Caregiver Service Plan

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The Nurse Monitor - Develop a Caregiver Service Plan (CSP) that documents services or tasks the caregivers are required to perform for the participant. The nurse monitor must: ask the case manager for a copy of the Plan of Care/Plan of Service (POC/POS), use the POC/POS with appropriate input from the participant and caregivers to help develop the CSP, ensure that caregivers understand all CSP tasks and expectations, complete a new CSP when adding services or tasks, add additional pages as needed and give a CSP copy to both case manager and caregivers. Immediately contact the case manager and other appropriate professionals to report suspected health and safety concerns. (Adult Protective Services at 1-800-917-7383, emergency Personnel, Police, etc.)

Tasks

Personal Hygiene (i.e. bathing, hair, oral, nail, and skin care)

Toileting (i.e. bladder, bowel, and bed pan routines; movement to/from bathroom)

Dressing & Changing Clothes

Mobility & Transfers

Eating & Drinking

Medications

Place a check next to each required item

Light Housekeeping

Errands

Other

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