# 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.

<!--
Guidance: How to use this template
- Write the plan with the person receiving care, not about them.
  Section 1 records what matters to them in their own words; every
  other section serves that.
- Fill section 3 (Care team) and section 6 (Emergency plan) first. They
  are what a stand-in carer needs on day one.
- Copy medications exactly from the pharmacy label or the clinician's
  list. This file records what was prescribed; it never changes a dose.
- Section 7 (Legal authority) records who may act, under which
  document, and where the original is. It does not create authority.
- Store the plan where the care team can read it, and remove access
  when someone leaves the team. It contains health information.
- Related templates: Emergency Document File
  (`personal/emergency-document-file`), Health Record
  (`personal/health-record`), Budget (`personal/budget`), Insurance
  Review (`personal/insurance-review`).
-->

## Document control

<!-- Guidance: Name the plan coordinator (usually the main carer) and the date of the next review. Care needs change; a plan older than three months is often out of date. -->

| 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| Status | [Draft / Current / Superseded] |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 |

## Contents

1. [About the person](#1-about-the-person)
2. [Care needs and support level](#2-care-needs-and-support-level)
3. [Care team and rota](#3-care-team-and-rota)
4. [Health contacts and conditions](#4-health-contacts-and-conditions)
5. [Medications as prescribed](#5-medications-as-prescribed)
6. [Emergency and escalation plan](#6-emergency-and-escalation-plan)
7. [Legal authority and money](#7-legal-authority-and-money)
8. [Respite and carer wellbeing](#8-respite-and-carer-wellbeing)
9. [Review log](#9-review-log)
10. [References](#10-references)

## 1. About the person

<!-- Guidance: What a new carer must know to treat the person as a person: how they like to be addressed, routines, what calms or upsets them, faith or diet rules, hearing or sight needs. Use their words where you can. -->

| 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

<!-- Guidance: One row per area of daily life. Say what the person does alone, what they need help with and who usually helps. Record changes in the review log in section 9. -->

| 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

<!-- Guidance: List everyone who helps, paid or unpaid, with the tasks they own. A rota with gaps written down is better than an assumption that "someone will cover it". -->

| 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

<!-- Guidance: The facts a paramedic or a new clinician asks for first. Keep the detailed medical history in the Health Record template and link it here. -->

| 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

<!-- Guidance: Copy from the current pharmacy label or the prescriber's list, and date the copy. Never change a dose based on this table. Ask the pharmacist or prescriber about any doubt, missed dose or new symptom. -->

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

<!-- Guidance: Decide in advance who to call for what. Write the local emergency number, not a generic one. Test the plan with a stand-in carer once. -->

```mermaid
flowchart TD
  A["Carer notices a change"] --> B{"Danger to life?"}
  B -- "Yes" --> C["Call emergency number [local number]"]
  C --> D["Tell plan coordinator"]
  B -- "No" --> E{"New or worsening symptom?"}
  E -- "Yes" --> F["Call doctor or out-of-hours health line"]
  F --> D
  E -- "No" --> G["Note it in the review log, section 9"]
  G --> D
```

| 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

<!-- Guidance: Record who is legally allowed to act for the person, under which document, and where the original is. Rules differ by country; check the current official guidance and ask a lawyer. A family relationship alone does not give someone authority over another adult's money in many countries. -->

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

<!-- Guidance: The main carer needs planned breaks, not only emergency cover. Book respite before it is needed and record who steps in. -->

| 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

<!-- Guidance: Short dated notes on changes in health, needs, team or authority. Review the whole plan at the date in Document control and after any hospital stay. -->

| 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

<!-- Guidance: Add your local health service, carer support and adult protection pages. Record the date you last checked each one. -->

| 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.