Home Care Client Intake Checklist
Everything to collect before a new home care client's first visit: contacts, payer, needs assessment, home safety, preferences, schedule and signed documents.
By Caregiver Scheduling Team ·
A good intake collects everything you need to start care safely and bill correctly: client and contact details, who pays, the client’s needs and routines, home safety risks, caregiver preferences, the starting schedule, and signed documents. Do it at an in-home assessment, usually 60 to 90 minutes, and turn it into the care plan before the first visit.
What should a client intake form include?
Seven sections. Collect every line before you schedule the first visit.
| Section | Collect | Why it matters |
|---|---|---|
| Contacts | Client name, date of birth, address, phone, entry instructions, responsible party, two emergency contacts, physician, pharmacy | Caregivers need to get in, and the office needs someone to call |
| Payer | Private pay, long-term care insurance, Medicaid or waiver, VA, deposit if required | Sets the rate, the paperwork and the billing cycle |
| Needs | ADLs and level of help, IADLs, memory, mobility, fall history, diet, allergies, medication reminders | Becomes the care plan and the caregiver’s task list |
| Home | Pets, smoking, stairs, parking, hazards, equipment such as walker or shower chair | Safety for client and caregiver, and what to bring |
| Preferences | Caregiver gender or language, routines, likes and dislikes | Drives matching and the first impression |
| Schedule | Days, start and end times, start date, minimum visit length | Goes straight onto the calendar as recurring visits |
| Documents | Service agreement, client rights, privacy notice, information releases, care plan | Required before care starts in most licensed states |
Who pays, and what do you need from them?
Settle the payer before the needs assessment, because it changes what you collect next.
- Private pay: the responsible party’s name, billing address, payment method and a signed service agreement. Collect any deposit your agreement requires.
- Long-term care insurance: policy number, carrier contact, elimination period, daily benefit and the forms the carrier needs from you. See billing long-term care insurance.
- Medicaid or waiver: the authorization number, approved service code, units per week and the authorization end date. Put the cap on the client record so you do not schedule past it. See authorization tracking and the Medicaid waiver tool.
- VA: the authorization and the VA contact who approved it.
What does the needs assessment cover?
The client’s daily routine, task by task, and what help each task needs. Walk through a normal day from waking to bed. For each ADL (bathing, dressing, toileting, transferring, eating, continence) note whether the client is independent, needs standby help, needs hands-on help or is dependent. Add IADLs: meals, housekeeping, laundry, shopping, transportation, medication reminders. Then record fall history in the last year, memory or judgment concerns, diet, allergies, and anything the family worries about most. Use the ADL checklist if you want a printed form.
What should you check in the home?
Anything that could hurt the client or the caregiver. Look at entry and parking, stairs and railings, lighting, loose rugs, the bathroom (grab bars, shower chair, non-slip mat), bed height, oxygen and smoking, pets, and where equipment lives. Note the cell signal too, since GPS check-in depends on it.
Which documents must be signed before the first visit?
At minimum the service agreement, a client rights statement, a privacy notice and releases that let you talk to family, physicians and the insurer. Many states require a written information packet before services start. Pennsylvania’s 28 Pa. Code 611.57, for example, requires agencies to give the consumer fees on an hourly or weekly basis, hiring and competency requirements, the state complaint hotline, and whether the worker is an employee or a contractor. Check your state in the licensing tool.
If your agency is a HIPAA covered entity, 45 CFR 164.520(c)(2) requires you to give the notice of privacy practices no later than the first service delivery and to make a good-faith effort to get a signed acknowledgment. Many private-pay agencies are not covered entities, but the notice is still good practice. See HIPAA for non-medical home care.
When does intake have to be finished?
Before the first visit, with the care plan written and the first caregiver briefed. Some states set deadlines. Minnesota’s home care statute, Minn. Stat. 144A.4791, requires the initial assessment within 5 days of starting comprehensive home care, the initial review within 30 days for basic home care, and a written service plan within 14 days. Treat those as outer limits, not targets.
| Step | When | Who |
|---|---|---|
| Phone inquiry and screening | Day 0 | Office |
| In-home assessment and signatures | Within 2 to 3 days | Care manager or supervisor |
| Care plan written, caregiver matched and briefed | Before first visit | Care manager |
| First visit, supervisor introduces caregiver | Start date | Caregiver and supervisor |
| First reassessment | 60 to 90 days, or as the state requires | Care manager |
How Caregiver Scheduling handles this
Enter the recurring pattern on the client’s record and the calendar builds every week from it, with preferred caregivers assigned by default and, on Growth and up, authorized hours kept in check. Caregivers see the address, care plan, task list and recent notes in the app before they arrive, and geofenced check-in confirms they did. $199/month for up to 10 caregivers or $299/month for up to 50, free for 30 days.
FAQ
How long should intake take? An in-home assessment usually runs 60 to 90 minutes. Allow another hour in the office to write the care plan and set up the record.
Who should do intake? A care manager or supervisor who can judge needs and safety.
Can I do intake over the phone? Collect contacts and payer by phone, but assess needs and the home in person.
This article is general information, not legal advice. Check your state’s home care licensing rules for required intake documents and deadlines.