Free Family Care Planning Checklist
Open or Download the Checklist (PDF)Planned Personal Assistance Services only; license pending.
This educational download does not ask for diagnoses, medication lists, insurance information, Social Security numbers, medical records, or other sensitive health or financial information. Privacy policy.
A PRACTICAL FAMILY PLANNING RESOURCE
Complete Home Support Planning Checklist
Use this home care planning checklist to identify which daily routines are becoming difficult, who is helping now, where dependable gaps exist, and what information a family should organize before contacting a nonmedical home-care provider.
START WITH THE ACTUAL GAP AT HOME
“We Need Help” Is Important, but It Is Not Yet a Care Plan
Families often recognize that something is wrong before they can explain exactly what kind of help is needed. Meals may be missed, bathing may become difficult, or one relative may be carrying nearly every responsibility.
Writing down the specific routines, days, and hours creating concern gives the family a clearer starting point. It also helps distinguish nonmedical support needs from concerns that require a physician, skilled home-health provider, therapist, emergency service, or another licensed professional.
PART ONE
Personal Routines and Daily Activities
Check the items that are becoming difficult, inconsistent, or heavily dependent on one family caregiver.
Personal Care
- Bathing or showering
- Dressing and selecting clothing
- Grooming and oral hygiene
- Toileting and personal hygiene
- Eating or maintaining meal routines
Mobility and Routine
- Getting out of bed or a chair
- Moving through the home
- Beginning the morning routine
- Preparing for the evening
- Completing ordinary daily activities
PART TWO
Meals, Household Tasks, and Community Access
Small household problems can become major barriers when they occur repeatedly or when the individual has no dependable backup.
Meals
- Planning simple meals
- Obtaining groceries
- Preparing food
- Cleaning the meal area
- Maintaining a regular eating routine
Household Routines
- Laundry and linens
- Dishes and light cleanup
- Tidying routinely used areas
- Managing ordinary household supplies
- Keeping frequently used spaces manageable
Errands and Appointments
- Getting to appointments
- Grocery or pharmacy errands
- Completing essential household errands
- Attending community activities
- Leaving the home safely and reliably
PART THREE
Map the Family’s Current Coverage
A care plan should be based on what relatives can consistently provide, not what everyone hopes will somehow work each week.
- Who currently provides most of the help?
- Which days and hours can that person reliably cover?
- Which routines require more than one person can manage?
- Does the caregiver have time to work and rest?
- Who serves as backup when the regular caregiver is unavailable?
- Are relatives coordinating care from another city?
- Which hours are repeatedly left uncovered?
- Is the current arrangement sustainable for another month?
PART FOUR
Define the Schedule Before Requesting Care
Days and Hours
- Morning assistance
- Midday assistance
- Evening assistance
- Overnight planning
- Weekday or weekend coverage
Timing and Duration
- Expected start date
- Temporary or recurring need
- Upcoming hospital discharge
- Family-caregiver absence
- Potential need for extended hours
PART FIVE
Identify Needs That May Require a Clinical Provider
Nonmedical home care cannot replace skilled healthcare services. Ask an appropriate licensed professional about concerns involving:
- Wound care or dressing changes
- Injections, IV therapy, or skilled medication administration
- New or worsening medical symptoms
- Skilled nursing assessments
- Physical, occupational, or speech therapy
- Continuous medical monitoring
- A behavioral-health or safety crisis
- Needs that cannot be managed safely at home
Contact the person’s physician or appropriate licensed healthcare provider for medical questions. Call 911 when there is an emergency.
PART SIX
Information to Have Ready for the First Conversation
- The city, ZIP code, and general care location
- The routines creating the most concern
- The preferred days and approximate hours
- The anticipated start date
- Whether support may be temporary or recurring
- The current family-caregiver arrangement
- The safest callback number and contact person
- Questions about coverage, staffing, and next steps
Do not submit Social Security numbers, insurance identification numbers, financial account information, detailed medical records, medication lists, or other highly sensitive information through a standard website form.
HOME CARE PLANNING FAQ
Questions Families Often Ask
When should a family begin home care planning?
Planning can begin when personal routines, meals, household tasks, mobility, isolation, or caregiver strain are becoming difficult. Families do not have to wait until the situation becomes a crisis.
Does completing this checklist establish a care plan?
No. This home care planning checklist is educational. An appropriate provider must evaluate the request and complete any required assessment, service planning, and acceptance process.
What if the family does not know how many hours are needed?
Begin by identifying which routines are difficult and when family coverage is unavailable. That information provides a more useful starting point than guessing a total number of hours.
Is Valiynt currently accepting clients?
Valiynt is preparing to provide planned nonmedical Personal Assistance Services. Licensing, coverage, staffing, scheduling, and availability must be confirmed before care begins.
TURN THE FAMILY’S CONCERNS INTO A CLEARER STARTING POINT
Discuss Home Support Planning With Valiynt
Share the general care location, routines creating concern, preferred schedule, and anticipated start date. Valiynt will explain whether the request can be considered and what the appropriate next step may be.