This client had contacted multiple agencies for in-home care. No angency wanted to take them on to their service because of the high risks involved with an ALS patient. We took the challenge because we couldn't bear the thought of an ALS patient being left alone. We had seven CNA's that covered a 24/7 case. We filled every shift with the exception of one shift which was covered by a family member. There was a couple of times that one of the CNA's called in sick. We filled it with another person. However, the client refused the fill-in which forced the CNA that was supposed to go home to stay an extra shift. Keep in mind, we had the sick person's shift covered but it was the clients decision to make the CNA work a double shift.