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Roots And Wings Tip of The Day!

By Roots and Wings | Aug 21, 2014

Caregiver? Consider a break! Everyone needs to get away, or take a break sometimes. There is no need to feel guilty.

Respite Care allows you the break you so badly need. Take a look at our checklist to make sure you have everything covered.

If you have aging parents, or are the caregiver, give me a call. I'd love to help you.

 

Susan Hayward
Your Eldercare Coach
Roots and Wings Eldercare Coaching
815-313-5738 (hm)      917-613-9903 (cell)
www.YourRootsandWings.com

 

 

 

RESPITE CAREGIVER CHECKLIST

Patient Name _______________________________________________________________

I will be away from ____________________________to_____________________________

Location________________________________________ Phone _____________________

Diseases / ailments patient suffers from__________________________________________

__________________________________________________________________________

Symptoms _________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Allergies ___________________________________________________________________

 

DOCTORS, MEDICAL CARE AND EMERGENCY CONTACTS

Primary care doctor __________________________________________________________

Phone _______________________ Location______________________________________

Specialist doctor ____________________________________________________________

Phone _______________________ Location _____________________________________

Nearest hospital ____________________________________________________________

Phone _______________________ Location _____________________________________

Medical Insurance ___________________________________________________________

FRIENDS AND RELATIVES TO CONTACT IN AN EMERGENCY

1.  Name/Address_______________________________________Phone_______________

2.  Name/Address_______________________________________Phone_______________

3.  Name/Address_______________________________________Phone_______________

4.  Name/Address_______________________________________Phone_______________

MEDICATIONS

Medication Name

Dose

Time to Give

Special Instructions

APPOINTMENTS (doctor's office, physical therapy, beauty/barber, visit friends, activities, etc. Include date, time, location, contact name, phone number)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

ABOUT THE PATIENT

Patient's general emotional state (shy, weepy, sudden outbursts) ______________________

__________________________________________________________________________

Favorite distractions _________________________________________________________

Dislikes____________________________________________________________________

PATIENT MOBILITY (circle those that apply)

Moves around unassisted                          Needs assistance transferring from/to chair

Requires lift----wheelchair----walker         Bedbound

Special moving instructions _____________________________________________

___________________________________________________________________

Physical Therapies/ Exercises Needed ___________________________________________

__________________________________________________________________________

TOILETING (circle those that apply)

Unassisted                Catheter                     Colostomy

Bedside commode   Bedpan                      Incontinent pads/diapers

Special instructions _____________________________________________________

_____________________________________________________________________

SLEEP

Bed time _________________ Wake time __________________ Nap __________________

MEALS (circle all that apply)

Eats unassisted                   Needs feeding assistance                                     Needs to be fed

Has difficulty swallowing   Eats soft foods only                                     Tube feeding

Breakfast time ________________________ Lunch time ____________________________

Dinner time ___________________________Snacks _______________________________

Food allergies ______________________________________________________________

Special eating instructions _____________________________________________________

__________________________________________________________________________

ENTERTAINMENT

Patient enjoys (circle all that apply)

TV                   Radio                         Reading                     Being Read to                      Cards

Other ________________________________________________________________

Avoid ________________________________________________________________