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Tips for Creating and Using a Care Plan
Once you determine that your aging loved one requires in-home care, you and they will benefit from
creating and implementing a care plan. This plan is a document, developed in consultation with your
loved one (and any necessary professionals), which details their day-to-day care. It will specify what
kind of care is needed, when and how it should be provided, who will provide it, and any long-term
goals that your loved one would like to accomplish. Creating such a detailed document may feel
daunting, but there are a number of steps you can take to make the process more efficient and
productive.
Conduct a needs assessment.
One of the first steps you should take once you and your loved one decides to hire home health
services is to conduct a needs assessment. This assessment allows you to pinpoint your loved one's
care needs so that you can address them in the care plan. For instance, if your loved one is coming
home from the hospital, you will need to determine whether they are arriving with medical equipment
(such as a trach) that may require you to hire a nurse. If you know you need a caregiver for a patient
with dementia, you will need to determine which areas of their lives are being most affected by their
diminishing memory.
Consult with your loved one.
Conducting a needs assessment and drafting the care plan based on the results of that assessment
require the input of your loved one. In fact, the care plan cannot work effectively unless your loved
one supports that plan and is confident that it will meet their needs. In addition, welcoming their input
is an important way to help them maintain their independence and alleviate any fears they have about
accepting help.
There are many ways in which your loved one can contribute to the care plan. For instance, they can
tell you what parts of their daily routine are hardest for them to complete. They can tell you what kind
of daily schedule they prefer to follow. They can tell you how often they wish to eat, or how often
they want to leave the house. They can also express when they want get exercise or enjoy company.
Once you have this information, you can work with them to address these needs and preferences
within the care plan.
Employ professional help.
Creating a care plan may also require the help of professionals who can assist you in thinking through
the many details that must be included in such a plan. There are many people whose expertise may
be beneficial. For instance, if your loved one is coming home from the hospital, their doctors may be
able to provide you with information about the kind of care they will require once they are home.
If you feel that you need more comprehensive support, you may want to hire a geriatric care manager
to work with you in creating your loved one's care plan. These professionals are skilled at overseeing
complex cases that may require the use of a number of different resources and caregiving services.
Other professionals who may be able to assist you in establishing the care plan for your aging loved
one include social workers, current caregivers, financial planners, and attorneys, who can all
contribute advice to relevant parts of the care plan.
Include long-term goals.
While a care plan details the day-to-day care that should be given to your loved one, no care plan is
complete without the inclusion of long-term goals. Ideally, your loved one, with your support and the
support of any professionals who are helping you to write the care plan, should set these goals. Each
of your loved one's caregivers should assist them in working toward these goals. Examples of goals
your loved one may want to achieve include getting back to some of their regular activities, building
enough strength to complete certain tasks, or starting a new hobby.
Make sure the care plan is followed.
The only way the care plan can work is if each participant in your loved one's in-home care follows
the plan as it has been written and approved. Your role should be to oversee the plan and how it is
being implemented. For instance, when you visit your loved one, you should observe how the
caregiver is following the plan. You should also consult with your loved one to determine how satisfied
they are with their care. If you find that there are areas in which the plan is not being followed, or
areas where your loved one is not satisfied, you can always call for a care plan review to implement
revisions to the plan.
Conduct regular care plan reviews.
Even if your loved one's care seems to be going well, it will be important to conduct regular care plan
reviews. These reviews are meetings that include you, your loved one, support professionals, and
your loved one's caregivers. They provide an opportunity for everyone to give input regarding how the
care plan is working. These reviews should take place at least once a year, but you or your loved one
should feel free to request one of these reviews anytime you feel that something needs to be adjusted.
By regularly updating, revising, and reviewing the care plan, you can ensure that your loved one
continues to receive the kind of care they need and want.
Creating a care plan is an important step in managing your loved one's care. When writing and
implementing such a plan, you should take the time to conduct a needs assessment, consult your
loved one and professionals, include long-term goals, make sure the care plan is followed, and
conduct regular care plan reviews to ensure the best possible care for your loved one.

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Tips for Creating and Using a Care Plan

  • 1. Tips for Creating and Using a Care Plan Once you determine that your aging loved one requires in-home care, you and they will benefit from creating and implementing a care plan. This plan is a document, developed in consultation with your loved one (and any necessary professionals), which details their day-to-day care. It will specify what kind of care is needed, when and how it should be provided, who will provide it, and any long-term goals that your loved one would like to accomplish. Creating such a detailed document may feel daunting, but there are a number of steps you can take to make the process more efficient and productive. Conduct a needs assessment. One of the first steps you should take once you and your loved one decides to hire home health services is to conduct a needs assessment. This assessment allows you to pinpoint your loved one's care needs so that you can address them in the care plan. For instance, if your loved one is coming home from the hospital, you will need to determine whether they are arriving with medical equipment (such as a trach) that may require you to hire a nurse. If you know you need a caregiver for a patient with dementia, you will need to determine which areas of their lives are being most affected by their diminishing memory.
  • 2. Consult with your loved one. Conducting a needs assessment and drafting the care plan based on the results of that assessment require the input of your loved one. In fact, the care plan cannot work effectively unless your loved one supports that plan and is confident that it will meet their needs. In addition, welcoming their input is an important way to help them maintain their independence and alleviate any fears they have about accepting help. There are many ways in which your loved one can contribute to the care plan. For instance, they can tell you what parts of their daily routine are hardest for them to complete. They can tell you what kind of daily schedule they prefer to follow. They can tell you how often they wish to eat, or how often they want to leave the house. They can also express when they want get exercise or enjoy company. Once you have this information, you can work with them to address these needs and preferences within the care plan. Employ professional help. Creating a care plan may also require the help of professionals who can assist you in thinking through the many details that must be included in such a plan. There are many people whose expertise may be beneficial. For instance, if your loved one is coming home from the hospital, their doctors may be able to provide you with information about the kind of care they will require once they are home.
  • 3. If you feel that you need more comprehensive support, you may want to hire a geriatric care manager to work with you in creating your loved one's care plan. These professionals are skilled at overseeing complex cases that may require the use of a number of different resources and caregiving services. Other professionals who may be able to assist you in establishing the care plan for your aging loved one include social workers, current caregivers, financial planners, and attorneys, who can all contribute advice to relevant parts of the care plan. Include long-term goals. While a care plan details the day-to-day care that should be given to your loved one, no care plan is complete without the inclusion of long-term goals. Ideally, your loved one, with your support and the support of any professionals who are helping you to write the care plan, should set these goals. Each of your loved one's caregivers should assist them in working toward these goals. Examples of goals your loved one may want to achieve include getting back to some of their regular activities, building enough strength to complete certain tasks, or starting a new hobby. Make sure the care plan is followed. The only way the care plan can work is if each participant in your loved one's in-home care follows the plan as it has been written and approved. Your role should be to oversee the plan and how it is being implemented. For instance, when you visit your loved one, you should observe how the caregiver is following the plan. You should also consult with your loved one to determine how satisfied they are with their care. If you find that there are areas in which the plan is not being followed, or areas where your loved one is not satisfied, you can always call for a care plan review to implement revisions to the plan.
  • 4. Conduct regular care plan reviews. Even if your loved one's care seems to be going well, it will be important to conduct regular care plan reviews. These reviews are meetings that include you, your loved one, support professionals, and your loved one's caregivers. They provide an opportunity for everyone to give input regarding how the care plan is working. These reviews should take place at least once a year, but you or your loved one should feel free to request one of these reviews anytime you feel that something needs to be adjusted. By regularly updating, revising, and reviewing the care plan, you can ensure that your loved one continues to receive the kind of care they need and want. Creating a care plan is an important step in managing your loved one's care. When writing and implementing such a plan, you should take the time to conduct a needs assessment, consult your loved one and professionals, include long-term goals, make sure the care plan is followed, and conduct regular care plan reviews to ensure the best possible care for your loved one.