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

The case studies in this toolkit involve fictitious victims and represent a collection of facts identified from multiple investigations and are used for illustrative purposes only.

CASE 1: Inattention to a resident’s acute medical need and a seizure in progress

A case of staff complicity and failure to communicate with the administrator on-duty, willful sleeping due to illness + co-worker sympathy or detachment.

Joseph works the day shift at a community residence for individuals with developmental disabilities. He observed co-worker Jessica lying on the living room couch, facing away from view of resident Sierra who was sitting in her wheelchair quietly watching television. Joseph proceeded to the kitchen to start making breakfast without advising Jessica because he knew that she did not feel well. While in the kitchen, Joseph heard a loud noise coming from the living room and rushed to see what was going on. He found Jessica fast asleep as Sierra was having a grand-mal seizure. Jessica failed to adhere to Sierra’s safety plan for her seizure disorder, which includes continuous one-to-one monitoring. Staff must also notify 9-1-1 if a seizure lasts more than four minutes or if Sierra turns blue.

Joseph quickly responded by observing Sierra’s airway and coloring and timed the length of her seizure. He stayed with Sierra until after the seizure was over and she appeared to be okay. He then documented the incident and notified the nurse before heading back to the kitchen.

About mid-morning, Jessica told Joseph that she was very sick and went home early. Joseph worked alone until another staff member arrived a half-hour later. Neither Joseph, nor Jessica reported to the administrator-on-duty that Jessica was unfit for duty all morning due to illness or that she needed to leave early.


*Additional case studies are available in the Dangers of Caregiver Fatigue Article included in the Toolkit below.

What You Can Do

Provider Agencies Staff Individuals, Self-Advocates
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 spot checks. 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.
Establish emergency contingency plans to address the occasional need to relieve staff found to be unfit for duty. 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 provider residences 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.
Identify and plan for addressing risk of staff accidentally sleeping on the job. Implement policies that assess and plan for identifiable risks of staff accidentally falling asleep 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. Don’t commit willful acts of sleeping on the job and don’t be complicit in a coworker’s authorized 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.
Encourage, teach and support persons receiving services to respond appropriately to emergencies and other unsafe conditions. Implement policies to direct treatment teams or other circles of support to assist each resident to develop Personal Safety Plans, which include instruction on how to call for help if a caregiver is unresponsive to immediate needs   Get involved. Ask provider agencies to provide you with copies of policies and procedures that are in place to deter and detect both willful and accidental sleeping on the job.


Toolkit Resources

Dangers of Caregiver Fatigue Toolkit Resources