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:
- Contact Names and Numbers
- Life History Snapshot
- Medication Tracker
- Allergies and Conditions Worksheet
- Dementia-Related Behaviors Chart
- Doctor Visit Worksheet
- Health Care Proxy
- DNR (Do Not Resuscitate) Order
- Advance Directives such as Living Will and Durable Power of Attorney
- Insurance Policies
- Will and Testament
- Copy of Medicare/Medicaid Card
- Anatomical Gift/Organ Donation Card
- Valuables Designation List
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…
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:
- Seasonal Allergies
- Heart Problems
- 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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