Care Plan Template

Name: May Grace Barrow Date of birth: 1/12/1916 Address: 58 Lily Lane Potsville Contact no: 9333 9999 Doctor: Dr Alan Trudeaux Doctor’s contact no: 9333 3333 Care plan Medicare no: 6999 12345 6 Pension no: 9999999999Z

Care alerts (write in red) For example: allergies, drug reactions, smoker, falls risk, diabetic

Communication Preferred name: May Care needs: Goal: (expected outcome) Vision Hearing Aids glasses magnifying glasses Aids hearing aids ( right left ) Clean and fit glasses daily Adjust volume daily Able to clean own glasses Check batteries and clean aids daily Place objects in range of vision Gain attention before speaking Read aloud - Speak loudly, clearly and directly letters/documents Allow extra time for response Assist to write Give step-by-step instructions Assist to use telephone Use repetition when difficulty persists Other Other Eye care required Ear care required Speech and language Comprehension issues (For example: inappropriate responses) Language/s spoken English

Speech disorder/s Translate for resident Take time to listen Initiate conversation Use language cards Use picture cards Other Mobility Care needs: Goal: (expected outcome) Ambulation (walking) Transfers ambulant (able to walk) independent weight bearing (able to stand) non-ambulant (unable to walk) non-weight bearing (unable to stand) 1-staff assist 2-staff assist hip replacement knee replacement amputee ( left right ) Aids walking stick zimmer frame Aids bed rail slide sheet gait belt wheelchair quad stick hoist standing hoist wheeled walker Hoist sling type and position of loop

Other Other Provide direction Supervise movement Encourage to maintain mobility

Grange Home Care Care plan Page 1 of 5 Name: May Grace Barrow Date of birth: 1/12/1916 Address: 58 Lily Lane Potsville Contact no: 9333 9999 Doctor: Dr Alan Trudeaux Doctor’s contact no: 9333 3333 Care plan Medicare no: 6999 12345 6 Pension no: 9999999999Z

Other Toileting and continence Care needs: Potential for skin breakdown due to incontinence Goal: (expected outcome) To maintain good skin integrity Continence Bladder control continent incontinent catheter ( occasionally frequently total incontinence ) Bladder management Toilet (times 0600 1000 1400 1600 2000 ) Other Bowel control continent incontinent constipation colostomy ( occasionally frequently total incontinence ) Bowel management high fibre diet encourage fluid intake aperients bowel chart Continence aids Day medium pad Night overnight pad Toileting Toileting aids Commode at night urinal uridome kylie bed pan over-toilet frame Other Toileting regime independent supervise some assistance/prompt fully assist Adjust clothing Position on toilet Encourage self care Clean perianal area Other Showering, dressing and grooming Care needs: Potential for infections related to incontinence Goal: (expected outcome) To maintain optimal personal hygiene Shower and washing independent supervise some assistance/prompt fully assist shower bath bed sponge flannel wash Frequency Preferred time Adjust water temperature Encourage to optimise self care Other Transfer walk to shower wheelchair Other Showering aids shower chair Other Toiletries normal soap deodorant aqueous cream moisturiser ( am pm ) Other Hair care wash in shower wash in bath Preferred days Fridays Grooming Hair care independent supervise some assistance/prompt fully assist Hairdresser Facial hair wet shave dry shave Frequency Hair removal Frequency Nail/foot care independent supervise some assistance/prompt fully assist Podiatry visits Teeth none some ( upper lower ) all Cleaning routine Dentures none partial full ( upper lower ) Night in out Cleaning routine

Dressing and undressing independent supervise some assistance/prompt fully assist callipers splints Other Cultural dressing Dressing assistance bra singlet buttons belt zips stockings socks jewellery make-up shoes Assist with selecting clothing Other Pressure area and skin care Care needs: Goal: (expected outcome) Norton Scale Score [ ] low risk [ ] medium risk [ ] high risk Pressure relief aids bed cradle sheepskin cushion bedrail/protectors Other Pressure area regime Reposition in bed Reposition in chair Frequency special mattress (type ) personal chair Other/specific orders Skin care emollient cream to dry skin areas ( daily twice daily ) Preferred time/s morning Eating and drinking Care needs: Goal: (expected outcome) Eating independent supervise some assistance/prompt fully assist right-handed left-handed Preferred place to eat dining room bedroom Other Lounge room in armchair with tray on lap Type of diet normal soft modified soft (minced) puree Special diet high fibre diabetic enteral feeding (PEG/NGT) Special instructions Aids modified crockery modified cutlery bowl lipped plate built up cutlery clothing protector Other Drinking independent supervise some assistance/prompt fully assist right-handed left-handed Aids modified cup clothing protector Thickened fluids level 1 level 2 level 3 Type of thickener to be used Sleep and settling routines Care needs: Goal: (expected outcome) Usual time to rise 0600 Usual time to bed 2130 Rest time ( am 2 pm ) Preferred sleeping position Pillows required Sleep Aids massage music hot packs Other Room light on door open door closed bedrail/protectors Other Night-time patterns Leaves bathroom light on. Sometimes wakes in the night and reads. Other preferences (For example: hot drinks or snacks) Night checks every hour every 2 hours Other Grange Home Care Care plan Page 3 of 5 Name: May Grace Barrow Date of birth: 1/12/1916 Address: 58 Lily Lane Potsville Contact no: 9333 9999 Doctor: Dr Alan Trudeaux Doctor’s contact no: 9333 3333 Care plan Medicare no: 6999 12345 6 Pension no: 9999999999Z

Medications Current medications eye drops ear drops Other

independent supervise some assistance/prompt fully assist pre-packed measure self-administer Blood sugar level testing independent supervise some assistance/prompt fully assist Frequency Specialised care plans Refer to specialised care [ x] Medications plans for [ ] Pain management [ ] Wound care

[ x] Therapy [ ] Restraint management OHS Completed injury risk Home environment Yes No assessment forms Client assessment Yes No Social and human needs/activities Care needs: Potential for social isolation Goal: (expected outcome) To ensure Sybil has opportunity to develop and maintain social networks Frequency of visit/contact by family/friends Monthly visits by daughter and son-in-law. Has close friendship with neighbour who checks on Sybil daily. Religion beliefs/practices Lutheran Pastoral requirements Attends place of worship (day/s Sundays – picked up and taken to Church by parishioners. ) Cultural needs Hobbies/interests Embroidery, Photography, Art Employment history Retired secretary Pets Name/s Marmalade Type/s Ginger Cat client manages pet requires prompt and assistance in pet care fully assist pet care Social group/s Bridge club – Wednesday afternoons picked up by friends Preferred activity/games Bridge Community care social outings (Frequency Once weekly ) Requirements Taxi vouchers Yes No Domestic needs/activities independent supervise some assistance/prompt fully assist Frequency ( daily every 2nd day weekly fortnightly Other ) Requirements Shopping Washing clothes Cleaning Cooking Transport required for appointments and outings Gardening – Lawn mowing and edges fortnightly, weeding/pruning assistance monthly Other

Emotional support

Recently widowed, requires time spent to listen and support. Husband name Jim, died last month from sudden heart attack.

Behaviour Care needs: Goal: (expected outcome)

Additional comments (For example: special needs, restraint, routines, pain, palliative care, pacemaker)

Terminal care recorded Yes No Date care plan evaluated (document in progress notes) Signature

Grange Community Care use only Entered in progress notes Date Signed Tanya Tomlinson Print name Tanya Tomlinson Position title Care Manager Review date every 3 months

Grange Home Care Care plan Page 5 of 5