Life Care Plan Outline

I.	Home Care Training
	A.	Make Training Tape 
	B.	Train Care Givers
	C.	Training Content
		1. 	Tube Feeding and Care of the Feeding Tube
		2. 	Medications
		3. 	Physical Therapy
		4. 	Transfers and turning - Hoyer lift, transfer board, physical lifting
		5. 	Breathing Treatments, Lung Care
		6. 	Wound Care
		7. 	Cleaning and Dressing
		8. 	Emergency Procedures
		9. 	General Health Evaluation and Assessment
		10.	General Rountine, ie., blood pressure, labs
		11.	Written Treatment Plan
		12.	Other ________________________________________________

II.	Physical Space
	A.	Home Evaluation
	B.	Air Conditioning
	C.	Room and Storage
		1.	Short Term - In process
		2.	Long Term - In process

III.	Medical, Physical Therapy, Occupational Therapy, Cognitive Therapy 
	A. Doctors
		1. Drs.
		2. Routine Care Outside the Home
			a. Who, When and How Often
	B. Skilled Nursing
		1. Who, When and How Often
	C. Emergency Plan
		1. Transportation
		2. Hospital or Urgent Care
	D. Physical Therapy
		1. Physical Needs, table, etc.
		2. Who, When and How Often
	E. Occupational Therapy
		1. Physical Needs
		2. Who, When and How Often
	F. Cognitive Therapy
		1. Needs - books, voyager, computer, tapes, people, animals, music, etc.
		2. Who, What, When and How Often

IV.	Daily Living and Care
	A. Family
		1. Who, When and How Often
	B. Paid Personnel
		1. Who, When and How Often
	C. Volunteers
		1. Who, When and How Often

V.	Respite for Care Givers 
	A. Who, When and How Often

VI.	Transportation 
	A. Ambulance
		1. Transfer from InterMed
		2. Emergency
	B. Van 
		1. Needs - Ramp or Lift, Chair Tie Downs, Head Restraints, Seat Belt

VII.	Daily Schedule

VIII.	Supplies and Medications
	A. Medical
		1. Wound Care
		2. Urinary Supplies
		3. Pressure Relief
		4. Medications
	B. Nutritional
		1. Tube Feeding
	C. Physical

IX.	Equipment 
	A. Medical
		1. Breathing Machine
		2. Suctioning Machine
	B. Nutritional
		1. Feeding Pump
	C. Physical
		1. Bed
		2. Portable and Permanent Lift
		3. Wheel Chair
		4. Bathing
			a. Bed Device
			b. Shower/Commode Chair
		5. Exercise Table
		6. Other physical therapy equipment
		7. Other occupational therapy equipment

X.	Written Treatment Plan with Goals

XI.	Follow-Up

XII.	Spiritual

XIII.	Financial
	A. Social Security
	B. State of Michigan
	C. Health Insurance
	D. Medicaid/Medicare
	E. Automobile Insurance
	F. Other