Effective: 9-12-2025 | Reviewed with no changes: 2/24/26
Alice is an alert but confused woman with dementia who resides with her son and his family in a one-story home. She requires a structured and supervised environment due to cognitive impairment and safety risks, including a history of wandering. Alice ambulates independently within the home and is able to navigate stairs, but requires supervision due to impaired judgment and safety awareness.
Alice requires assistance with all activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Due to dementia, she is unable to safely initiate, sequence, or complete tasks independently and relies on caregiver support for all aspects of daily care.
The family initially sought additional support to provide daytime respite; however, this was not successful due to Alice's resistance to bringing in an outside caregiver. Care is now provided by her daughter-in-law as the dedicated caregiver through the agency, who also serves as her primary informal support. Additional support is provided by her son and grandchildren.
Care should be provided with a calm, reassuring, and consistent approach. Redirection, cueing, and supervision are essential to maintain safety and reduce confusion. Care should begin with supervision and cueing, progressing to hands-on assistance as needed to ensure safety and task completion. The environment should remain structured and predictable, with close attention to wandering risk and changes in behavior.
Maintain ongoing awareness of Alice's overall condition and baseline. Monitor for and respond to any changes, including physical status, cognition, weight, safety risks, and general well-being.
Any changes or significant events—such as incidents, falls, or emergency care—must be addressed in real time. This includes taking appropriate action at the time of care to ensure safety and escalation as necessary, contacting emergency services when needed, and seeking medical guidance as appropriate.
All changes and events must be reported to the office promptly.
Prepare and serve meals and snacks. Ensure meals are appropriate, timely, and safely provided. Support adequate food and fluid intake throughout the day.
Maintain a clean and safe living environment, including bedroom care, laundry, and keeping walkways clear of hazards.
Housework Tasks (select all completed today):
Complete shopping for household and personal needs as required.
Provide transportation to appointments and outings as needed. Ensure safe transfers in and out of the vehicle.
Full assistance with dressing, grooming, and personal hygiene including hair care, oral care, nail care, and skin care as needed throughout the day.
Full assistance with bathing including setup, undressing, shower or bath transfer, washing, drying, and dressing. Monitor water temperature for safety and comfort.
Full assistance with laundry.
Assist with hygiene including oral care and grooming. Provide cueing and step-by-step guidance, progressing to hands-on assistance as needed. Ensure Alice is clean, appropriately groomed, and comfortable. Monitor for changes in skin condition, hygiene, or overall presentation.
Assist with selecting appropriate clothing and dressing. Provide cueing and hands-on assistance as needed.
Assist with lower body dressing and clothing selection. Provide cueing and hands-on assistance as needed.
Alice ambulates independently but requires supervision for safety due to impaired judgment. Provide hands-on assistance as needed.
Alice transfers independently. Provide supervision for safety and assist only if needed.
Provide ongoing supervision due to impaired judgment and wandering risk. Maintain awareness of Alice's location and safety at all times during care. Monitor for unsafe behaviors, including attempts to leave the home or decreased awareness of surroundings. Ensure the environment remains safe and that Alice is not left unattended when supervision is required.
Provide assistance with toileting as needed. Monitor bowel and bladder function during care, including whether the client is urinating and having bowel movements, how often, and maintaining cleanliness after toileting. Observe for changes such as constipation, straining, inability to have a bowel movement, going more or less often than usual, or changes in urine (color, odor, or appearance).
Be alert to possible signs of urinary tract infection, including increased confusion, agitation, foul-smelling urine, pain or burning with urination, or fever.
Assist with getting in and out of bed as needed.
Assist with meals as needed, including setup, cueing, and hands-on assistance to ensure adequate intake. Encourage fluids throughout care. Monitor for changes in appetite, intake, or difficulty eating or drinking.
Supervise stairs within the home. Provide hands-on assistance with stairs, curbs, and changes in elevation outside the home.
Caregiver Tip: Use calm redirection and simple step-by-step cues. Maintain a consistent routine and environment.
Effective: 9-12-2025 | Reviewed with no changes: 2/24/26
Client / Representative
Name
Date
Signature
Caregiver
Name
Date
Signature
Call the office without delay for:
Emergency Protocol
In case of emergency, call 911 first, then call the office immediately.