Client 117394
Effective Date: September 9, 2025
Client is an adult male who is alert and oriented and resides in the family home. He recently relocated from out of state due to increased need for support related to vision loss, which impacts his ability to navigate his surroundings, locate items, and complete daily tasks independently.
Client is fairly independent and manages most daily tasks on his own. Caregivers provide supportive assistance with instrumental activities of daily living (IADLs) including transportation, shopping, meal planning and preparation, and managing tasks within the home. Support also includes medication reminders to help him stay on track with his medication schedule, as well as assistance with personal care tasks as needed. Services are provided daily for 6 hours. Family support is available outside of scheduled care hours.
Care is provided through clear, direct communication, encouraging Client's independence while offering support when needed. The focus is on maintaining safety, consistency, and a structured environment that supports his ability to function as independently as possible. A dedicated caregiver through the agency ensures continuity, familiarity, and a consistent approach to daily routines.
Full assistance with meal planning and preparation as needed.
DailySupport as needed; client directs.
As NeededProvide reminders only for medication schedule.
DailyHands-on assistance with hygiene as needed.
DailyHands-on assistance with lower body dressing as needed.
DailyStandby assistance for safe movement and navigation.
DailyCaregiver available to provide standby or hands-on assistance as needed.
DailyStandby or hands-on assistance with bathing as needed.
DailyHands-on assistance with applying lotion as needed.
DailyFull assistance with laundry as needed.
DailyHands-on assistance with stairs for safe navigation.
As NeededSelect the type of review you're completing
Date: _______________ | ☐ 3-Month ☐ 6-Month ☐ 9-Month
Date: _______________ | ☐ 6-Month ☐ Annual