Caregiving conversation planning worksheet

Purpose, who it is for and how to use it

Purpose: prepare for one conversation at a time, record what people agree to, and set the next check-in.

Who it is for: adult children, spouses or partners, siblings, other relatives, friends and neighbors who help an older adult or expect to. It also works when the older person wants to plan the talk themselves.

How to use it:

1. Fill in Parts 1 to 3 on your own before the conversation.
2. Share Part 4, the agenda, with everyone attending a day or more ahead, and invite additions.
3. Use Part 5 during or right after the meeting, and give everyone a copy.
4. Keep the page with the family's caregiving notebook and bring it to the next check-in.

Write in pencil. Do not write Social Security numbers, account numbers, passwords or diagnoses on this page. Note only where important papers are kept, not what they contain.

Part 1: What I have noticed

Write what you saw and when. Use observations, not labels ("left the stove on twice in May," not "can't cope anymore").

Help already in place (who does what, how often):

______________________________________________

______________________________________________

If memory, mood or health seems to be changing, one goal can be a visit with the person's clinician. It is not this page's job to decide what is wrong.

Part 2: My goal for this one conversation

Choose one. Leave the rest for later conversations.

• Hear how the older person thinks things are going
• Agree to a visit with their clinician
• Try one kind of help for a set time (for example, one month)
• Learn who they would want to speak for them in a medical emergency
• Find out whether key papers exist and where they are kept
• Agree how family members will share tasks
• Other: ______________________________

What a good outcome would look like: ______________________________

Part 3: Who should be there, and how

• Asked the older person who they want included
• Chose a calm time, not during a crisis or a holiday gathering
• Chose a comfortable place with few distractions
• Planned for language needs, hearing aids, large print or an interpreter
• Set a start and end time

If the person has dementia: consider a first planning meeting among family, then a second meeting with the person present. Their wishes stay at the center either way.

Part 4: Agenda to share

Date: ____________ Start: ________ End: ________ Place or call link: ____________________

1. Latest health information (only what the older person has agreed to share)
2. What the older person wants: where to live, what matters most, what help feels acceptable
3. Daily needs now, and what may change in the next few months
4. Who can do what (see Part 5)
5. Costs, and how much time or money family members can realistically give
6. Who will make which decisions: health, money, hiring help
7. What the main caregiver needs, including regular breaks
8. Papers: do they exist, and where are they kept? (health care agent, advance directive, financial power of attorney, will, permission forms for clinics and banks)
9. Date of the next check-in

Ground rules (read aloud at the start):

• Say "I need..." instead of "You should..."
• Stay on the present, not old disagreements
• Look for the part of each view you can agree with
• One person speaks at a time; one person takes notes
• The older person makes their own decisions while they are able

Phrases that can help open the talk:

• "I've noticed ___, and I'm worried. How are things going for you?"
• "What matters most to you about how you live over the next few years?"
• "Would ___ help, or would you rather ___?"
• "If you were too sick to talk to the doctors, who would you want to speak for you?"

Part 5: Who agreed to what

A perfectly even split is rarely possible. Write down every kind of contribution: time, money, calls and paperwork all count.

What we will try, and for how long: ______________________________

Questions still open: ______________________________

Next check-in date: ____________ Who will send the reminder: ____________

Part 6: Safety check

A choice the family disagrees with is not, by itself, a safety report. Contact Adult Protective Services if you suspect abuse, neglect, financial exploitation, or self-neglect (the person can no longer get food, clothing, shelter or health care for themselves).

• In California: Adult Protective Services, 1-833-401-0832, 24 hours a day, 7 days a week. Enter a ZIP code when prompted to reach county APS.
• In a California nursing home, residential care home for the elderly or adult day program: Long-Term Care Ombudsman statewide line, 1-800-231-4024, 24 hours a day.
• Outside California: find your state's APS through the National Adult Protective Services Association, or call the Eldercare Locator at 1-800-677-1116 for local services.

Limitations

• This page helps you plan a conversation. It does not assess anyone's health, decision-making ability or safety, and it is not legal advice.
• An adult who can make their own decisions has the right to refuse help. A plan written without the older person is a draft, not a decision.
• Legal documents such as an advance health care directive or a power of attorney belong to the older person and have their own signing rules. A lawyer, a legal aid program or a California Caregiver Resource Center can explain them.
• Phone numbers and program details were checked on October 21, 2026, and can change. Confirm them with the agency.

Sources

1. Sharing Caregiving Responsibilities — National Institute on Aging, content reviewed October 12, 2023; accessed October 21, 2026.
2. Does an Older Adult in Your Life Need Help? — National Institute on Aging, content reviewed October 12, 2023; accessed October 21, 2026.
3. Advance Care Planning and Health Care Decisions: Tips for Caregivers and Families — National Institute on Aging, content reviewed May 23, 2023; accessed October 21, 2026.
4. Getting Your Affairs in Order Checklist — National Institute on Aging, content reviewed February 1, 2023; accessed October 21, 2026.
5. Elder Abuse — National Institute on Aging, content reviewed July 21, 2023; accessed October 21, 2026.
6. Holding a Family Meeting — Family Caregiver Alliance, 2003; accessed October 21, 2026.
7. Siblings and Caregiving — Family Caregiver Alliance, 2001; accessed October 21, 2026.
8. Adult Protective Services: Report Abuse — California Department of Social Services; accessed October 21, 2026.
9. Long-Term Care Ombudsman — California Department of Aging; accessed October 21, 2026.
10. About Us — California Caregiver Resource Centers; accessed October 21, 2026.