caregiver fatigue

Protecting People With Special Needs from the Dangers of Caregiver Fatigue

Protecting People With Special Needs from the Dangers of Caregiver Fatigue


Falling asleep on the job puts caregivers at risk of making mistakes that could endanger adults and children who may require consistent and responsive attention to ensure their health and safety. The Justice Center’s 24-hour abuse and neglect hotline has received numerous reports of incidents involving staff inattention to their duties and poor decision-making resulting from sleep deprivation, workplace fatigue or sleeping during a shift.

Whether you are an individual, self-advocate, direct care provider, agency administrator, friend or family member — you have an important role to play in preventing a needless tragedy from happening. The information provided in this toolkit will help raise awareness of the serious consequences of caregiver fatigue and falling asleep on duty. It also includes simple safety practices to reduce the risks linked to this serious safety hazard. A printable copy of this toolkit can be found at the bottom of this page.

The Issue

Caregiver inattention may result in an incident that jeopardizes the safety and well-being of people receiving services.  This could include:

  • An individual’s personal care and health needs not being met;
  • Failure to prevent or de-escalate an individual’s high-risk behaviors, such as choking or elopement;
  • Inability to respond to an individual’s acute medical needs; and/or
  • Failure to respond to an emergency, such as a fire.

Case Studies

These case studies are offered for use in staff training and are loosely based on real Justice Center cases. The names of the people, settings, and other information have been changed.

Case #1

Brandon works the overnight shift as a direct support professional at an individualized residential alternative (IRA). He injured his shoulder on the job during a physical intervention and received a prescription for Lortab, a medication that is known to cause drowsiness. There was no de-briefing after the intervention so management was unaware of Brandon’s injury. Brandon’s doctor offered to write him a note to take a few days off from work but Brandon turned him down. He knew that the IRA he worked at was short staffed and was relying on him to work extra shifts. Brandon believed that there were not many staff who had the necessary training to work at the IRA or who could deal with “his guys” so he decided to power through and return to work without taking any time off. 

During his next shift, Brandon had some pain in his shoulder, so he took one Lortab.  Brandon drank extra coffee so he didn’t think he would fall asleep, even though the medication made him drowsy. 

Brandon dozed off for an hour and missed the 2 a.m. check of the people living in the IRA. When Brandon did the 3 a.m. check, he noticed Jeffrey, one of the people receiving services, was missing from his bed. Brandon searched the house and found Jeffrey outside on the front porch.   

Case Concerns:

  • There was no debriefing following the physical intervention
  • Brandon did not report his injury to the agency
  • Brandon did not practice self-care by taking the recommended time off
  • Brandon took prescription medication that could cause drowsiness
  • Brandon’s decision to “power through” and keep working despite his injury and medication put people receiving services at risk.


*Additional case studies, information and resources are available in Protecting People with Special Needs from the Dangers of Caregiver Fatigue included in the Toolkit below.

What You Can Do

Partners in Prevention

Remember: Everyone has a role in preventing and responding to dangerous caregiver fatigue.

Provider Agencies

Staff Individuals, Self-Advocates
Monitor staff assignments, overtime and staff fatigue. Implement policies that limit the amount of overtime staff are permitted to work. Ensure staff assignments are manageable and monitor employees for fatigue and burnout. Report to work fit for duty. Communicate with your supervisor and utilize appropriate strategies (including approved time-off) anytime you are unfit for duty or you are concerned about your ability to fulfill work-related expectations, especially due to exhaustion, illness or medication. Speak Up. Tell trusted staff and others anytime you find a caregiver sleeping on the job or otherwise unable to attend to your, your housemates, or your loved one’s needs.
Provide support to staff through an Employee Assistance Program (EAP). Employees may need support to address personal problems or work-related issues that are adversely affecting their work and contributing to caregiver fatigue. Identify and plan for addressing your individual risks of accidental sleeping on the job. Whenever possible, complete and comply with a formal set of personalized strategies with your supervisor, such as a Personal Action Plan to prevent accidental sleeping on the job. Know emergency phone numbers and/or program them into a phone for ease of use. Ask providers to post emergency phone numbers, make an Administrator-on- Duty’s phone number available, and make sure a working phone is available for your use in an emergency.
Deter and detect willful acts of sleeping on the job. Implement and regularly review the effectiveness of policies meant to deter and detect unauthorized willful sleeping on the job through practices such as conducting frequent, unannounced visits. Don’t commit willful acts of sleeping on the job and don’t be complicit in a co- worker’s sleeping on the job. Be aware that sleeping on the job is routinely addressed as misconduct and may also constitute neglect. Have a strategy in place and be prepared to address any co-workers unauthorized sleeping on the job. It is your responsibility to address and report unsafe conditions. Make A Personal Safety Plan for yourself or your loved one. Practice strategies including how to alert others if a caregiver is unavailable or incapacitated.
Establish emergency contingency plans to address the occasional need to relieve staff found to be unfit for duty. Contact EAP programs for assistance when experiencing compassion fatigue, burn out, or frustration.  Ask for help when you are stressed, frustrated, irritable or overwhelmed.  Get involved. Ask provider agencies to provide you with copies of policies and procedures that are in place to support staff and to deter and detect both willful and accidental sleeping on the job.
Identify and plan for addressing risk of staff accidentally sleeping on the job. Establish procedures that direct staff to develop Personal Action Plans with their supervisors, especially for staff working, non-traditional shifts or who work alone. Practice Self-Care. Get a good night’s sleep before reporting to work. Use your days off to rest, recover and recuperate.  
Teach and support people receiving services to respond to emergencies and other unsafe conditions. Implement policies to direct treatment teams or other circles of support to assist each person receiving services to develop Personal Safety Plans, which include instruction on how to call for help if a caregiver is unresponsive to immediate needs.    
Consider using a “buddy” or mentor system to provide staff with peer support. Implement a system for co-workers to monitor each other for fatigue.    
Use creative strategies: Consider identifying administrative staff who may be willing to assist with non-direct care responsibilities such as grocery shopping or cleaning in order to give breaks to front line staff.    


Toolkit Resources

Dangers of Caregiver Fatigue Toolkit Resources