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Senior Emergency Kit Worksheets and Checklists

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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® 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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Last revised: April 26, 2011

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Thoughts and stories from others
  1. July 13, 2011 at 9:21 am | Posted by Cat Koehler, Social Media Advocate, Home Instead

    Thanks to everyone for the interest in this valuable kit! Because many of the needed documents are not standard, we were not able to include them in the kit. Work with your attorney and health care professional to complete the following: • 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 You can also go to http://www.HomeInstead.com to locate your local office to request a kit. Just enter your city and state or zip code. Cat Koehler Social Media Advocate Home Instead

    Reply

  2. July 11, 2011 at 2:37 pm | Posted by Vickie Wheeler

    I would like to know how to get the entire booklet. with all the items mentioned but I can not find out how to download...•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 these are the ones which I need. Love this helpful info... I saw the info on channel 4 TV Little Rock AR... I could not get the number in my phone before the segment was over. Please Help Thank You in advance

    Reply

  3. July 11, 2011 at 1:31 pm | Posted by Jo Cox

    How do I order this packet I live in Sherwood, Arkansas

    Reply

  4. July 9, 2011 at 3:58 pm | Posted by Kim Fair

    This is a wonderful idea for all not just seniors. However it is quite inconvient to have to print each page seperately, or go to another webpage to find a location in my area and then call and have someone mail it to me. This should be "one click" easy for the whole packet.

    Reply

  5. July 9, 2011 at 1:35 pm | Posted by Nancy Schroeder

    Please send me the Senior caregiving medical information kit or do we have to download each and every separate item????

    Reply

  6. July 7, 2011 at 9:39 am | Posted by ckoehler

    Jennifer - You can contact your local Home Instead to request a kit. Visit www.HomeInstead.com to locate your local office. Cat Koehler Social Media Advocate Home Instead

    Reply

  7. July 6, 2011 at 3:58 pm | Posted by Jennifer Gillingham

    Where can I order the WHOLE packet??

    Reply

  8. July 6, 2011 at 2:56 pm | Posted by Maureen Chabot

    I really love the idea of the different worksheets for the senior community to have at their fingertips but I'm afraid they are not very easy to read...especially the "Important Contact" worksheet that has them lining up the horizontal information w/the vertical. Although the good information is there, it's not easy to determine at a glance. Not very "Senior Friendly".

    Reply

    • February 25, 2012 at 12:41 pm | Posted by Cristian

      Great find and post. Thanks for sahirng those very useful information and advice which are needed to be at hand specially in times of emergencies.Keep posting.

      Reply

  9. July 6, 2011 at 12:15 pm | Posted by Lowell Banks

    I like the work sheets but would like to download in word format so I could type in the information on the computer. Is this possible?

    Reply

  10. July 5, 2011 at 7:00 am | Posted by Home Instead® network's Senior Emergency Kit | cdaamerica

    [...] This toolkit will provide you with all the important information you need in a centrally located file so you are ready for a crisis, day or night. The toolkit materials are available for download here. [...]

    Reply

  11. July 1, 2011 at 8:44 pm | Posted by Barbara Andersen

    I thought the kit looked interested, but can't find the "button" that will enable me to print the kit -- it seems awkward to have to open each underlined section and then print it -- isn't there a place where the entire kit can be printed at one time.

    Reply

  12. July 1, 2011 at 10:38 am | Posted by ckoehler

    Hi Shirley! You can download and then print the documetns by clicking the links above. The links are underlined and pink. Thanks!

    Reply

    • February 25, 2012 at 12:10 pm | Posted by Josie

      Thanks for pnsoitg! Im a volunteer for the Red Cross, and everyone needs this info! So many people think it cant happen to them, but on any given day it can happen to anyone!

      Reply

  13. June 29, 2011 at 2:55 pm | Posted by Shirley

    How do you download the kit? Or order it by mail?

    Reply

  14. June 29, 2011 at 8:11 am | Posted by Jan

    For George, You have to print out the pages yourself. Use the "pink" underlined PDF at the end of each paragraph.

    Reply

  15. June 25, 2011 at 9:31 am | Posted by Having “The Talk” « Straw Flowers

    [...] Contact Names and Numbers [...]

    Reply

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