ATTENDANT CARE CHECKLIST

The following checklist and agreement is for the purpose of planning care routines and setting up expectations and responsibilities between the attendant and the attendee. It is very important that the attendee check ALL items necessary for his or her care. This information is used to determine the appropriate care level. A copy of this should be shared with your attendant.

DRESSING                                         BATHING

__ Underwear                                      __ Shower – Frequency __/Week

__ Pants                                               __ Bed Bath – Frequency __/Week

__ Corset, girdle                                    __ Wash hair

__ Shirt, blouse                                     __ Wash upper body

__ Tie, belts                                          __ Wash lower body

__ Socks, stockings                               __ Dry body

__ Shoes                                              __ Push to and from shower

__ Braces, prosthesis                            __ Other _______________

__ Other __________

PERSONAL HYGIENE                   

__ Brush teeth                                     

__ Brush, comb, style hair                     

__ Wash face                                      

__ Shaving                                           

    __ Face __ Legs __ Underarms       

__ Clip nails                                         

__ Apply cosmetics, deodorant, powder 

__ Change sanitary napkin/tampon        

__ Dispense medication __/day             

__ Other  

TRANSFER

__ Standing (pivot) transfer

__ Minimum transfer assistance

__ Bed to wheelchair

__ Wheelchair to bed

__ Bed to shower chair

__ Shower chair to bed

__ Wheelchair to toilet seat

__ Toilet seat to wheelchair

__Other _______________                                                                                                 

BOWEL AND BLADDER CARE    

Bowel                                                  

__ Suppository – frequency __/week    

__ Digital Stimulation                           

__ Manual removal                              

__ Colostomy care                               

                                                                 

Bladder                                                

__ Indwelling                                       

    __ Change __/week                         

    __ Irrigate __/day                            

__ External __Change __/day

__ Empty leg bag

__ Rinse leg bag

__ Change disposable protective shield

__ Change sheets if necessary

__ Other _____________________

MISCELLANEOUS

__Food cut

__ Feeding

__ Cooking (for summer)

__ Laundry

__ Room clean-up

            __List duties ________

__ Positioning in bed

__ Getting books & daily material together

__ Packing, unpacking clothes

__ Transportation (doctor's appt, etc.)