Communication & Planning
Care Needs & Support Planner
A printable worksheet for organizing what your loved one currently needs help with, who's currently helping, and what's worth raising with your family or their care team.
This tool helps with:
How do I organize what my loved one needs help with day to day, so I can talk it through with family or bring it to a healthcare visit?
A few things worth knowing before you use this: this planner is a way to organize what you're noticing about daily life, safety, and support -- it does not diagnose dementia, assign a stage, or tell you what level of care is needed. Those are judgments for a physician or care team to make with you, using what's written here as one useful input, not a replacement for their evaluation.
There's no scoring or total on this page, on purpose. Filling in every line isn't the goal -- capturing what's actually true for your family, right now, is. It's fine to leave sections blank if they don't apply yet.
Nothing here is saved automatically. Fill it out on screen and print it right after, or print a blank copy first and fill it out by hand -- both work the same way.
Daily Activities
For each area, mark what's generally true right now. It's fine for this to change from week to week -- that's useful information too.
Daily Independence
These are often the first areas where extra support becomes helpful -- sometimes well before hands-on personal care does.
Safety & Supervision
These are worth tracking honestly, even when it's hard -- noticing early is what makes it possible to plan ahead rather than react in the moment.
Current Support System
Understanding who's already involved -- and where the gaps are -- makes it easier to ask for more help specifically, rather than generally.
Where might your family want or need more support? Looking back at what you marked above can help point to specifics.
Changes & Concerns to Note
Questions for Your Healthcare Team or Support Network
A few starting points, if they help:
- What changes, if any, should prompt us to reach out sooner than our next scheduled visit?
- Are there specialists or resources we should know about based on what we're noticing?
- What's typical day-to-day variation, and what should we flag right away?
- How can we reach you between visits if something changes?
Next steps
If what you're noticing here points toward needing more support than home currently provides, MemoryPath's guide to Independent Living, Assisted Living & Memory Care explains how those settings generally differ, and the Facility Visit & Comparison Checklist is built for touring specific communities once you're ready to compare options.
Bring a printed copy of this planner to your next appointment or family conversation -- it's meant to make that conversation easier to start, not to have on your own.