Respite Care Information Sheet

Who this is for

One page that goes with the person. It tells a respite provider how the day usually runs, what the person likes and dislikes, the help they are used to, what equipment is coming with them and who to ring — written by the people who know, for the people who are about to meet them.

Families arranging a respite stay, day service or short break, carers taking a holiday and handing over to someone new, and providers who would rather have the family's own account than work it out over the first two days.

What this helps you track

• How the day runs — waking, meals, rest, bed — in the family's words
• Likes and dislikes, from food to noise to how they like to be spoken to
• The help the person is used to, and what they do for themselves
• Equipment and belongings that travel with them
• Who to contact, in what order, and where the medication record is

How to use it

1. Fill in the person's details, the dates of the stay and where they are going.
2. Write the usual day in the first box as a simple sequence, with the times that matter to them.
3. Fill in likes, dislikes and the help they are used to as plainly as you can; a new carer will read this on the first morning.
4. List the equipment and belongings going with them, so that they come back.
5. Put the contacts in the order you want them rung, and note that the medication record travels with the person.
6. Give the provider the sheet on arrival and keep a copy, or fill it in online and save it in your own browser.

Formats

• Printable PDF (A4 and US Letter)
• Fillable PDF with form fields
• Fill in online, saved in your browser

The printable is laid out inside a box that fits both A4 and US Letter, so the two files are identical and neither one is scaled. The fillable PDF has real form fields. The online version keeps what you enter in your own browser and builds the completed PDF on your device.

How to print

Download the A4 or US Letter file to match the paper in your printer, open it in a PDF reader and print at 100% — not "fit to page", which shrinks the writing space. Both files leave a 14 mm margin, which clears the unprintable edge on home printers. To print the online version with your entries in it, use the Print this sheet button, which prints only the sheet and none of the page around it. More on printing.

Questions

Where do medicines go on this sheet?

They do not. Medicines are on the medication administration record, which travels with the person; this sheet only says that it does and where it is. Keeping the two separate stops a summary being read as an instruction.

How much do we write?

One page is the point. A provider reads this on the first morning between two other things; the things that make the person's day go well are what matters, not a full history.

Is this a care plan?

No. The care plan and any assessment come from whoever arranged the care. This is the family's own one-page introduction, and it sits alongside those rather than replacing them.

Can the person write it themselves?

Yes, and that is the best version. Where they cannot, write it with them as far as possible and say at the top who wrote it.