Caregiver’s
OrganizerT

he following pages are meant to help you gather important information and organize
your time so you can care for your parent efficiently and smoothly. They are merely
guidelines; adapt them to suit your needs.
If a number of people are involved in your parent’s care, you might want to put
copies of some of these pages into a storage service, such as Dropbox or Evernote,so you and others can access them from anywhere, and update them regularly. The
pages provided here are:• Key Information• Emergency Identification
Cards• Emergency Medical
Information• Medications List
• Weekly Medications Chart• Medical Contacts• Medical Log• Home Safety Checklist

how to care for aging parents• Community Services• Employment Agreement• Caregiver Contacts• Daily Log• Family Caregiver Contract• Financial/Legal Contacts• Financial Planner• Monthly Budget• End-of-Life Wishes

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Key Information
Parent’s full name
Address
Phone
Date of birthSocial Security number
Driver’s license number
Medicare number
Miltary ID
Emergency contacts
Religious affiliation/Place of worship
Name of clergy person

Cell
Place of birth
Passport number
Medicaid number

Phone

LOCATE THE FOLLOWING:❒ Certificates of birth, marriage, divorce/separation, citizenship❒ Will and any codicils (amendments) to the will
❒ Durable power of attorney❒ Living will and power of attorney for health care
❒ DNR or other medical orders❒ Insurance policies (life, health, home, etc.)❒ Keys to house, office, safe-deposit box, post office box, etc.
❒ Combinations to any safe or lock
❒ List of recent employers, dates of employment, terms of employment❒ Contracts or rental agreements❒ Titles to real estate, cars, boats, and other vehicles❒ Jewelry and other valuables❒ Charge, debit, and banking cards❒ Check registers, savings passbook❒ Internet passwords, access codes, PINs
❒ Appraisals of personal property❒ Copies of federal and state tax returns from the past three to five years❒ Receipts from property taxes and other large recent payments❒ Instructions on how to care for a pet, plants, house, or dependent❒ Burial/cremation and funeral instructions, if any
NOTE: Keep sensitive information (such as Social Security number and passwords) private.

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Emergency Identification Cards(FRONT)For your parent’s wallet:

EMERGENCY MEDICAL ID
NAME:
ADDRESS:CITY:
EMERGENCY CONTACTS:
NAME
PHONE

PHYSICIAN

PHONE

DOB:
STATE:
PHONE

PHONE

For yours:(It’s best not to list your parent’s name and address here because if your wallet is stolen, you don’t
want to alert the wrong people that your parent is alone and vulnerable. Instead, list emergency
contacts who can then check on your parent.)

IN CASE OF EMERGENCY
I AM THE CAREGIVER OF A DISABLED PERSON.
MY NAME IS:

If I am injured or otherwise detained, please contact
the alternate caregivers listed on the back of this card.

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Emergency Identification Cards(BACK)For your parent’s wallet:

EMERGENCY MEDICAL ID
Medical Conditions:Allergies:
Medication:
Medication:
Medication:
Medication:

For yours:

IN CASE OF EMERGENCY
NAME

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PHONE

PHONE

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Emergency Medical Information
Fill this out and place it in a clear plastic bag with a copy of your parent’s medications list, advancedirectives, and any medical orders. If more than one elderly person resides in the house, include
a photo. Tape the bag to the refrigerator door (or inside of the front door), with “EMERGENCY
MEDICAL INFORMATION” clearly visible. Update the information regularly.

Name

Nickname

Address
Phone

Cell

Date of birth

Gender M/FPrimary language
Primary insurance provider

Policy number

Secondary insurance provider

Policy number

Do you have a living will? ❍ Y ❍ N

Health care proxy? ❍ Y ❍ N

Health care agent:

Phone:EMERGENCY CONTACTS:
Name

Cell phone

Home phone

Primary physician

Phone

Secondary physician

Phone

Preferred hospital

Phone

Work phone

MEDICAL CONDITIONS/DISABILITIES:

Allergies
Past surgeries (TYPE/ DATE)HeightWeightBlood Type

Needs: ❑ Glasses ❑ Dentures ❑ Hearing aid ❑ Oxygen ❑ Cane/Walker

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Medications List
Keep track of all your parent’s medications (including over-the-counter drugs and supplements).
Update this list any time prescriptions change.

DRUG(brand and generic)

START / END
DATESDESCRIPTIONPURPOSEDOSE / INSTRUCTIONS(ex.: 10 mg, 3x/day, withfood)

PRESCRIBING
DOCTOR / PHONE(ex.: white, oval)

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Weekly Medications Chart
When multiple medications and/or multiple caregivers are involved, it’s wise to have people checkoff when each pill is taken so there are no mix-ups.

Drug:

TIME

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THU

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TIME

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TIME

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TIME

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TIME

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TIME

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TIME

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TIME

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Dose:
Instructions:

Drug:
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Instructions:

Drug:
Dose:
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Drug:
Dose:
Instructions:

Drug:
Dose:
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Drug:
Dose:
Instructions:

Drug:
Dose:
Instructions:

Drug:
Dose:
Instructions:

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Medical Contacts
PRIMARY PHYSICIAN _____________________________________________________________________
Address ___________________________________________ Email _________________________________
Phone_______________________________ Second phone ________________________________________PHYSICIAN _______________________________________________________________________________
Address ___________________________________________ Email __________________________________
Phone_______________________________ Second phone ________________________________________PHYSICIAN _______________________________________________________________________________
Address ___________________________________________ Email __________________________________
Phone_______________________________ Second phone ________________________________________DENTIST _________________________________________________________________________________
Address ___________________________________________ Email __________________________________
Phone_______________________________ Second phone ________________________________________PHYSICAL / OCCUPATIONAL THERAPIST _____________________________________________________
Address ___________________________________________ Email __________________________________
Phone_______________________________ Second phone ________________________________________PHARMACY _______________________________________________________________________________
Address __________________________________________________________________________________
Phone ____________________________________________________________________________________HOSPITAL ________________________________________________________________________________
Address __________________________________________________________________________________
Phone ____________________________________________________________________________________OTHER ___________________________________________________________________________________
Address __________________________________________________________________________________
Phone ____________________________________________________________________________________
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Medical Log
Keep a log of ailments, symptoms, appointments, test results, and other medical information that you
can refer to as your parent’s health and medical needs change.

DATE

SYMPTOM /ISSUE

how to care for aging parents

CLINIC /DOCTORSEEN

NOTES / TESTS /PROCEDURESINSTRUCTIONS

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Home Safety Checklist❑ Program the phone with 911 on speed dial. Be sure it’s clearly marked.
❑ Post emergency information by the phone or on the refrigerator (whom to call in case of
emergency, house street address and cross street, medical information).
❑ Lock up or clearly label harsh cleaning agents, insecticides, chemicals, etc.
❑ Lock up firearms.
❑ Check that smoke and carbon monoxide detectors work.
❑ Purchase a backup generator for use in case of a power outage.
❑ Store a flashlight by the bed.
❑ Set the hot water heater to 120°F (as elderly people are easily scalded).
❑ Mark hot and cold taps clearly.
❑ Remove or tack down loose rugs (remove throw rugs).
❑ Clear pathways of clutter, small furniture, electrical cords, etc.
❑ Install handrails along stairs and hallways (one on each side of a stairwell).
❑ Install grab bars in the bathroom, but also near the closet or bed, if needed.
❑ Fix loose floorboards and remove thresholds at doorways.
❑ Get rid of wobbly chairs, three-legged tables, or other unstable furniture.
❑ Use nonslip treads and/or mark the edges of steps with bright tape.
❑ Check that lighting is adequately bright and evenly distributed.
❑ Be sure light switches are easy to locate and use.
❑ Reduce glare by aiming lights at walls or ceilings.
❑ Use night-lights along any path your parent might use at night.
❑ Switch to lever-style handles (which are easier to use).
❑ Consider a raised toilet seat.
❑ Use rubber mats and nonslip strips on floors that might be wet (in the bathroom and kitchen).
❑ Place items your parent uses frequently on shelves that are easily reached.
❑ Clearly mark stove dials, epecially the OFF position, with red tape or nail polish.
❑ Note food expiration dates and review basic food safety tips.
❑ Be sure all medications are clearly labeled so your parent can easily read them.
❑ Dispose of medications that are no longer needed.

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Community Services
To find services in your parent’s community, contact the area agency on aging, which you can findthrough the Eldercare Locator (eldercare.gov or 800-677-1116).

PHONE / WEBSITECONTACT PERSONNOTESArea agency on aging

Senior center

Adult day services
Transportation
services
Meal programs
Chores /Home repair
Companions /Visitors
Home care agency

Phone reassurance
Geriatric caremanager
Hospice

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Employment Agreement
This agreement between _____________________________________________________ (employer) and_______________________________(employee) ___________________________________ (address)_______________________________(phone) ________________________________________ (email)is effective starting on ______________________________________ (date). The employee agrees tocare for ______________________________________ (the client) during the following days and hours:_____________________________________________________________________________________
The client has the following limitations and needs: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Services to be provided by the employee include, but are not limited to:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________The employer will pay $___________ /____________ (hour/day/week) for these services.
The employee understands that despite any physical or mental limitations, this client deserves
to be treated with respect, dignity, and compassion. The client should retain as much autonomy as
possible. The employee must not take advantage of or coerce the client in any way.
Changes in the terms of employment must be arranged with the employer in advance. The
employee promises to discuss any concerns, problems, changes in symptoms, or mishaps with theemployer as soon as they arise. The employee will keep a log and receipts of any approved expenses.
Likewise, the employer understands that the employee deserves respect, privacy, patience, andcompassion. The employer also agrees to discuss any concerns with the employee as they arise.
Signed this day by:_____________________________________________(employee) _________________________(date)_____________________________________________(employer) _________________________(date)

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Caregiver Contacts
When siblings, therapists, aides, and companions are all providing care, it helps to keep a masterlist of who’s who.

NAME/TITLE

PHONEEMAIL AND / OR ADDRESS(c)___________________________(h)___________________________(w)___________________________(c)___________________________(h)___________________________(w)___________________________(c)___________________________(h)___________________________(w)___________________________(c)___________________________(h)___________________________(w)___________________________(c)___________________________(h)___________________________(w)___________________________(c)___________________________(h)___________________________(w)___________________________(c)___________________________(h)___________________________(w)___________________________(c)___________________________(h)___________________________(w)___________________________(c)___________________________(h)___________________________(w)___________________________

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Daily Log
When multiple caregivers are involved, you may want to keep a log of who’s doing what. Circle orhighlight the boxes to indicate what needs to be done on each day, and then ask caregivers to checkoff each item when it’s done. Here’s an example:

SUN

MON

TUES

WED

THU

FRI

SAT

Shower
ShampooOral care
Nail care
Shave
Get dressed
Breakfast
ToiletingMorning meds
Wound care
Skin care
Laundry
Clean kitchen
Change linens
Vacuum/Dust
Lunch
Afternoon
meds
Emails/Calls
Groceries
Exercises
DinnerDress for bed
Night meds
Other

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Family Caregiver Contract
When one family member does most of the caregiving, compensation for the work can ease family
tensions and reduce stress on the primary caregiver. However, the details need to be carefully ironed
out. It’s wise to consult an attorney when drafting such a document, because taxes and Medicaid
eligibility can be affected. This provides a starting point as you write your own agreement:This agreement between __________________________________________________ (caregiver) and___________________________________________________________________________________________________________________________________________________________(family members)
is effective starting on _______________________________ (date).
The caregiver agrees to care for _____________________________________ (parent’s name) during
the following days and hours: ___________________________________________________________The duties will include, but are not limited to [be as specific as possible]:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
As compensation, the caregiver will receive ________________________________________________[This might be a weekly fee comensurate to what local home care agencies charge, a lump sum,or some other compensation, such as free rent or proceeds from a life insurance policy.
Note: Compensation is considered income and is subject to taxes.]
The caregiver will get vacation and personal days as follows:______________________________________________________________________________________________________________________.
When a sibling steps in to provide respite, he or she will not be paid, as assisting temporarily is a filial
duty and not a full-time arrangement. If the caregiver is sick, the backup plan is __________________________________________________________________________________________________.
We, the other siblings and family members, understand that compensation is the right thing to do and
we fully support it. We bear no grudges or reluctance in endorsing this agreement. We will continue
to help our parent and the primary caregiver in any way we can.
Signed by:_______________________________________________________ (date)________________________________________________________________________________ (date)________________________________________________________________________________ (date)________________________________________________________________________________ (date)_________________________

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Financial/Legal Contacts
Account information and passwords are extremely private, so store this in a safe place.

PRIMARY BANK __________________________________________________________________________
Contact __________________________________________ Phone _________________________________
Account #/description _____________________________________________________________________
Website _____________________________ Login/password _______________________________________SECONDARY BANK _______________________________________________________________________
Contact __________________________________________ Phone _________________________________
Account #/description_____________________________________________________________________
Website _____________________________ Login/password _______________________________________

ACCOUNTANT_____________________________________________________________________________
Firm _____________________________________________ Phone _________________________________
Email _____________________________________________________________________________________LAWYER _________________________________________________________________________________
Firm _____________________________________________ Phone _________________________________
Email _____________________________________________________________________________________FINANCIAL ADVISOR _____________________________________________________________________
Firm _____________________________________________ Phone _________________________________
Email _____________________________________________________________________________________

INSURANCE AGENT ______________________________________________________________________
Firm _____________________________________________ Phone _________________________________
Email _____________________________________________________________________________________

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Financial Planner
If you are (or one day might be) helping with your parent’s finances, you will need a list of assets
and liabilities. Gather records, contracts, bills, agreements, trusts, account numbers, and so forth,or know where that information is kept. Update these records as needed.

ACCOUNT #BALANCE

Savings account______________________________________________

Checking account______________________________________________

Investment account______________________________________________

Other securities/funds______________________________________________

Retirement accounts (IRA, 401k)______________________________________________DESCRIPTIONVALUEReal estate______________________________________________

Cars, boats, and other vehicles______________________________________________

Valuables (jewelry, paintings, etc.)______________________________________________

Business and partnership agreements ______________________________________________

Profit-sharing and pension plans______________________________________________

Annuities______________________________________________ASSETSLife insurance______________________________________________

Other______________________________________________DEBTS

DESCRIPTION

Mortgage______________________________________________Car loan______________________________________________

Other outstanding loans______________________________________________

Credit card debt______________________________________________

Other______________________________________________ESTIMATED FUTURE EXPENSES
Home renovations (to make it more accessible)

AMOUNT

COST_______________________

Assisted living devices(automatic door openers, stair lift,hearing/vision aids, walkers, etc.)_______________________

Medical bills, copays_______________________

Home health care_______________________

Assisted living and/or nursing home_______________________

Legal/financial fees_______________________

Funeral expenses_______________________

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Monthly Budget
If you are helping your parent create a budget, make a list of all income and expenses, so you know
where the money is going and what can be trimmed if necessary.

MONTHLY INCOME
Salary/Wages____________________________________

Other business income____________________________________

Retirement benefits (pension, IRA, Keogh, etc.) ____________________________________
Social Security____________________________________

Dividends____________________________________

Interest (from investments)____________________________________

Rental income____________________________________

SSI, food stamps, or other entitlements____________________________________

Other____________________________________MONTHLY BILLS
Mortgage/Rent____________________________________

Taxes____________________________________

Utilities(Gas/Electric/Oil/Phone/Cable/TV/Water)____________________________________

Insurance premiums(Home/Car/Health/Life/Disability/Long-term care) ________________________________
Food____________________________________

Transportation
Car payments/garage fees/gas and upkeep____________________________________

Public transportation____________________________________

Clothing____________________________________

Medical(medications, copays, etc.)
Home and yard upkeep________________________________________________________________________

Interest payments(credit cards, outstanding loans)____________________________________

Hobbies and pastimes____________________________________Pet care____________________________________

Entertainment____________________________________

Gifts/Donations____________________________________

Other________________________________________________________________________

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End-of-Life WishesYour parent needs advance directives (a living will and health care proxy) that are particular tohis state. It’s essential that he also discuss his views at length because the issues that arise are
extremely complicated. Here’s a starting point for these conversations:

YOUR PROXY
s 7HO WILL MAKE MEDICAL DECISIONS ON YOUR BEHALF IF YOU CANNOT MAKE THEM YOURSELF
s 7ILL THIS PERSON BE ABLE TO CONFER WITH DOCTORS AND MAKE HARD CHOICES AT AN EMOTIONAL TIME
s 7HO BEYOND YOUR DOCTORS AND YOUR PROXY SHOULD BE CONSULTED
s $O FAMILY MEMBERS KNOW AND ACCEPT THAT YOUR PROXY WILL BE MAKING DECISIONSIMMEDIATE GOALS
s 7HAT ARE YOUR GOALS AT THIS POINT IN YOUR LIFE
s )S THERE ANYTHING LEFT UNDONE OR UNSAID
s )F THERE IS SOMETHING YOU WANT TO ACCOMPLISH OR DO CAN THAT HAPPEN NOWGENERAL VIEWS
s 7HAT DO YOU FEAR ABOUT ILLNESS AND DEATH
s 7HAT DISABILITY OR SITUATION DO YOU THINK WOULD BE INTOLERABLE
s (OW DO YOUR RELIGIOUS OR PERSONAL BELIEFS AFFECT YOUR VIEWS ON THE END OF LIFE
s (OW WOULD YOU DESCRIBE A hGOODv DEATH
s (OW IMPORTANT IS IT TO YOU WHERE YOU DIE EG AT HOME OR IN A HOSPITAL 

MEDICAL DECISIONSs (OW DIRECT SHOULD YOUR DOCTOR BE WITH YOU $O YOU WANT TO KNOW EVERYTHING
s 7HAT SHOULD BE THE GOAL OF TREATMENT -ORE TIME #OMFORT -OBILITY ,UCIDITY
s (OW MIGHT THOSE GOALS CHANGE IF YOU WERE EXTREMELY ILL AND IN PAINs (OW AGGRESSIVELY SHOULD DOCTORS ACT TO KEEP YOU ALIVEs )F YOU WERE EXTREMELY ILL AND THE PROGNOSIS BLEAK WOULD YOU WANT
Hospitalization

Artificial hydration

Surgery

Resuscitation

Artificial nutrition

Ventilators $O YOU HAVEWANT MEDICAL ORDERS SUCH AS A $.2 OR 0/,34 THAT PROTECT YOU FROM ANY OF
THE ABOVECOMFORTs 7HAT DO YOU THINK OF HOSPICE CARE AND WOULD YOU LIKE THAT FOR YOURSELF
s 7OULD YOU LIKE TO TALK WITH A HOSPICE PROVIDER TO LEARN MORE ABOUT IT
s 7HAT MIGHT BRING YOU COMFORT IF YOU WERE AT THE END OF LIFE &OR EXAMPLE
Music

Visitors

Massage/touch

People talking

Prayer, stories, or music

SilenceA particular pet

Solitude

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