Apart from reading, singing, and plodding up muddy trails, Grace enjoys scribbling notes and thinking up a storm. She is particularly interested in community support for the special needs population, and learning and education.

With age comes unexpected changes, one of which is changes in sleep. In a local study surveying the well-being of the elderly, about 13 per cent of the participants aged 60 years and above reported having difficulties with sleep.

Some of these difficulties were related to physical and medical conditions. These findings imply that night care may be an option at the top of your mind when thinking about caring for your loved one. However, when should you consider night care for your loved one, and what can you expect from it? 

How does ageing affect sleep for the elderly? 

Everyone ages differently. It is a myth that the elderly require less sleep. They have the same sleep needs as younger adults, with seven to eight hours being ideal. While some elderly continue to sleep well, some experience more sleepless nights and a poorer quality of sleep. Why is this so?

1. Bodily changes

As a person ages, their sleep cycle changes, making them wake up earlier and also get tired earlier before bedtime. Older adults experience more time in light sleep rather than in deep sleep, the latter being the kind of sleep which is important to feel rested.

2. Wakeful nights and more tiredness during the day

The elderly wake up in the middle of the night more frequently due to the changes in their body. This results in fragmented and poor sleep. 

As a result, older people tend to take naps during the day. While short naps can be refreshing, extended long naps can further worsen sleep quality at night.

3. Increased nighttime urination

The frequency of nighttime urination increases with age due to physical changes in the urinary system. This phenomenon may affect up to 80 per cent of older adults.

4. Insomnia 

All of the above factors may culminate in insomnia. Having persistent difficulty in falling or staying asleep is one of the most common sleep issues in older adults. Insomnia may be caused by a variety of overlapping factors but can get better with treatment.

Plus, there are certain health conditions that can cause disrupted sleep, such as dementia. Seniors with sleep problems were also reportedly more likely to have a range of chronic physical conditions and/or disabilities.

Getting the right type of night care

Some of our services include:

• Wound Care
• Stoma Bag Care
• Dementia Care
• Feeding Tube Care

When might your loved one need night care?

Sleep difficulties can be a part of the regular ageing process, but it also can be a result of specific health conditions. When is night care needed for your loved one? You would have to consider your loved one's physical status and overall health condition before making the decision.

1. If they are at high risk of falling

If your loved one is at a higher risk of falling, having an extra pair of hands to help out at night can prove to be vital. With decreased visibility at night, it is easier to trip over loose wires or furniture. Seniors who are at a higher risk of falls are those who have poor vision, take medication which has side effects, and are not physically active to name a few. If your loved one falls down, chances are you may not be sure how to assist them back up, and a professional would be able to guide you or assist accordingly.

2. Incontinence issues

Incontinence is when someone experiences uncontrolled urinary or faecal leakage. This will result in the person getting up more often to use the bathroom, or needing to change clothes more often. For an elderly person to repeatedly get up and get out of their clothes could pose the possibility of falling down, especially if they are rushing to the washroom and are doing so alone.

Moreover, as a caregiver, you can get tired from having to constantly change bedsheets and wash soiled clothes. This is when having a dedicated carer to help your loved one with such tasks may prove handy. 

3. Dementia and sundowning behaviour

Dementia is the gradual deterioration of memory and function, which tends to affect the elderly. With dementia, people will experience changes such as disorientation, personality and behaviour changes, and forgetting where they have placed things.

At night, they may not be able to find the bathroom and may require help in getting items around the house as they may not remember where they are placed. 

Sundowning is typically associated with dementia, and it refers to increased confusion, fatigue, agitation, and restlessness after sundown. It can be challenging for you to deal with sundowning behaviour on a daily basis, and that is where night caregivers come in. 

4. Palliative care or cancer care supervision 

Round-the-clock care is required for patients who are on palliative care and can be beneficial for those on cancer treatments. They may require medication to be administered in the late hours of the night, or someone to be up to monitor their condition for any changes which require immediate response. Having someone on stand-by and available to monitor your loved one can give you peace of mind especially if you have other matters about the house to manage.

What can Homage Care Professionals help with at night?

Regular night care

These include caring for the person's activities of daily living, such as toileting and bathing them before your loved one goes to sleep. During the night, our Care Pros are able to assist your loved one with anything they need, whether it is helping them head to the washroom, diaper changes, or accompanying them if they are unable to fall asleep.

Costs start at $21 per hour. 

Specialised care

These can include monitoring vitals, administering medication, and any procedure which requires a medical professional to do. Costs start at $24 per hour.

How much does night care for the elderly cost? 

Let us use two scenarios to consider the cost breakdown. 

Scenario 1: Hiring a professional night caregiver for supervision and basic care needs

Mr Ng, a 55-year-old man, has just had a stroke. While his case of stroke is not severe and he is undergoing regular physical rehabilitation at the hospital, he needs crutches or a wheelchair to get around in the meantime. The doctor has mentioned that he would likely need about four to six months to recover and regain his strength. His family is considering getting help in the meantime as he recuperates.

Since Mr Ng's wife, Mdm Ng, is a housewife, it was agreed that she could take care of him during the day. The family has decided to engage part-time help for household chores at the moment. Suzie, Mr Ng's daughter, will help to cook meals as well.

For the night, they are uncertain whether to hire a helper or to look into part-time caregiving options, bearing in mind Mr Ng's lengthy recovery period. They do not want to commit to hiring a full-time helper as they may not need one after Mr Ng has recuperated. They are also hesitant to sign up for a long caregiving package due to the commitment. 

The family looks through the package options at Homage and decides on a Care Relief 40-hour package with a caregiver, to try out part-time caregiving as a start. The package costs $860, which amounts to a base rate of $21.50 an hour. As the Ng family is engaging night care services, there is an additional cost of $1 an hour.

Suzie typically sleeps at 11pm, so she will help out until 11pm. Our Care Pro will step in to care for her father from 11pm to 6am, helping with toileting needs, accompanying him to a commode or the washroom, or changing any soiled linen, without waking the rest of the family. This would amount to seven hours of help a night, and it will cost $22.50 x 7 = $157.50.

Their package would cover them for at least five nights of night care — just the right amount to try it out before further committing. 

Scenario 2: Hiring a professional nurse for more intensive night care

Mdm Tan, a 63-year-old housewife, lives alone with her husband Mr Tan. Their grown-up children visit them weekly on the weekends. Mr Tan has been diagnosed with Alzheimer's a while back and his condition is worsening, with frequent night wakings and behavioural changes. Recently, Mr Tan has had an illness which requires nightly administration of medicine through an IV drip.

Mdm Tan is concerned about handling Mr Tan alone at night, and is also starting to feel the brunt of caregiving and become burned out. Her children have offered to hire extra help for her to give her some downtime. Mdm Tan decides she will need help from 7pm to 9am, which gives her time to cook, sleep, and do some house chores on some of the days in the week.

Looking at the Homage packages, she thinks that hiring a professional freelance nurse who can administer night care would be most effective for her since she needs help with giving Mr Tan his medicine. She decides to go for the Care Relief package of 80 hours. Mdm Tan decides to engage help for a weekday night. Looking at the charges, there is an additional $2 hourly rate from 9pm to 6am. Her total cost for 7pm to 9am the next day would be: $24.75 x 5 + $26.75 x 9 = $364.50. 

At the end of these night care sessions-that is, in the mornings-the Care Pro would then help Mr Tan with his hygiene needs, such as brushing his teeth, showering, and shaving, before Mdm Tan resumes caring for her husband after 9am.

Depending on your loved one's situation and what type of help your family needs, you may require different options. You can with our Care Advisory team to see what will work for you and your situation. 

Alternative night care options in Singapore

Besides engaging a caregiver, there are other options available for night care, which you can take into consideration:

Nursing homes

Nursing homes are an alternative to home care and night care. At nursing homes, there is round-the-clock care provided for occupants and the staff there are trained in caring for individuals with higher medical or physical care needs. You can choose to put your loved one in a nursing home for a short period of time for respite and be at peace of mind. 

The benefit of engaging a nursing home's care service is that you will not have to arrange your schedule or make appointments for the caregiver to come down, as occupants stay in nursing homes for the whole day.

However, given the high costs of care-which can soar to above $2,000 per month-nursing homes may not be optimal if you are able to care for your loved one intermittently or during the day, or wish to spend time with them at home.

Domestic helpers 

A trained domestic helper can be an option for night caregiving as well. You can equip your helper with the know-how by sending them for caregiving courses suited to the profile she is caring for, such as caregiving for dementia. However, you will have to consider the time taken to hire a suitable candidate and to train them as well-not to mention the costs of doing so.

You can hire a helper starting from $570 a month, bearing in mind there will be additional costs in terms of time and money in training them. 

Do you need to modify your home environment for your loved one?

This is an option if you feel that your loved one is in good health, is fairly independent and able to manage themselves. Instead of hiring help, consider installing mobility equipment around the house such as safety rails or alarms. This ensures your loved one is still able to maximise their independence safely. However, this is only to be considered if your loved one is generally fit and only if a medical professional has given the go-ahead. 

Night caregiving can take a toll on your mental and physical health in the long term, especially if you are unable to find pockets of time to rest and recharge. For such instances, Homage offers night care services that can be tailored to your family and elderly loved ones' needs.

ALSO READ: Death is inevitable but chaos isn't: 10 reasons why you should write a will ASAP

This article was first published in Homage.