Lillian Gordon
Effective Date: April 22, 2026
Lillian lives in senior housing and is able to make decisions about her own care. Her daughter-in-law is her main caregiver, and her family is very supportive. Help includes cooking meals, keeping her home clean, assisting with personal hygiene, dressing, and bathing. She gets reminders to take her medications and is given rides to appointments or errands when needed. Grocery shopping and errands are done based on what Lillian wants. Everything is done with her guidance, and any changes or concerns are shared with her son, her POA or the agency.
Lillian is currently experiencing an exacerbation of her venous disease. She is wearing compression stockings and keeping her related medical appointments. Caregiver should remind her to perform her prescribed exercises daily. Lillian states that she tries to do as much as she can for herself. Level of care remains unchanged and appropriate. Lillian continues to benefit from proximity and consistent caregiver support. She is overall satisfied with her services, and current hours remain appropriate. There have been no falls or incidents reported in the past 6 months.
| Code | Task | Level of Care | Instructions | Frequency |
|---|---|---|---|---|
| 115 | Meal Planning & Preparation | Full Assistance | Full assistance with meal planning and preparation as needed. Prepare breakfast, lunch, and dinner. | Daily |
| 116 | Housework / Chores | Full Assistance | Full assistance with keeping home clean and organized as needed. | Daily |
| 118 | Managing Medications | Reminders Only | Provide reminders for medication schedule. Medications are pre-organized in daily med boxes. | Daily |
| 119 | Shopping | Support | Support with grocery shopping and errands as needed based on client preferences. | As Needed |
| 120 | Transportation | Support | Provide transportation to appointments and errands as needed. | As Needed |
| 122 | Hygiene | Hands-On | Hands-on assistance with personal hygiene as needed. | Daily |
| 123 | Dressing Upper | Hands-On | Hands-on assistance with upper body dressing as needed. | Mon โ Fri |
| 124 | Dressing Lower | Hands-On | Hands-on assistance with lower body dressing as needed. | Daily |
| 129 | Eating | Support | Verbal coaching and cueing during meals as needed. | Every Shift |
| 132 | Personal Care | Standby/Hands-On | Caregiver available to provide standby or hands-on assistance as needed. | Daily |
| 134 | Bathing | Standby/Hands-On | Standby or hands-on assistance with bathing as needed. | Daily |
Complete this section each time the care plan is reviewed or updated.
| Name | Initial | Date Reviewed | Changes / Notes |
|---|---|---|---|