CARE PLAN

 

Client Name: [Client Name]

Date of Birth: [Date of Birth]

Address: [Client Address]

Care Plan Start Date: [Start Date]

Care Plan Review Date: [Review Date]

 

1.        Assessment Summary

 

The following is a summary of the initial assessment conducted by Stillwater Respite Care Inc. to evaluate the client’s needs:

 

Primary Diagnosis: [e.g., Developmental Disability, Dementia, Behavioral Issues]

 

Secondary Conditions: [e.g., Anxiety, Depression]

 

Physical Health: [e.g., Requires mobility assistance, medical condition details]

 

Mental/Behavioral Health: [e.g., Exhibits signs of aggression, social withdrawal, etc.]

 

Additional Considerations: [e.g., Dietary restrictions, allergies, cultural preferences]

 

2.        Goals of Care

 

The goals are to ensure the well-being, safety, and development of the Client based on their needs.

 

Short-Term Goals:

 

1.        [e.g., Reduce instances of aggressive behavior]

 

 

2.        [e.g., Improve daily living skills]

 

 

3.        [e.g., Increase physical activity levels]

 

 

 

Long-Term Goals:

1.        [e.g., Support independent living]

 

 

2.        [e.g., Provide emotional and mental health stability]

 

 

3.        [e.g., Ensure safe and supportive environment]

 

4.        Care Services Provided

 

Service Type: [e.g., In-Home Care, Hospital Support, Community-Based Support]

 

Schedule: [e.g., Monday to Friday, 8:00 AM – 4:00 PM]

Caregiver Assigned: [Name of Caregiver]

Frequency of Services: [e.g., Daily, Weekly]

Duration of Services: [e.g., Ongoing, until a specified date]

 

Services Include:

 

Personal Care: Assistance with bathing, dressing, grooming, and personal hygiene.

 

Medication Management: Ensure that medications are taken as prescribed.

 

Meal Preparation: Prepare meals in accordance with dietary restrictions.

 

Mobility Assistance: Provide support with moving around the home or community, including use of mobility aids.

 

Emotional and Behavioral Support: Manage challenging behaviors through non-physical restraint methods, positive reinforcement, and counseling.

 

Companionship: Engage the client in social activities to reduce isolation and promote well-being.

 

Specialized Support: [e.g., Pediatric behavioral support, mental health interventions, addiction recovery, or trauma-informed care]

 

 

Additional Services (if applicable):

 

Respite Care for Family: [Describe respite services if the client’s family is receiving temporary relief]

 

Transportation Services: [Specify if the client requires transportation to appointments or community engagements]

 

 

5.        Risk Management and Safety Considerations

 

Known Risks:

 

[e.g., Risk of falls, choking hazards, medication side effects, wandering]

 

 

Safety Measures:

 

Fall Prevention: Use of mobility aids (walker, cane), installation of grab bars, regular safety checks in the home.

 

Medication Safety: Regular review of medications and storage in a secure location.

 

Behavior Management: Use of de-escalation techniques for aggressive behaviors.

 

 

Emergency Contacts:

 

Primary Contact: [Name, Relationship, Phone Number]

 

Secondary Contact: [Name, Relationship, Phone Number]

 

Medical Emergency Contact: [Name, Phone Number of Healthcare Provider]

 

 

 

6.        Client Preferences and Special Considerations

 

Dietary Restrictions: [e.g., Gluten-free, diabetic diet]

 

Cultural or Religious Preferences: [e.g., Time for prayers, special dietary needs, or cultural traditions]

 

Communication Preferences: [e.g., Verbal, non-verbal, assistive devices]

 

Daily Routine Preferences: [e.g., Prefers to wake up at 7:00 AM, likes to have a quiet time after lunch]

 

7.        Monitoring and Review

 

Monitoring Plan:

 

Daily Logs: Caregiver will maintain daily logs of services provided, noting any changes in behavior, physical condition, or other concerns.

 

Weekly Check-ins: Supervisor will conduct weekly check-ins to assess progress and ensure care plan is being followed.

 

Review Schedule:

 

Next Review Date: [Date]

 

Care Plan will be reviewed and updated based on the client’s progress, feedback from the client and family, and any changes in health or condition.

 

8.        Agreement

 

By signing this Care Plan, both parties agree to the services and terms outlined above. Stillwater Respite Care Inc. commits to delivering quality care in line with the client’s needs, and the Client agrees to communicate any changes in their condition or preferences.

 

Client/Guardian Signature: ____________________________

Name: [Client/Guardian Name]

Date: [Date]

 

Care Provider Signature: ____________________________

Name: [Care Provider Name]

Title: [Title]

Date: [Date]