Ioana's Personalized Service Plan

Plan of Care & Instructions • Effective 05-11-2020

Click each row to see detailed instructions

Current Status

Ioana is a 98-year-old woman who receives 24-hour care. She has a daughter (DTR) who is a doctor and stops by periodically to check on her. She has standing appointments on Monday and Wednesday at 12:45 PM at her daughter's office for infusion treatments—please coordinate transportation for those days.

Ioana is alert but not reliably oriented. She understands English and used to speak it fluently, but now speaks mostly Romanian. Communication can be challenging at times. She doesn't remember names very well, but she knows the people she knows and the people she likes. She doesn't like a lot of fuss made over her and rarely complains. While she can make her needs known, she may not tell you if she is uncomfortable or if something is bothering her—please be observant of non-verbal cues.

Safety & Supervision

⚠️ NEVER LEAVE UNATTENDED

Ioana will get out of bed or out of her chair the moment you leave the room. She is fast, so you must be attentive at all times. She has a baby monitor and bed alarm in place. Be mindful that she may try to get up when you're not looking. This is an extreme fall risk client—never allow her to walk or transfer without full physical contact.

Daily Routine & Engagement

Ioana naps throughout the day, but please try to keep her engaged and limit naps to 2 hours or less. To keep her engaged, offer snacks throughout the day, do simple exercises together, open the blinds to let in natural light, and open the door if the weather is nice—she loves fresh air. If weather permits, consider sitting outside together. At bedtime, please encourage her to stay up until 9:00 PM if possible.

Monitoring Requirements

📊 Input & Output Monitoring

We monitor input and output for this client. Be sure to track and document all food intake, fluid intake, and output (urination, bowel movements) thoroughly during your shift.

Task Codes & Instructions

Full Assistance Supervision to Hands-On Continuous Supervision
115 Meal Preparation
Full Assistance

Prepare and serve meals and snacks. Ensure meals are appropriate, timely, and safely provided. Support adequate food and fluid intake throughout the day.

116 Housekeeping
Full Assistance

Maintain a clean and safe living environment, including bedroom care, laundry, and keeping walkways clear of hazards.

123 Dressing Upper
Full Assistance

Full assistance with upper body dressing. Assist with clothing selection and dressing as needed.

125 Locomotion
Full Assistance

Provide full hands-on assistance with walking and transfers. Maintain physical contact at all times when client is standing or walking.

128 Bed Mobility
Full Assistance

Full assistance with bed mobility including turning, repositioning, and getting in and out of bed as needed.

129 Eating
Full Assistance

Assist with meals as needed, including setup, cueing, and hands-on assistance to ensure adequate intake. Encourage fluids throughout care.

130 Bladder Incontinence
Full Assistance

Full assistance with bladder incontinence care. Monitor output and maintain hygiene. Report any concerns to the office.

131 Bathing / Wash Up
Full Assistance

Full assistance with bathing including setup, undressing, washing, drying, and dressing. Monitor water temperature for safety and comfort.

132 Personal Care
Full Assistance

Full assistance with dressing, grooming, and personal hygiene including hair care, oral care, nail care, and skin care as needed throughout the day.

133 Personal Property Care
Full Assistance

Keep client's personal items organized and within reach. Ensure belongings are maintained and accessible.

135 Shower
Full Assistance

Full assistance with shower including setup, undressing, shower or bath transfer, washing, drying, and dressing. Monitor water temperature for safety and comfort.

140 Bowel Incontinence
Full Assistance

Full assistance with bowel incontinence care. Monitor bowel function and maintain hygiene. Report any concerns to the office.

117 Medication Reminders
Verbal/Prompt

Provide medication reminders at scheduled times. Ensure medications are taken as prescribed. Document any refusals or concerns.

127 Toilet Use
As Needed

Assist with hygiene including toileting as needed. Monitor bowel and bladder function during care. Ensure client is clean and comfortable.

141 Supervision
Continuous

Provide ongoing supervision for safety. Maintain awareness of client's location and safety at all times during care. Monitor for unsafe behaviors and ensure the environment remains safe.

Signatures & Acknowledgment

Care Plan:

By signing below, I acknowledge that I have received, reviewed, and understand this Personalized Service Plan and its instructions.

Caregiver

Name (Print)

Signature

Date

Client / Representative

Name (Print)

Signature

Date

Daily Check-In

Complete at the end of each shift. All fields required unless marked optional.

116 - Housework Tasks (Select all that apply)

Tasks completed today.

Important: Do not use this form to report urgent or time-sensitive issues

Call the office immediately for any incidents, falls, safety concerns, or changes in condition.

Communication & Reporting

Call the office without delay for:

  • • Any incident, near incident, or fall
  • • Changes in condition or behavior
  • • Safety concerns or wandering
  • • Complaints or requests
Contact Numbers
On-Call 24/7: 800-719-6912 (Option 2)

Emergency Protocol

In case of emergency, call 911 first, then call the office immediately.