequately, and how service providers handle such services.

The four types, which are genuinely different

When you hear overnight care, it could mean different arrangements, and each of these has various price tags. You need to understand the categories of overnight care to get started.

1. Sleepover (Inactive Night): The support worker is expected to stay in the house with the patient, but can sleep. The goal is to provide coordination services when needed at midnight. At most two wake-up times. This arrangement is recommended for patients who are always settled at night and need occasional support for the bathroom, water at midnight, or assistance to fall back to sleep.

Payment is charged per night and not hourly, making it cheaper than active care. In Brisbane, sleepovers typically cost between $250 and $400 per night. The price is also dependent on the agency and the worker’s level of experience.

Clause: If the worker is called or has to assist the patient more than a few times at night, or stays awake for a longer time, payment converts to hourly rates instead of a fixed price.

2. Active Night: The worker stays awake all night. Types of services rendered for active night include repositioning, medication, toileting, or supervision of someone who wanders. Payment is charged per hour, and it typically ranges between $60 and $95 per hour depending on the provider, support worker, and type of care. This implies that a 10-hour night shift will cost $600 to $950.

Wondering about the difference between sleepover and active night? The difference is quite enormous, and the financial implication is also substantial.

24-hour care (shift-based)

24-hour care involves a patient receiving support round the clock. The aged residents usually have two to three workers rotating shifts over 24 hours. This arrangement is considered the most expensive; it costs about $1,300 to $1,450 per day. Agency fees are way above that, with a price cap of $1,800 per day. The annual cost of a 24-hour shift exceeds the budget of most support at home classification, hence it is either always a short-term arrangement or partly self-funded.

Live-in care

A live-in care worker lives alongside the aged residents. The worker is expected to be present at specific work hours, with a routine for rest and night time. Live-in care is cheaper than 24-hour care because the worker doesn’t provide care all through the day. However, the client has to provide accommodation for the worker. This is ideal for people with large spaces and whose health condition is quite stable.

When overnight care becomes necessary

Overnight care is not a luxury, yet it is highly crucial if your aged parents are not able to do things independently. While you may consider helping out, we often advise that families focus on what is sustainable. Here are a few scenarios that indicate that overnight is the next step for you.

• Falls or near-falls experience: An elderly person getting up unassisted is risky and extremely dangerous if it is in the dark. A 85years old woman with a joint or hip fracture needs support to move around the house. If there are no support, whether human or assisted technology, the person is at risk of falling while navigating the house.
• Constant disorientation in people living with dementia: The danger of an elderly person leaving the house with no form of ID, shoes, or winter jacket is risky. While sensor doors, and technological tools within the home are helpful, human supervision cannot be overemphasized.
• Night-time distress or symptoms of anxiety: Elderly people living with dementia are prone to experience increased agitation, sleep disruption, and sometimes anxiety that makes them not recognize their caregiver. This pattern often causes exhaustion for carers; especially when the aged residents continuously yell at her relatives due to fear. We explored this pattern in our guide on dementia care in Brisbane.
• Frequent toileting needs: Overnight care services also assist with toileting. Post-op care often involves catheter care because urine has to be monitored, and an exhausted spouse cannot handle such responsibilities. Whether the support worker is a home nurse or home care provider, having a professional overnight home care provider reduces risks of infection.
• Repositioning requirements: Patients with injuries, or diabetes patients at risk of developing bed sore requires frequent repositioning. Repositioning is also a clinical care treatment that promotes wound care in case of previous injuries.
• Clinical support or overnight medication: Blood pressure monitoring, timed medication, or disability support require sleepover support services.
• Carer burnout: This is the most common sign in exhausted family members. Many Australian citizens serve as the primary care giver for their aged parents. While this is great, it eventually puts a strain on their personal lives. In no time, their health deteriorates, leading to more mistakes, which may affect the aged care. Please note that we encourage allied health care; however, instead of handling the primary caregiving role, hire a care team that provides home care services.
• Post-hospital transition: Whether it is post-operative or the first few weeks after admission, the services of registered nurses are required. The first few days after leaving the hospital are a window, and the patient is at risk of any type of infection. We recommend that families undergo home modification to improve the day-to-day living of the patient.

What it costs in Brisbane: the real numbers

Take a look at the table below and understand the numbers:

Weekends and public holidays rates are often 25% to 50% more expensive than weekdays. The rate goes higher on public holidays. What does this mean for you? If your overnight care is seven nights a week, then you should consider the weekends when calculating your fees.

Hiring a worker directly costs between $40 and $65 an hour, while agency rates cost $65 to $85 an hour. The cost goes up when there is a significant change in services rendered during the 24-hour arrangement.

How funding covers it (and where it does not)

This is often the most difficult hurdle families face. Under the Support at Home program, the quarterly budget is fixed by classification. The top classification, which is Classification 8, funds $78,106 a year, with roughly $19,527 as the quarterly fee, or $17,574 after 10% is deducted from the fee.

Compare the above figures to overnight costs:

1. Sleepover, two nights a week at $300 per night: That is roughly $2,600 every quarter. The Support at Home can fund this at the mid classification.
2. Sleepover, seven nights a week at $300 per night: This costs $9,100 every quarter, and it is fundable at classification 6. However, it doesn’t give room for other expenses.
3. Active nights, seven nights a week at $750 per day: This costs about $22,750 per quarter. This budget exceeds classification 8, which is the highest. This implies active nights are expensive.
4. 24-hour care: It costs $475,000 to $650,000 a year. This is also far above any classification. However, many families who engage in this do it for short-term and are partly funded.

24-hour home care is not fundable through the Support at Home classification. Families either self-fund or partly fund this arrangement.

What the funding does cover well

Getting Support at Home in the Gold Coast area is accessible, but you need to understand their policy to effectively plan around it. The Queensland Community Support Scheme funds overnight care in these three cases:

• Intermittent sleepovers: Two or three nights to give the family caregiver an unbroken sleep. This is affordable at mid-level classifications, and is sustainable for both the funding and the family.
• Short-term intensive care: A deterioration episode of health, a relapse, post-operative care, or post-hospital transitions. Quarterly budgets can be used within a short period of time.
• Respite. This exists within the institution to relieve carers of caregiving roles. Families are entitled to respite care.

The clinical exception worth knowing

Clinical care is fully funded by the government. When the overnight care involves clinical care such as wound management, complex medication management, or any form of nursing care, it can be funded. This is worth noting and having conversations with your provider about clinical care. Moreover, putting your support in the right category can change your funding structure.

The alternatives worth trying first

Before you commit your time and money to overnight care, there are other factors that can reduce the need for overnight support.

• Occupational therapy is also clinical care, and it is free. An OT helps you identify how night-time movement may be risky and how to address it correctly. With the help of bed rails, sensor lighting and clear pathway to the bathroom, falls are minimal. Just before negotiating an overnight shift, get an OT to your home for an assessment.
• Continence review. This is also free; a consistent need for toileting at night may be an underlying health issue. Getting the symptom treated reduces waking at night.
• Medication timing review. Firstly, medication that has to be taken at midnight can be reviewed. Secondly, diuretics increase urination, using a medication before bedtime will lead to frequent toileting. The solution? Visit a GP or Pharmacist for consultation on medication review.
• Assisted technology: Motion-activated lighting, door alarms, and bed sensors can save you the cost of overnight support. For patients with risk associated with falling, alarms and sensors are effective.
• Evening routine change: Anxiety and late-night agitation can be fixed if the routines are changed. Avoid late-night stimulation, better light placement at night, having dinner early, and exploring relaxation techniques.
• Respite blocks: Many times carers do not just need a few hours of relief; they want a week, a few days, or something more tangible. This is not because they stopped caring; it is because of the continuous exhaustion. A respite can fill in this gap and provide night support.

Finally, understand that all of these do not work for everyone. In fact, they may not work for you. However, it is better to try them and assess each process before committing to an enormous budget.

How to make overnight care work well

Just before committing to an overnight routine, here are a few arrangements that make the home care program effective without falling apart.

• Understand the sleepover Vs active night classification correctly. Sleepovers and Active nights are different things. Do not make a mistake paying a support worker who only wakes two times a day the fee for an active night. Understand the health needs of your family members and ask the right questions.
• Continuity matters in overnight support. We advise clients against changing overnight support workers every week. Nobody wants to deal with rebuilding trust or relationships with a new person every week. Ensure that the overnight worker is established. This is why you should work with an experienced service provider.
• Sort out the workers’ practicalities. Does the worker have access to the bathroom? Is there a bed or the worker has to manage a sofa? Poorly set up overnight shifts lose workers quickly.
• Be specific with your expectations. Have a written note on care requirements, and what is in and out of scope of care.
• Start with a trial. Commit to two nights a week first before committing to seven. Your family and the workers need to adjust and grow warmth to each other.
• Build a small pool of support workers. While we encourage continuity, having a pool of local care teams who know the household is helpful. Overnight workers are difficult to find on short notice, even with a search service.

When home is no longer the right answer

What happens when you have tried all options, yet nothing is working? This section is such an honest one, we do not want you to get exhausted spending so much without getting value.

When you get to the point where your 24-hour costs more than you budget, you need to go back to the drawing board. This doesn’t mean the home care program has failed your loved one, it just simply means it is unsustainable for you. With intensive home care, Brisbane families can extend independent living for older Australians who need palliative care. With intensive home care, community care services and social clubs are guaranteed. These intensive homes have registered nurses and specialist care services. They can provide safe, and quality care without costing a fortune. If you are considering this option, we have a guide on Aged Care Services in Brisbane, it covers the topic indepth.

The bottom line

Overnight care comes in four categories, and each has its own costs:

• Sleepovers at the cost of $250 to $400 a night
• Active nights is typically between $60 to $950
• 24-hour care is roughly $1,300 as starting fee, while agencies charge $1,800 per day.

Support at Home providers funds, if you have two or three sleepovers a week, a mid-level classification can fund that. However, the Queensland Community Support Scheme does not fund 24-hour care. Before committing to any of these forms, ensure an OT home assessment, medication timing review and continence review is done.

Overnight support becomes effective when there is a clear expectation from your end, proper arrangement for the staff and pool of workers who can cover when a support worker is unavailable.

If you have been the primary caregiver, and you are suffering from burnout, this is a conversation you should have now. Call us 1300 671 931 or see how we support families with overnight care in Brisbane.

Have any questions? We will answer them at no cost.

Getting the funding conversation right

Now that you understand the value of overnight support, the next focus on funding. How does it get funded? Who pays the largest chunk of money?

Start by documenting your nights before requesting funds. You are expected to have at least two weeks of overnight support. The log should entail information like:

• How many hours of sleep does the patient take per night?
• Assistance received during the night: Disability support, home care, dementia care at night or nursing care in the midnight.
• Personal care in the morning or any home maintenance service.

All of this information is evidence as the assessor can act on to prove that your claims are true.

State the family’s impact. While you have a local care team, sometimes family members still provide independent services. For example, “My wife sleeps by the bedside to provide dementia care support”. Many family members offer clinical support services, but it is often invisible because it is never mentioned. Whatever is not presented cannot be funded.

Get clinical documentation. The Australian Government is strict and it is advised that you have a GP letter describing the exact condition of the patient to back up your claim. For example, a letter that details night-time falls, dementia symptoms or the next for constant blood pressure or sugar monitoring. Clinical evidence is far more important than an attendance monitoring system or persuasive word of mouth.

Request a reassessment if circumstances have changed. When an elderly person starts My Aged Care, no one expects that an overnight will be needed one day. However, when the need arises, a reassessment through My Aged Care is routine.

Ask questions about respite funding. Respite care is underused because many people do not know the benefits it entails. With respite, care coordinators can get relief, and support can be funded even if it is provided by family members.

What good overnight care actually looks like

Before you invest in overnight care, there are a few factors that make the arrangements work effectively.

• Do not let a new worker handle an overnight shift. We recommend that you allow the support worker to get familiar with the aged resident during the day so the work relationship can be seamless at night.
• A written handover note is important. A handover note should have information such as evening routine, bath time, sleep time, timed medication, urine monitoring, catheter care, and when to call family members or an ambulance. In most cases, overnight workers work without supervision, and detailed information provides enough clarity.
• Support workers setup. Your support workers need a room to sleep, clean up and tidy up. Dedicate a space in the house for them to use.
• Start with a short time, then go for extended periods later. Start with two or three nights so your family can warm up to them. Both the support worker and the aged person need time to warm up to each other.
• Plan for absence. Your overnight worker can go on leave or miss a few days of different circumstances, and have a plan with the agency to have someone cover for the worker.

Frequently asked questions

What is the difference between a sleepover support and an active night?

A sleepover is a situation where the support worker comes to the home to sleep, and is woken for two or three care management. During an active night, the worker stays awake all through the night, monitoring patients and rendering clinical support. The price difference is roughly threefold, so understanding each category and what you need every night is important.

Does an overnight worker need their room?

Yes. You are expected to provide a bedroom and access to a bathroom. It is part of the policy to set up a sleep area for overnight workers. Many support workers are poorly treated, and this has affected their work efficiency.

Can Support at Home fund 24-hour care?

Currently, there are no classifications for 24-hour home care services. While the Australian government prioritises the health of older Australian citizens, the cost of running 24-hour care exceeds the NDIA budget. Continuous home care costs $475,000 to $650,000 a year, while Classification 8 costs $78,106.

24-hour care can be funded for a short-term period, in case of surgery, post admission experience, fracture, or bone-related issues. It can also be funded partly by the family, as the government doesn’t provide funding for such.

Is overnight care cheaper than residential aged care?

Occasional overnight support is cheaper, albeit a consistent 24-hour shift is expensive. Residential care provided by an in-house nurse is safe and less expensive than continuous 24-hour care. The goal is to understand your care needs and weigh your options.

Will my parents accept a stranger in their house overnight?

Having a stranger come for a sleepover may be difficult, which is why we recommend introducing the worker during the day, while the support worker renders services for a few days during day time. As soon as both parties get to know each other, overnights are usually easier.

Can I use respite care instead of overnight care?

Respite support is better and less expensive compared to overnight services. The Scheme funds respite specifically to relieve families of their care giving roles, yet it is so underused.

What happens where there is a medical emergency at night?

What happens during an emergency should be documented as soon as you hire a support worker. Emergency number for families, when to call an ambulance, and emergency response, if any. Overnight workers are professionals who provide support without supervision; however, they need to have a laid-down care process.

Do overnight rates surge during weekends?

Yes. The weekend and public holiday surge also applies to overnight services. Payment increases by 25 to 50 percent during weekends. If you need overnight service 7 days a week, factor in the weekend cost because the rates are not the same every day of the week.

Is there any technology that can alternate the need for overnight care?

Yes, assistive technology like bed sensors, door alarms, and motion-activated lighting can reduce the risk of fall. This equipment can be funded by the Assistive Technology and Home Modifications stream. However, if the patient needs active monitoring for blood pressure or blood sugar, meal preparation early in the morning, or recurrent disorientation that happens at midnight, then a home care package is necessary.