A care plan will define the services and support needed to provide appropriate care. Developing a care plan is a four-step process that you can adapt to your specific circumstances.

1. List the needs for support and additional care. These will generally fall into the areas shown in the table below:
   • Housekeeping—laundry, shopping, and household paperwork
   • Social and safety needs—transportation services, companionship, and daily telephone checks
   • Nutrition—meal planning, cooking, and meal delivery
   • Health care—nursing, social work, physical and rehabilitative therapy, and medication monitoring
   • Personal care—assistance with personal hygiene, medical equipment, dressing, bathing, and exercise
2. Figure out who can devote the necessary time/attention to provide support (e.g., siblings, friends, etc.).
3. Make a list of specific help needed (e.g., laundry once a week).
4. Get specific commitments (e.g., Cousin Julius will do the shopping every Saturday). These commitments need to include, as appropriate, a statement of who, what, when, where, and how.
   

Depending on the person’s needs, the plan may simply outline a schedule for house visits by you and other family members. Or it may identify community resources that will provide additional support, including meals (e.g., Meals on Wheels), transportation services, and visiting nurses. Consider whether you or a family member may be able to handle the responsibility. In some cases, you may want to consider seeking other forms of support; nutrition or preventive health services and caregiver support services that are funded in part through the Older Americans Act and administered by the U.S. Administration on Aging. For more information about local services, contact the Eldercare Locator at 1-800-677-1116 or at www.eldercare.gov. In some cases, you may need to employ a service to supply a live-in aide(s) to provide full-time care, or consider assisted living or nursing home placement.

No doubt, you’ll need to revise the care plan as needs change. For example, you would need to adjust the plan when:

• Your loved one’s needs increase or decrease (e.g., recovery from a stroke).
• A caregiver quits or withdraws.
• Your life situation changes (divorce, birth of children or grandchildren, unemployment, retirement).
  

Organizing Documents and Paperwork
Encourage your loved one to organize important documents and medical information. Offer your help. It’s critical that this be done while your loved one is medically and mentally capable of participating in this process. For example, if he or she has specific wishes for end-of-life care, they need to be documented before they’re needed. (See Managing Your Loved One’s Affairs.)

Important Documentation
The following documents should be assembled in one place so they’re available when needed:

• Medicare card
• Social Security card
• All health insurance ID cards
• Copy of the birth certificate
• Names, phone numbers, and addresses of doctor(s). Note: If your loved one wants you to be able to discuss medical issues with a doctor, ask him or her to complete privacy release forms. Keep them on file with each doctor’s office.
• List of health conditions
• List of current medications and the name and phone number of the corresponding pharmacy and prescribing physician.
• List of allergies to food or medications
• Will, Living Will, and Powers of Attorney: ask if you may make copies to retain. If these documents don’t exist, encourage your loved one to prepare them. (See Managing Your Loved One’s Affairs.). If you’re reluctant to do so, ask the doctor to discuss the medical issues and/or the attorney or financial advisor the other issues.
• Copies of insurance policies, including life insurance and long-term care insurance.
• Information about finances including the name and contact information for the tax preparer or accountant. Note: Ask your loved one where he or she keeps the financial records.
  

Create a Laminated Reference Sheet
It is a good idea for every older adult to have a complete list of emergency telephone numbers and information. Laminate the list and put it in an obvious place (e.g., the refrigerator door, by the phone, in the top drawer of your desk, etc.) so it will be available for Emergency Medical Technicians (EMTs) or others who may need it. The sheet should contain at least the following information:

• Name, address, and telephone number, his or her birth date, social security number, and medical insurance information (e.g., Medicare and supplemental insurance information).
• Name and contact information for primary caregiver.
• Primary physician’s name and contact information.
• A list of all medications and dosages.
• Name and phone number of pharmacy.
• Names and contact information for other caregivers, relatives.
• Specialist medical personnel and their contact information (e.g., Cardiologist).
• Whether your loved one has a living will and/or a durable power of attorney that allows another person(s) to make financial and/or medical decisions if your loved one is unable to do so (if so include contact information).