When does someone with dementia need 24 hour care? Usually in the later middle or late stage, when they can no longer be left alone safely for any length of time: they need help day and night, are up and about at night, cannot call for help, or are at risk of serious harm when no one is there. There is no fixed point, and some people need round-the-clock support earlier because of falls, distress or other health problems.
This guide explains how dementia usually progresses, the signs that 24-hour care is needed, the realistic options in West Sussex and what they cost, and when NHS funding may apply.
In short: watch for night-time needs, safety risks and carer exhaustion rather than a particular stage. Options include live-in care, overnight care added to daytime visits, or a care home.
What are the stages of dementia?
The Alzheimer’s Society describes dementia in three broad stages: early, middle and late. It stresses that these are only a guide. Symptoms appear in different orders for different people, stages overlap, and some changes come and go.
| Stage | What it often looks like | Typical support |
|---|---|---|
| Early (mild) | Memory lapses, losing track of time, difficulty with finances or planning; still manages most things independently | Reminders, occasional help, planning ahead, technology |
| Middle (moderate) | More confusion, needing help with washing, dressing and the toilet; changes in behaviour and sleep; may walk about or get lost | Daily care visits, rising to several a day; respite for family carers; overnight help may start |
| Late (severe) | Needs help with most everyday tasks, including eating, drinking and moving; communication much reduced; may be in bed or a chair much of the day | Constant care, often from professional carers; 24-hour care at home or in a care home |
You may also see seven-stage scales, such as the Global Deterioration Scale, which break the same progression into smaller steps. They are used by some professionals and on many websites. Whichever scale is used, what matters for care planning is what the person needs now.
For more on the progression, see the Alzheimer’s Society’s page on the stages of dementia, and our guide to early signs of dementia.
When does someone with dementia need 24 hour care? The signs
These are the signs that care visits during the day are no longer enough:
- Night-time needs: getting up repeatedly, walking about, trying to leave the house, or needing the toilet with help during the night. See our guide to dementia and walking about at night.
- Falls or being found on the floor, especially if they cannot use an alarm.
- Not recognising danger, such as leaving the cooker on, going out in the cold without a coat, or letting strangers in.
- Distress when alone, including anxiety, calling out or sundowning in the late afternoon and evening.
- Help needed at unpredictable times, for continence, repositioning or reassurance, rather than at set visit times.
- Swallowing or eating difficulties that need supervision at every meal.
- A family carer who is exhausted, or who is being woken every night. This on its own is a valid reason to increase care.
If several of these apply, ask West Sussex County Council for a review of care needs. If your relative already has a care package, ask for a reassessment rather than waiting for the annual review.
What are the options for 24 hour dementia care?
Live-in care
A carer lives in the person’s home, usually working in rotation with a second carer. They provide help through the day and are there at night, with agreed breaks and sleep. Live-in care keeps the person in familiar surroundings, which often reduces distress in dementia. It needs a spare bedroom for the carer. Our guides to live-in care in West Sussex and live-in care versus a care home cover the details.
Daytime visits plus overnight care
Some families combine daytime visits with a carer overnight. A sleeping night carer is there in case they are needed and can be woken occasionally. A waking night carer stays awake and is the right choice if the person is up several times a night. Read more in our guide to overnight care at home.
A care home or nursing home
A care home provides staff around the clock. A nursing home also has registered nurses on duty, which matters when someone has complex health needs. Some homes specialise in dementia. A move can be the right choice when needs cannot be met safely at home, or when the person would benefit from company and a more structured environment.
How much does 24 hour dementia care cost?
These are indicative figures for West Sussex in 2026. Prices vary between providers, and dementia care may cost more when needs are complex.
| Type of care | Typical cost | Best for |
|---|---|---|
| Visiting care | £28 to £38 an hour | Help at set times; not 24-hour cover on its own |
| Sleeping night | £210 to £260 a night | Someone who needs help occasionally at night |
| Waking night | Higher than a sleeping night | Someone who is up several times a night |
| Live-in care | £1,400 to £1,700 or more a week | Round-the-clock support at home |
| Care home or nursing home | Varies by home and level of need | When needs cannot be met safely at home |
Visiting care alone becomes very expensive if it has to cover most of the day, which is why live-in care is often better value at the 24-hour stage. See our home care costs guide for more detail.
Who pays?
If your relative has savings above £23,250, they will usually pay for their own care. Below that, the council may contribute after a financial assessment. For care at home, the value of their home is not counted. For a care home, it usually is, unless a partner or certain relatives still live there. Attendance Allowance at the higher rate of £114.60 a week is paid to people who need help both day and night, and is not means-tested. Our funding checker gives a quick view of what may be available.
Can the NHS pay for 24 hour dementia care?
Possibly. NHS Continuing Healthcare (CHC) pays the full cost of care, at home or in a care home, for people whose needs are mainly health needs. It is not means-tested. A diagnosis of dementia does not qualify someone on its own, but the needs dementia causes can, particularly in the late stage: severe behavioural needs, significant difficulties with eating and swallowing, continence, skin integrity and mobility.
Eligibility starts with a checklist and, if that is positive, a full assessment using the Decision Support Tool, which looks at 12 care domains including cognition, behaviour and psychological needs. In Sussex, the decision is made by NHS Surrey and Sussex, following the national framework for NHS Continuing Healthcare. Ask for a checklist whenever needs increase significantly. Our guides to Continuing Healthcare and dementia and NHS Continuing Healthcare at home explain how to prepare.
If someone lives in a nursing home and does not qualify for CHC, they may still get NHS-funded nursing care, a contribution paid directly to the home towards nursing costs.
Making the decision
If your relative can still take part in the decision, involve them as much as possible. If they lack the capacity to decide where they live or what care they receive, the decision must be made in their best interests under the Mental Capacity Act, and must take account of what they would have wanted. Anyone holding a health and welfare lasting power of attorney can make that decision for them. Our guide to when it is time for a care home may help if you are weighing up a move.
Find care near you
Tell us your postcode and what you need help with. We pass your details to one vetted CQC-registered agency in your area — you are told who they are, and that they pay us a fee, before anything is sent.
Frequently asked questions
At what stage of dementia is 24-hour care needed?
Most people need 24-hour care in the late stage, and some in the later middle stage. The trigger is usually night-time needs or safety risks rather than a particular stage, so focus on what the person needs now.
Is live-in care cheaper than a care home for dementia?
It can be similar, and for couples it may be cheaper because one live-in carer can support both. Live-in care in West Sussex typically costs £1,400 to £1,700 or more a week, while care home fees vary widely by home and level of need.
Does dementia qualify for NHS Continuing Healthcare?
Not automatically. Eligibility depends on whether the person has a primary health need, assessed across 12 care domains. People in the late stage with complex behaviour, eating or mobility needs are more likely to qualify.
Can someone with late-stage dementia stay at home?
Yes, with the right support. Live-in care, or a combination of daytime visits and waking nights, allows many people to stay at home, sometimes until the end of life, with support from the GP and community nurses.
What is the difference between a sleeping night and a waking night?
A sleeping night carer sleeps in the home and helps if needed, usually no more than once or twice. A waking night carer stays awake all night and is needed when the person is up frequently or needs regular turning or toileting.
The Care Panel is an independent publication. We are not a care provider and are not regulated by the Care Quality Commission, because we do not deliver care. Always check a provider’s own CQC registration and inspection report before you commit.
Written and fact-checked by The Care Panel. Last updated September 2026. Sources: Alzheimer’s Society (stages of dementia), NHS England National Framework for NHS Continuing Healthcare, NHS guidance on the Mental Capacity Act, West Sussex County Council adult social care, GOV.UK Attendance Allowance guidance. General information, not financial, legal or medical advice — figures are indicative and subject to change.