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Respite Care Check List

Respite care is when someone comes and gives the regular caregiver some "time off" from their duties (and is usually covered in some extent by most home health care policies). But that does not mean that the respite care caregiver has complete knowledge of the patient nor knows the best way of treating them. Here is checklist developed by the Dini Alves who cared for her mother for 15 years. She suggests that the caregivers be given this form along with backup instructions for Universal Precautions, advanced directives, food preferences or any medical equipment in use. Print out and make your own revisions. But do use it- it can save a lot of time, questions and anxiety


Medical Equipment When Needs Assistance Need to Know
To (Name) Location phone Date Time
Catheter Care Hearing aid Shaving Peri-Care Mouth/Oral care
Bed Sores Foley Bag Dressings Changed Hair/skin/nail care Dentures

Moving Patient

Moves around unassisted Transfers from bed to chair with assistance Bedbound Reposition Requires Special life
Unassisted Cane Walker Wheelchair
Unassisted Bedpan Urinal Catheter Colostomy
Bedside Commode Incontinent pads other


Bed bath Shower Tub Needs assistance __times per week
Bedtime Wake time Nap time(s) Room temperature Closed windows
Prefers room dark
Pull sheet Blankets(s) Day__ or night__
Needs Assistance feeding Needs to be fed Has difficulty swallowing Takes nothing by mouth Tube feeding
Soft foods Record Liquid Intake
TV Radio Reading or being read to cards Other


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