Caregiver Forms
Caregiving can become very overwhelming but getting yourself organized can help you stay in control. Taking ten minutes to fill out these forms right now can save you hours later. It also allows you to print copies for other caregivers, family members and professionals who need this information, saves you from repeating it and keeping everybody on the same page.
You may download the following Caregiver Forms and if you would like to fill in your data via keyboarding then you must have Adobe Acrobat. Click here to download a free version.
Please note that these forms are copyrighted and are only authorized for personal use.
Best wishes and good health in your caregiving!
Simply click onto the form icon that you want:
- My Med Minder (.pdf format)
- My Medical Biography (.pdf format)
- My Medical Data (.pdf format)
- My Contact Sheet (.pdf format)
- Daily Living Tasks Work Sheet (.pdf format)
- Caregiver Resource Assessment Worksheet (.pdf format)
Nursing Home Navigator
Researching a good nursing home (skilled nursing facility) is no small task, especially if you're doing the research during a medical crisis. My navigational guide should help you get a solid start but it's not meant to be the only tool you use.
- Part 1 identifies questions you can ask over the phone to narrow your search. Ask to speak to the Admissions Director.
- Part 2 centers on Nursing Home Survey and Inspection Reports. It guides you on how to get the reports, what to look for, and how to interpret the findings.
- Part 3 gives you a list of things to look for when you visit the facility.
Throughout the guide you're given tips to help you better understand why you're asking these questions. Feel free to make copies of this guide for each facility you research.
- Click here to dowload the Guide (.pdf format)
Resource Directory
Government Agencies and Services || Caregiving Resources
General Resources || Books of Interest
Health and Medicine
Alcoholics Anonymous (AA)
Alzheimer's Association
Alzheimer's Disease Education and Referral Center
American Diabetes Association
American Heart Association
The American Lung Association
Arthritis Foundation
Healthfinder
The Lighthouse National Center for Vision and Aging
MEDLINEplus
National Association for Continence
National Coalition for Cancer Survivorship
National Council on Alcohol and Drug Dependence
National Eye Institute
National Health Information Center
National Heart, Lung and Blood Institute
National Institute of Diabetes, Digestive and Kidney Diseases
National Institute of Mental Health
National Institute of Neurological Disorders and Stroke
National Institute on Aging
National Institutes of Health
National Mental Health Association
National Osteoporosis Foundation
National Sleep Foundation
National Stroke Association
Paralyzed Veterans of America
Parkinson's Resource Organization
Self Help for Hard of Hearing People
Death and Dying
Aging with Dignity
American Hospice Foundation
Growth House, Inc.
National Hospice Organization
Government Agencies and Services
Access America for Seniors
Administration on Aging
Department of Veterans Affairs
Eldercare Locator
Housing and Urban Development (HUD)
Medicare Hotline
Social Security Administration (SSA)
Caregiving Resources
Children of Aging Parents
National Association of Professional Geriatric Care Managers
National Family Caregivers Association
National Federation of Interfaith Volunteer Caregivers
General Resources
AAA Foundation for Traffic Safety
Abledata[md]Assistive Technology
American Association of Homes and Services for the Aging
American Association of Retired Persons (AARP)
Center for Medicare Advocacy
Commission on Legal Problems of the Elderly
ElderWeb
Families USA
Meals on Wheels Association of America
National Academy of Elder Law Attorneys, Inc.
National Association for Hispanic Elderly
National Association for Home Care
National Caucus and Center on Black Aged
National Consumers League
National Council of Senior Citizens
National Council on the Aging
National Safety Council
National Shared Housing Resource Center
The National Women's Health Information Center
Older Women's League (OWL)
SeniorLaw
Visiting Nurses Association (VNA) of America
Phone: 212-870-3400
Website: www.alcoholics-anonymous.org
Check your phone book first for a local chapter. AA offers support to alcoholics and their families. Click on "Is there an Alcoholic in your Life?" to help answer questions about family members and loved ones.
Phone: 1-800-272-3900
Website: www.alz.org
This is an excellent organization with a Web site that offers you a wide range of information and support services. Provides a caregiver's guide, "ask the expert" online, medical information, and a finder to locate your local Alzheimer's chapter.
Phone: 1-800-438-4380
Website: www.alzheimers.org
This site provides the latest information on new treatments; you can track current clinical trials and how to connect to 20 national Alzheimer's disease centers throughout the country. The site also keeps you posted on results of the most recent research studies.
Phone: 1-800-342-2383
Website: www.diabetes.org
The association's Web site is very extensive giving you the latest in research, general info, nutrition, news, lifestyle tips, and links to other great sources. On this site you can also find local chapters near you.
Phone: 1-800-242-8721
Website: www.americanheart.org
This group provides research, information, and education about the heart. Click on a great site map to see what's available. Includes: warning signs of heart attacks and stroke; separate sections on women; patient information; and links to other sites.
Phone: 1-800-586-4872
E-mail: info@lungusa.org
Website: www.lungusa.org
Contact a local chapter by typing in your zip code on the Web site. Search the site for information on all lung topics[md]asbestos, air quality, tobacco, tuberculosis, etc. View and download free pamphlets.
Phone: 1-800-283-7800
Website: www.arthritis.org
This foundation offers very good consumer health information on prevention and treatment of arthritis. It provides information and referral services and can refer you to a local chapter, support groups, and classes by phone or at the Web site. The Web site also has a product store and a section on advocacy.
Website: www.healthfinder.gov
This is a gateway site to consumer health and human services information from the U.S. Department of Health and Human Services. It's a great site, easy to use, has links to agencies and databases, and has a directory of services.
Phone: 1-800-334-5497
Website: www.lighthouse.org
This center provides very helpful information for those with vision problems, and a terrific catalog of devices to make life easier and vision better. It will also tell you where a low vision clinic is near you.
Website: www.nlm.nih.gov/medlineplus
This is the site for the National Library of Medicine and National Institutes of Health; if you want to bookmark just one site for your medical information, this is it. It's a terrific resource for all kinds of medical information linking you to other resources. Click on the drug information site[md]you can review reports on over 9,000 prescription and over-the-counter drugs.
(formerly Help for Incontinent People)
Phone: 1-800-252-3337
Website: www.nafc.org
Provides education, information, advocacy, and support for the public and health professionals on incontinence. The Web site includes "10 Warning Signs of Incontinence," a guide to products, and a continence referral service.
Phone: 877-622-7937
E-mail: info@cansearch.org
Website: www.cansearch.org
This is a patient-led organization for patients with cancer and their families. The Web site includes a "Help for Caregivers" section with a "Cancer Survival Toolbox" series[md]listen to audiotapes or view transcripts. Click on CanSearch: Online Guide to Cancer Resources for an excellent primer on how to get cancer information on the Web.
Phone: 212-206-6770; 1-800-622-2255 for affiliate referral
Website: www.ncadd.org
This is a nationwide, voluntary organization dealing with alcoholism and other drug addictions. It provides education and information, along with advocacy efforts. Click on "Publications" to get a copy of the brochure "What are the Signs of Alcoholism?" a self-test to determine if you or a family member needs to discover more about alcoholism.
Phone: 301-496-5248
Website: www.nei.nih.gov
This institute specializes in vision[md]research and information for professionals, the public, media, and educators. The Web site has everything[md]a search function, eye charts, online publications, and a great site map.
Phone: 1-800-336-4797
E-mail: nhicinfo@health.org
Website: www.nhic-nt.health.org
This is a multi-purpose Web site designed to help the general public and professionals find health information. It includes a listing of health-related organizations, with links, and a year 2000 list of toll-free numbers for assistance.
Phone: 301-251-1222
Website: www.nhlbi.nih.gov
Receive excellent information on diseases of the heart, lung, and blood. Learn about the latest results of studies, news, and centers that are seeking patients for clinical trials.
Website: www.niddk.nih.gov
The institute offers a wealth of information on these diseases, giving you the latest research results, a clinical trial finder, understandable health information, and links to other helpful sites to prevent and control these diseases.
Phone: 301-443-4513
E-mail: nimhinfo@nih.gov
Website: www.nimh.nih.gov
Get the latest information on symptoms, diagnosis, and treatment of mental illness. Call for brochures, fact sheets, and other materials. On the Web site, click on "For the Public" for quizzes to help see if someone has an anxiety disorder or depression, or to find out more about medications and mental disorders.
Phone: 1-800-352-9424
Website: www.ninds.nih.gov
The institute offers a top-notch Web site describing brain attacks and offers prevention strategies. It also offers information on other brain disorders such as Parkinson's, Alzheimer's, and epilepsy. You can also receive referrals to local clinical research centers.
Phone: 301-496-1752
Website: www.nih.gov/nia/
This Web site includes a resource directory with links to other aging-related sites, as well as a list of "Age Pages" on various topics related to aging available to the public. You can read the "Age Pages" online.
Website: www.nih.gov
This federal agency houses a wide range of health institutes cited in this appendix. By visiting this gateway site you can link onto other institutes, find clinical trials for most diseases throughout the country, and review the data on 9,000 prescription and over-the-counter drugs.
Phone: 1-800-969-6642
E-mail: infoctr@nmha.org
Website: www.nmha.org
This is an organization with 340 local affiliates dedicated to improving mental health and conquering mental illnesses. The Web site has an information center to find affiliates and obtain free publications. Click on "Confidential depression-screening test" to gauge your (or a loved one's) sense of depression.
Phone: 202-223-2226
Website: www.nof.org
This is a membership organization with a lot of information on the Web site. Get advocacy, news, information for patients, prevention tips, brochures, videos, awareness kits for free and for sale. Since there is no osteoporosis specialty among doctors, the "Find a Doctor" button provides a strategy for finding a doctor.
Phone: 202-347-3471
Website: www.sleepfoundation.org
Great information on sleep disorders and treatment. Print out the foundation's "Sleep Journal" so that your parents can keep track of their sleeping patterns and give it to their doctor. You can also find sleep clinics on the Web site.
Phone: 1-800-787-6537
Website: www.stroke.org
The association offers a wide range of information on strokes. It makes referrals to medical experts, rehab centers, and support groups. The Web site offers very good links to other related sites.
Phone: 1-800-424-8200
E-mail: info@pva.org
Website: www.pva.org
This veteran's service organization focuses on special needs of veterans with spinal cord dysfunction. Issues include: health care, research, education, benefits, civil rights, and opportunities for paralyzed veterans.
Phone: 877-775-4111
Website: www.parkinsonsresource.org
A 10-year-old national organization devoted to helping people affected by Parkinson's disease, it provides information, education, support, and a newsletter.
Phone: 301-657-2248
Website: www.shhh.org
This nonprofit, educational organization offers very good links and information on hearing loss and hearing aides. It identifies free screening sites throughout the country during annual Hearing Loss Week.
Phone: 850-681-2010
E-mail: fivewishes@aol.com
Website: www.agingwithdignity.org
This is a privately funded nonprofit organization that puts a special emphasis on improving care for the elderly at the end of their lives. "Five Wishes" is an easy-to-understand living will, or advanced directive, for all ages. Click on "Five Wishes" on the Web site for a preview.
Phone: 202-223-0204
Website: www.americanhospice.org
This organization provides you with helpful information on hospice care. Referrals to a hospice near your parent, counseling resources, and support programs are available on its Web site.
Phone: 415-255-9045
Website: www.growthhouse.org
This group is billed as the "Internet's leading online community for end of life care." It is an award-winning gateway site to resources for life-threatening illnesses and end-of-life care. You get great information and group support through chat rooms.
Phone: 1-800-658-8898
Website: www.nho.org
News, public policy information, general hospice information, and links to other good sites are offered on this Web site.
Website: www.seniors.gov
This is: "[el] a government-wide initiative to deliver electronic services from government agencies and organizations to seniors." A one-stop Web site for anyone who wants information on senior issues[md]from A to Z. Link to your state's aging site.
Website: www.aoa.gov
This is the federal agency that acts as the hub for all government aging services and provides the network of state and area agencies on aging. The Web site is chock full of information and links to other related government sites.
Phone: 1-800-827-1000
Website: /www.va.gov
This federal agency operates all of veteran's services. The Web site is excellent and will save you a great deal of time. You can determine your parents' benefits, who qualifies for what, and how to apply. Contact information is provided and application forms can be downloaded and printed.
Phone: 1-800-677-1116
Website: www.aoa.dhhs.gov/elderpage/locator.html
This service is run by the National Association of Area Agencies on Aging. If you call and describe your problem, someone will direct you to local and regional agencies for senior services and to your local area agency on aging. You can also receive this info by visiting the Web site.
Phone: 888-569-4287
Website: www.HUD.gov/senior.html
This federal agency runs low-income housing for seniors. Visit its Web site to find out if your parent qualifies for federal congregate housing and other housing services.
Phone: 1-800-MEDICAR (1-800-633-4227)
Website: www.hcfa.gov or Website: www.medicare.gov
Call the Medicare Hotline to inquire about plans and what HMOs offer service in your area, to get brochures mailed to you, or to complain about problems or report fraud. At Website: www.medicare.gov you can click on "Nursing Home Compare" and get the latest inspection reports on every nursing home in the country.
Phone: 1-800-772-1213
Website: www.ssa.gov
SSA is the federal agency that runs Social Security retirement, survivor's benefits, disability insurance, and SSI (Supplemental Security Income). The Web site is an award-winning government site, easy to use, and answers most of your questions. It offers a directory of local offices.
Phone: 1-800-227-7294
This is a national nonprofit group offering information and referrals. It is listed in almost every guide or resource directory that lists caregiving referral and information resources. Call for information on all caregiving questions.
Phone: 521-881-8808
E-mail: info@caremanager.org
Website: www.caremanager.org
An association of member geriatric professionals, with an emphasis on advocacy, education, and standards of care for the elderly. Click on "Care Management Resources" for a very good list of Web site links, with a description of each Web site accompanying the link to help you in your search.
Phone: 1-800-896-3650
E-mail: info@nfcacares.org
Website: www.nfcacares.org
This is a national charitable organization for caregivers. It provides assistance in the areas of information and education, support and validation, and public awareness and advocacy. Its Web site is comprehensive.
Phone: 1-800-350-7438
Website: www.NFIV.org
This is a nationwide alliance of 1,300 faith-based, community-based programs. Volunteers help people remain independent, and provide respite for families who are caregivers. Call the toll-free number to get connected with a local chapter or visit the Web site.
Phone: 1-800-305-7233
Website: www.aaafts.org
A foundation focused on driver education, safety, and prevention. Order free brochures on driving and the older driver or buy videotapes about older drivers and safety issues. Several written driving tests for the older driver can help families deal with difficult issues.
Phone: 1-800-227-0216
Website: www.abledata.com
This is an organization that catalogs of assistive technology. Product information price ranges are included on the Web site. The National Institute on Disability and Rehabilitation Research of the Department of Education funds the site but it does not endorse any of the products.
Phone: 202-783-2242
Website: www.aahsa.org
Represents 5,000 not-for-profit facilities that care for the aging and those in assisted living. The Web site has a section designated "For Consumers and Family Caregivers." Search by city, state, zip, and type of facility or service to find a not-for-profit nursing home, assisted living facility, or community-based service.
Phone: 1-800-424-3410
Website: www.aarp.org
An educational and action organization for those 50 and older The Web site is excellent. To find caring for an aging parent info, type the word "caregiver" into the search box. AARP members can take advantage of the AARP Legal Services Network (www.aarp.org/lsn), a free first consultation with a lawyer.
Phone: 860-456-7790; 1-800-262-4414 in Connecticut; 202-216-0028 in Washington, D.C.
Website: www.medicareadvocacy.org
This is a private, nonprofit foundation. Focus is on health care rights, especially needs of Medicare beneficiaries. The Web site has links to other sites that emphasize Medicare.
Phone: 202-662-8690
E-mail: abaelderly@abanet.org
Website: www.abanet.org/elderly
The commission focuses on improving legal services for the elderly, with involvement of the private bar. It deals with elderly legal issues that surround HMO's, elder abuse, guardianship, and others. You can download an advance directive. (The commission is not active in all states.)
Website: www.elderWeb.com
Considered the "grand daddy" of aging information Web sites. It offers a wide range of topics that affect older people; it's easy to use, has great links, and is a very good site to bookmark.
Phone: 202-347-2417
Website: www.familiesusa.org
This is a great advocacy organization in health care and long-term care. It offers an award-winning Web site filled with consumer information on Medicare, Medicaid, prescription drug costs, a legislative action center, and Web health links. Apply your caregiving experience and become an advocate.
Phone: 703-548-8024
Website: www.mealsonwheelsassn.org
Track down the number of the local Meals on Wheels program in your area to have meals delivered to your parents' home, or to volunteer. Or check your local phone book for Meals on Wheels.
Phone: 520-881-4005
Website: www.naela.com
A nonprofit association that provides information, education, networking, and assistance to those who deal with the specialized issues of legal services to the elderly and disabled. The Web site also has a function that helps you find elder law attorneys in your area.
Phone: 1-800-953-8553
This agency provides information and referral services for elderly Hispanic and low-income people. Employment counseling, training, and placement services are available. Other referrals include housing, disaster relief, and income tax help.
Phone: 202-547-7424
Website: www.nahc.org
This nonprofit group has an excellent Web site on home health care. Learn about all of the different services and therapies available under home care. It offers a home care and hospice locator on the site. It also offers a guide on how to choose a home care provider.
Phone: 202-637-8400
Website: www.ncba-aged.org
The center's mission is to improve the quality of life among aging African-Americans. It is not a service provider; however, it offers programs in job opportunities, health care, housing options, and long-term care.
Phone: 202-835-3323
E-mail: info@nclnet.org
Website: www.nclnet.org
A private, nonprofit group advertised as the oldest consumer's group in the United States. It represents consumers on all workplace and marketplace issues. One click gives you access to information on telemarketing and Internet fraud, or drug interactions.
Phone: 1-888-373-6467
E-mail: membership@ncscerc.org
Website: www.ncscinc.org
This organization works to improve the lives of elderly people. It is a self-described activist agency representing older Americans, with over 2,000 affiliate councils. Members can call 301-578-8938 for the Nursing Home Information Service.
Phone: 202-479-1200
Website: www.ncoa.org
An organization of agencies and professionals whose mission is to: "[el] help community organizations to enhance the lives of older adults." Click on "Aging Issues", then on "Caregiving" for information.
Phone: 630-775-7615
Website: www.nsc.org
This council stresses highway safety. Call for pamphlets and publications. On the Web site click on "Defensive Driving Training", then on "Defensive Driver Courses" to find a local site that offers the course "Coaching the Mature Driver."
Phone: 507-433-8832
E-mail: sayoung@smig.net
Website: www.nationalsharedhousing.org
This is a nonprofit national clearinghouse for information on shared housing. On the Web site you can click on "Directory," then choose a state and get the name, address, and phone number of a program, as well as a thumbnail description.
Office of Women's Health, DHHS
Phone: 1-800-994-9662
Website: www.4women.gov
A Web site with a focus on women's issues. Use the "Search" box by typing in "aging," "caregiver," or "elder care" for a multitude of excellent direct links. Resource information is available on Alzheimer's, empowering caregivers and working women, and elder care.
Phone: 1-800-825-3695
E-mail: owlinfo@owl-national.org
A nonprofit, 20-year-old organization that focuses on issues of women as they age, particularly women 40 and older. There are 73 chapters nationwide. It produces an annual "Mother's Day Report"[md]the 2000 issue highlights prescription drug coverage legislation.
Website: www.seniorlaw.com
Excellent one-stop source for all legal matters affecting older people. It has great links and information and its very current.
Phone: 1-800-426-2547
Website: www.vnaa.org
There are over 500 VNAs throughout the country providing skilled nursing, hospice, home health aides, homemakers, nutrition advice, and personal assistance. Find a VNA near you and ask if your parents are eligible for home health care.