All caregivers need some time off. But entrusting someone else to care for their loved one can cause stress and anxiety – and result in the caregiver not taking the time away they need to remain healthy, both physically and mentally.

It is essential that caregivers have planned temporary, intermittent, substitute care, allowing for relief from the daily responsibilities of caring for the care recipient. It can take place in an adult day center, or in the home of the person being cared for.

This checklist can help ease the caregiver’s mind, knowing that the person providing respite care has all the information he or she needs to provide complete, safe care.

Printable Respite Care Checklist 

Information to include in the checklist

• Patient Name
• Dates caregiver will be away
• Caregiver's location and phone number
• Diseases / ailments patient suffers from
• Symptoms
• Allergies

Medical and emergency care

• Primary care doctor, including phone and location
• Specialist doctors, including phone and location 
• Nearest hospital, including phone and location
• Medical Insurance information
• Friends and Relatives to contact in an emergency
• Medications, including name, dose, time to give and special instructions

About the patient

• Appointments (doctor's office, physical therapy, beauty/barber, visit friends, activities, etc. Include date, time, location, contact name, phone number)
• Patient's general emotional state (shy, weepy, sudden outbursts)
• Favorite distractions
• Dislikes
• Moving the patient (moves around unassisted, needs assistance, requires lift/wheelchair/walker, bedbound)
• Physical Therapies/ Exercises Needed
• Toileting (Catheter Colostomy Bedside commode Bedpan Incontinent pads)
• Bed time
• Wake time
• Nap time

Meals

• Eats unassisted, needs to be fed,  has difficulty swallowing, eats soft foods only, tube feeding
• Breakfast time
• Lunch time
• Dinner time
• Snack time
• Food allergies
• Special eating instructions

Entertainment

• What patient enjoys (TV, radio, reading, being read to, cards)
• Activities to avoid

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Related Links

National Adult Day Services Association, Inc.
866-890-7357
This association provides information about locating adult day care centers in your local area.

National Respite Locator Service
800-473-1727, ext. 222
Access a list of sites nationwide. While the vast majority focuses on respite care for families of special needs children, the service now assists programs that provide respite for caregivers of adults and the elderly.

Visiting Angels
A national network of non-medical, private duty care agencies that can provide respite and companion care.

Lotsa Helping Hands
A simple, immediate way for friends, family, colleagues, and neighbors to assist loved ones in need. Includes a private group calendar, designed for organizing helpers, where everyone can pitch in with meals delivery, rides, and other tasks.