Caregiver Plan Template

Person-centred profile, care needs by area, care team and rota, health contacts, medications as prescribed, escalation flowchart, legal authority (CFPB roles, UK and US examples), respite, review log

개인 및 PKM표준CFPB managing someone else's money guides (2026)caregiver plan diagram업데이트됨 2026. 10. 29.

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사용법: Use it when family or friends share the care of someone who needs regular help. Fill the care team and the emergency plan first, with the person themselves. The main pitfall is assuming a relative has legal authority to act on money or health matters without a document that grants it.

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Caregiver Plan: [Name of the person receiving care]

A shared plan for looking after a family member or friend who needs regular help: their daily care needs and preferences, the care team and who covers which tasks, medications as prescribed, health and emergency contacts, who holds legal authority for money and health decisions, respite cover for the main carer, and a review log. Authority roles follow the Consumer Financial Protection Bureau guides for managing someone else's money (page modified 2026-06-25), with UK and US examples. Replace every [bracketed] value and every row marked Example. This is a coordination format, not medical, legal or financial advice: follow the instructions of the person's clinicians and check the current official rules and a qualified professional where you live.

Document control

Field	Value
Document ID	[CARE-001]
Person receiving care	[Full name, date of birth] (Example: Margit Halvorsen, born 1941)
Plan coordinator	[@coordinator] (Example: Ines Halvorsen, daughter)
Version	[1.0]
Status	[Draft / Current / Superseded]
Agreed with the person on	YYYY-MM-DD
Last updated	YYYY-MM-DD
Next review	YYYY-MM-DD (every three months or after any hospital stay)
Classification	Private: health and financial information
Shared with	[Names of care team members with access]

Revision history

Version	Date	Author	Change
1.0	YYYY-MM-DD	[@coordinator]	First plan agreed with the person
1.1	YYYY-MM-DD	[@coordinator]	Example: New evening medication after clinic visit, respite week booked

About the person
Care needs and support level
Care team and rota
Health contacts and conditions
Medications as prescribed
Emergency and escalation plan
Legal authority and money
Respite and carer wellbeing
Review log
References

1. About the person

Topic	Notes
Preferred name and language	Example: "Margit". Norwegian at home, good English
What matters most to them	Example: Staying in her own flat, morning coffee on the balcony, Sunday calls with her grandson
Daily routine	Example: Up at 07:30, rest after lunch, bed by 22:00
Communication	Example: Hearing aid in the left ear, speak facing her
Food and drink	Example: Soft diet, tea not coffee after 15:00
Things that upset or calm them	Example: Loud TV upsets her, music from the 1960s calms her
Faith, culture, personal wishes	[Notes]

2. Care needs and support level

Area	Does independently	Needs help with	Usual helper	Notes
Personal care (Example)	Washing face, dressing top half	Showering, socks and shoes	Home care agency, mornings	Shower seat installed
Mobility (Example)	Walking indoors with frame	Stairs, outdoor walks	Ines, weekends	Fall in March, see section 6
Meals (Example)	Making tea, light snacks	Cooking hot meals	Meal delivery Mon to Fri
Medications (Example)	Taking tablets from a filled organiser	Filling the weekly organiser	Ines, Sundays	Pharmacy blister pack requested
Household tasks	[What they do]	[What they need]	[Who]	[Notes]
Money and paperwork	[What they do]	[What they need]	[Who]	See section 7
Transport and appointments	[What they do]	[What they need]	[Who]
Social contact	[What they do]	[What they need]	[Who]

3. Care team and rota

Role	Name	Relationship or organisation	Phone	Tasks owned	Availability
Plan coordinator (Example)	Ines Halvorsen	Daughter	[Phone]	Medications, appointments, this plan	Evenings, weekends
Second carer (Example)	Tomas Halvorsen	Son	[Phone]	Shopping, finances	Wednesdays
Home care agency (Example)	[Agency name]	Paid care	[Phone]	Morning personal care	Daily 08:00 to 09:00
Neighbour (Example)	[Name]	Neighbour	[Phone]	Key holder, checks in	Weekdays
[Role]	[Name]	[Relationship]	[Phone]	[Tasks]	[When]

Weekly rota:

Day	Morning	Afternoon	Evening	Overnight
Monday (Example)	Agency	Meal delivery	Ines (phone call)	Alone, alarm pendant
[Day]	[Who]	[Who]	[Who]	[Who]

4. Health contacts and conditions

Item	Details
Main doctor or practice	[Name, practice, phone]
Specialists	[Name, speciality, phone]
Pharmacy	[Name, phone, opening hours]
Health insurance or health service number	[Where the card is kept, last 4 digits only]
Conditions	[List, as written by the clinician]
Allergies and reactions	[List, or "No known allergies" if confirmed by a clinician]
Advance care plan or treatment wishes	[Exists? Where is it kept?]
Full health record	[Link to `personal/health-record` copy]

5. Medications as prescribed

List copied from: [pharmacy label / prescriber's list] on YYYY-MM-DD.

ID	Medicine and strength (as on label)	Instructions (as on label)	Purpose (as told by clinician)	Prescriber	Given by	Refill due
MED-01 (Example)	[Medicine name] [strength]	[Example: one tablet in the morning with food]	[Example: blood pressure]	[Doctor]	Self from organiser	YYYY-MM-DD
MED-02 (Example)	[Medicine name] [strength]	[Example: one tablet at night]	[Example: sleep]	[Doctor]	Evening carer	YYYY-MM-DD
[MED-NN]	[Medicine]	[Instructions]	[Purpose]	[Prescriber]	[Who gives it]	YYYY-MM-DD

Questions to take to the next appointment or pharmacy review:

Is every medicine on this list still needed?
Do any of them interact with each other, with food or with over-the-counter products the person takes?
What should a carer do if a dose is missed or refused?
Which side effects mean the carer should call for advice?

6. Emergency and escalation plan

Situation	First call	Then tell	Notes
Life-threatening emergency	[Local emergency number]	Plan coordinator	Bring this plan and the medication list
Fall without obvious injury (Example)	Out-of-hours health line	Ines	Do not lift alone; follow the advice given
Carer cannot attend	Second carer, then agency	Plan coordinator
Person goes missing or is confused	[Number]	[Name]	Recent photo kept at [location]

Hospital bag kept at: [location]. Spare keys held by: [names].

7. Legal authority and money

The CFPB guides describe four roles in which someone manages another person's money, each with duties to act in that person's interest, keep their money separate and keep records:

Role (CFPB guide)	What it usually means	Holder in this plan	Document and where kept	Valid from
Agent under a power of attorney	Named by the person while they had capacity	[Name]	[Document, location]	YYYY-MM-DD
Court-appointed guardian of property or conservator	Appointed by a court	[Name]	[Order, location]	YYYY-MM-DD
Trustee under a revocable living trust	Manages assets placed in a trust	[Name]	[Trust deed, location]	YYYY-MM-DD
Government fiduciary	Appointed by an agency to manage benefit payments	[Name]	[Letter, location]	YYYY-MM-DD

Examples of local rules to check (dated 2026-10-30, not exhaustive):

United Kingdom (England and Wales): a lasting power of attorney comes in two types, health and welfare, and property and financial affairs, and is registered with the Office of the Public Guardian before it can be used. Check the current process and fee on GOV.UK.
United States: under the HIPAA Privacy Rule, a person with legal authority to make health care decisions for an adult is treated as that adult's personal representative for relevant health information (45 CFR 164.502(g)), and providers may in some cases share information with family members involved in the person's care (45 CFR 164.510(b)). Powers of attorney and guardianship are set by state law.
European Union: powers of attorney and adult protection measures are set by each Member State's national law. Check the rules of the country where the person lives and where their assets are.

Money tasks and who does them:

Task	Who	Authority used	Record kept at
Pay rent and utilities (Example)	Tomas	Power of attorney (property and financial affairs)	Shared spreadsheet, receipts folder
Manage benefits or pension payments	[Name]	[Authority]	[Location]
Pay the care agency	[Name]	[Authority]	[Location]

8. Respite and carer wellbeing

Item	Details
Main carer's regular break	Example: Ines off duty every second weekend, Tomas covers
Planned respite	[Dates, provider or family member covering]
Respite or carer support services found	[Local service, phone, eligibility notes]
Carer's own health contacts	[Doctor, support group]
Warning signs the carer is overloaded	Example: Missing own appointments, sleeping less than six hours, snapping at the person

Questions for the care team at each review:

Is any one person doing more than they can sustain?
Which tasks could a paid service, a neighbour or a community group take on?
Has the carer had a full day off in the last two weeks?

9. Review log

Date	What changed	Section updated	By
YYYY-MM-DD (Example)	Fall at home, no injury; walking frame provided	2, 6	Ines
YYYY-MM-DD (Example)	Pharmacy now supplies blister packs	5	Ines
YYYY-MM-DD	[Change]	[Section]	[Name]

10. References

Reference	Checked	Use
Consumer Financial Protection Bureau, Guides for managing someone else's money, https://www.consumerfinance.gov/consumer-tools/managing-someone-elses-money/	Page modified 2026-06-25, checked 2026-10-30	Four fiduciary roles in section 7
GOV.UK, Make, register or end a lasting power of attorney, https://www.gov.uk/power-of-attorney	Checked 2026-10-30	UK example in section 7
45 CFR 164.502(g) and 164.510(b), HIPAA Privacy Rule, https://www.law.cornell.edu/cfr/text/45/164.502	Checked 2026-10-30 (LII reproduction of the eCFR)	US example in section 7
[Local carer support service]	[Date]	[Respite options]

Standard and licence note

Based on the Consumer Financial Protection Bureau guides for managing someone else's money and on public UK and US government guidance named in section 10; CFPB works are US federal government works in the public domain, and the names are used only to identify the sources. The structure, text and examples are original; the Halvorsen family is fictional. This is not medical, legal or financial advice: follow the person's clinicians, check the current official text for your country, and ask a qualified professional. Template licence: MIT.