One sheet per visit. The caregiver records which activities of daily living (ADLs) and instrumental activities (IADLs) they helped with and how much help the client needed.
Assistance levels: I = independent, S = standby / cueing, P = partial hands-on help, F = full help, R = refused,
N/A = not in care plan
Activities of daily living (ADLs)
Activity
Level
Notes
Bathing / shower
Dressing
Grooming (hair, teeth, shaving)
Toileting
Continence care
Transferring (bed, chair)
Walking / mobility
Eating
Instrumental activities (IADLs)
Activity
Done?
Notes
Meal preparation
Light housekeeping
Laundry
Medication reminder (not administration)
Errands / shopping
Transportation / escort
Companionship / activities
Changes to report to the office today
Fall or near-fallNew painSkin change or rednessConfusion or mood changeNot eating or drinkingRefused careOther:
Caregiver signature
Why record an assistance level instead of a checkmark?
A level shows change over time. A client who moved from standby to partial help with transfers over a month needs a
care plan review, and a checkmark would hide that. File each sheet with the care plan, and have the office review new
sheets the same day for reported changes.
How Caregiver Scheduling handles this
Caregivers record visit notes in the app, and AI note taking turns what they say into a draft note they review and sign before leaving. See AI visit notes.
These free tools are made by the team behind Caregiver Scheduling,
caregiver scheduling software for home care agencies.
Simple pricing
From$199/month
Up to 10 caregivers on Starter, 50 on Growth.
More than 50 caregivers? We'll put together a custom Scale plan for your agency.
