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Senior Emergency Kit Worksheets and Checklists

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April 26, 2011

The Senior Emergency KitSM features several worksheets that family caregivers can complete with the help of a senior loved one. This toolkit can be kept in an easy-to-reach location, such as a nightstand, to allow easy access to information.

Checklist of Things to Have in Your File

Keep these documents about your senior loved one in your information management tool file:

The toolkit is part of the Home Instead Senior Care® network's Answering the Call® program designed to help family caregivers be ready for a call when a senior loved one needs emergency assistance.


Download individual senior emergency tracking kit components below…

Important Contacts

It's important that a family caregiver has easy access to the medical and business professionals that manage their senior's affairs in the event of an emergency. List on the worksheet all of those individuals with whom your senior does business.
Important Contact Information Worksheet (PDF 732k)

Life History Snapshot

Use this worksheet to record key details pertaining to each stage of your senior's life from childhood through older adulthood. Documenting this type of background information is particularly important for a loved one with Alzheimer's or other dementias to help cope with memory loss or manage difficult behaviors.
Life History Snapshot Worksheet (PDF 632k)

Medications and Dosages

Tracking medications is one of the most important exercises that a family caregiver can do to help keep an older adult safe from medication accidents. This worksheet is a valuable resource to keep all of a senior's medications and dosages up-to-date.
Medication Tracker Worksheet (PDF 331k)

Allergies and Conditions

Your loved ones and any emergency workers who may assist your senior in a medical crisis should be aware of allergies or conditions that a senior is suffering from, including:

  • Foods
  • Seasonal Allergies
  • Medications
  • Heart Problems
  • Diabetes
  • Arthritis
  • Macular Degeneration

Allergies and Conditions Worksheet (PDF 247k)

Dementia-Related Behaviors Chart

Behaviors associated with Alzheimer's or other dementias may become more evident as the disease progresses. Use this chart to track the prevalence of these behaviors.
Dementia-Related Behaviors Chart (PDF 654k)

Doctor Visit Worksheet

Doctor visits can be confusing for older adults. Take this doctor visit worksheet to an appointment so you can write down questions, answers, and what you need to do next.
Doctor Visit Worksheet (PDF 592k)

Senior Emergency Wallet Card

Keep emergency information quickly available wherever your loved one goes. Information such as emergency contacts, medical data and a medical conditions list are easily available with this wallet card.
Emergency Wallet Card
(PDF 210k)

Download the complete Senior Emergency Toolkit (PDF 3.9 mb)


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Thoughts and stories from others
  1. June 28, 2014 at 10:11 am | Posted by Lynn V. Bovingdon

    the comment that first came to mind was - check with others who may have had contact with the insurance you are considering. They can tell you if they have had a good or bad experience.

    Reply

  2. March 13, 2014 at 10:12 pm | Posted by Cyndi

    I never thought about being a caregiver, until my best friends mother was dying of cancer, and she asked me to take care of her. I thought, wow, what a privilege to be asked such a important job. It turned out to be one of the most rewarding jobs I have ever had. Now I can not wait to have the privilege to experience that again. It is such a honor to be able to be in someones daily life and to be able to enrich their day, by just being their for them.

    Reply

  3. December 18, 2013 at 5:55 am | Posted by angela williams

    thank you.

    Reply

  4. December 9, 2013 at 6:49 pm | Posted by JOSEPH AVILES

    MAY GOD JEHOVA GOD OF ISRAEL, GOD THE SON JESUS CHRIST, GOD THE HOLY SPIRIT BLESS ALL AND EACH OF YOU. FOR EVER AND EVER ! YOU ALL ARE THE BEST OF THE BEST. THE INTERNATIONAL CARE-GIVER. LE CREAM DU CREAM. AMEN

    Reply

  5. October 21, 2013 at 10:44 am | Posted by ANN BOURQUE

    I'm a the point in my life where I would like to be a companion for a lonely senior, helping with laundry, grociers, ready, taken them on an educational trip, e.t. museum, fine arts, antigue shop, many different things they may like as a I do. Maybe sit and read a good book, play a good board board. Help them with a shower or bath. I think I could make their somewhat quiet life to a much brighter life. I hope a get the chance to help someone who has help my parents when I was in school

    Reply

  6. August 19, 2013 at 7:26 pm | Posted by Esperanza

    It feels great the satisfaction of helping others.

    Reply

  7. August 5, 2013 at 7:46 pm | Posted by Lois Eggleston

    How do I get information and rating on a company that is offering me this kind of insurance? Thanks, Lois

    Reply

  8. July 11, 2013 at 3:27 pm | Posted by marie stfleur

    help wanted LPN private duty/companion with 8 yrs exp. own transportation FT/PT or Perdeem. afternoon/evening shift

    Reply

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