Daily Care Report - Form 592

Silver Home Care - Private Pay Client Documentation

De-Identified Form for Security & HIPAA Compliance

This form is designed to be completely anonymous and can be posted publicly — on a website, bulletin board, or anywhere else — without exposing any protected health information (PHI).

Do NOT enter any identifying information about the client (no names, addresses, phone numbers, SSN, etc.). This form is pre-linked to the correct client through an internal reference — simply fill out your observations and care details. The system automatically associates this submission with the right client file.

Client Care Notes

The client is a pleasant and cooperative woman who lives with her husband. Caregivers provide companionship, supervision, and assistance with daily routines, including bathing, dressing, and maintaining personal hygiene. Caregivers may also accompany the client and her husband on shopping trips, errands, and appointments as needed.

The client has dementia and reduced safety awareness and requires continuous supervision. She must remain within the caregiver's sight at all times and should not be left unattended while care is being provided. Exterior doors in the home do not currently have specialized safety locks, so caregivers should remain attentive to door access while maintaining visual supervision.

The client may be resistant to bathing. Hygiene should be approached calmly with encouragement rather than pressure, accepting the level of care the client is willing to tolerate during the visit. Some days this may include a full shower, while on other days assistance with changing clothing or completing basic hygiene may be more appropriate. Her husband monitors overall hygiene needs and will advise when a more complete bath or shower should be attempted.

The client moves about the home independently, including using stairs. Hands-on assistance is required when navigating outdoor stairs and curbs.

A calm, confident, and reassuring approach works best. The client generally responds well to gentle direction and tends to follow the caregiver's lead when approached in a supportive and respectful manner.

Basement Safety: The basement area presents a safety hazard for the client. The basement door must remain closed, and caregivers must redirect the client if she approaches it. The husband plans to install a lock on the basement door to improve safety.

Plan of Care

Private Pay Client

Task Code Description Level of Care Schedule
115 Meal Preparation Full As needed - Approach and try, do not push if she refuses
119 Shopping/Errands Full As needed - Approach and try, do not push if she refuses
122 Hygiene Full/Prompt As needed - Approach and try, do not push if she refuses
123 Dressing Upper Full As needed - Approach and try, do not push if she refuses
124 Dressing Lower Full As needed - Approach and try, do not push if she refuses
125 Locomotion Full As needed - Mobility assistance
132 Personal Care Full As needed - Approach and try, do not push if she refuses
135 Bathing Full Daily - Approach and try, do not push if she refuses
141 Supervision Full Continuous - Never leave alone

Task Code Instructions

Client-specific instructions for each task code. Refer to these when providing care.

115 - Meal Preparation

The husband will let you know what to prepare. Provide companionship and prompting during the meal. Offer snacks and fluids throughout the day. Keep fluids within her reach and encourage hydration.

119 - Shopping/Errands

You may accompany the client and her husband on shopping trips and errands as needed. Maintain continuous visual contact during all outings - wandering risk.

122 - Hygiene

Offer hygiene assistance daily in the morning and as needed throughout the day. The client may resist personal hygiene tasks. Approach calmly and respectfully using encouragement and simple prompts rather than pressure. Focus on what she is willing to tolerate - some days may include a full shower, other days only assistance with changing clothing or basic hygiene. The husband monitors overall hygiene needs and will guide when more complete bathing should be attempted.

123 - Dressing Upper

Daily clothing change and/or after shower. Don't push if she is resistant. Try again later. Use a calm, confident approach.

124 - Dressing Lower

Assist with dressing lower body as needed. Don't push if she is resistant. Try again later. Ensure proper footwear for safety.

125 - Locomotion

Assist with walking and mobility as needed throughout the shift. Client is able to move about the home independently but may require encouragement or light assistance. Hands-on assistance required for outdoor stairs and curbs. Ensure proper footwear for safety.

132 - Personal Care

She toilets independently and is not incontinent. Help with oral hygiene, overall hygiene, and bathing as needed. Approach calmly and respectfully. Maintain dignity and privacy at all times.

135 - Bathing

Offer bathing assistance every day. Important: The client may be resistant to bathing or showering. Approach calmly and respectfully using encouragement and simple prompts rather than pressure. Focus on what she is willing to tolerate during the visit - on some days this may include a full shower, while on other days assistance with changing clothing or basic hygiene may be more appropriate. The husband monitors overall hygiene needs from day to day and will guide when more complete bathing should be attempted. NEVER leave her alone in the bathroom.

141 - Supervision (PRIORITY TASK)

Primary Responsibility: Client must NEVER be left alone. The client has dementia with reduced safety awareness and a risk of wandering. Maintain continuous visual supervision at all times - both inside and outside the home. This is mandatory - do not leave her alone under any circumstances.

Caregiver Information

Shift Details

Care Duties Performed

115 - Meal Prep

119 - Errands

122 - Hygiene

123 - Dress Upper

124 - Dress Lower

125 - Locomotion

132 - Personal Care

135 - Bathing

141 - Supervision

Signatures