Care Plan: Write Down Older Adults' Health Needs Clearly for More Organized Care
A care plan is a written document that organizes an older person's health conditions, medications, treatment needs, and emergency contact information, making it easier for family members to provide care and reducing last-minute confusion. Studies from abroad show it may help reduce emergency department visits and hospitalizations. China can draw on this practice; the specific content should be developed by professional medical staff after assessment and updated promptly as the condition changes.
Machine translation of our Chinese article, without human translation review. Suggestions concerning China remain specific to China.
Chinese fact summaries and suggestions for China (not a full translation)
Original: Steps for Creating and Maintaining a Care Plan | Caregiving | CDC · Original language: en
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Facts from the sources
A care plan can help caregivers better manage caregiving responsibilities while balancing their personal lives. View source
A care plan includes key information such as the care recipient's health status, treatment, care needs, and healthcare providers' contact information. View source
It is recommended to update the care plan once a year; if the care recipient's health or medications change, it should be updated more frequently. View source
A care plan may reduce emergency department visits and hospitalizations. View source
U.S. Medicare can cover appointments for managing chronic disease and discussing advance care planning; these appointments include planning appointments for people with dementia, memory problems, or suspected cognitive impairment. View source
Compared with caregivers of people with other chronic diseases, caregivers of people with dementia or Alzheimer's disease have a higher risk of anxiety, depression, and decreased quality of life. View source
For older people and families
Together with family members, write down the older person's disease names, regular medications, and doctors' phone numbers on one piece of paper, and keep it in a fixed place or carry it with you.
The care plan should clearly state treatment and care needs, such as when to take which medication and which activities require someone to provide support; the more specific, the better.
When the older person's health changes, update the plan promptly; as a general recommendation, review it at least once a year, and update it any time the condition or medications change.
While caring for an older person, also take care of yourself: rest properly, find people to take turns sharing the load, and do not tough it out alone.
If the older person shows signs such as poor memory or not recognizing people, caregivers may be under greater psychological stress. It is recommended to communicate more with doctors and also give yourself breathing room.
Some care plans abroad may be covered by health insurance. In China, please first consult your local community hospital or health insurance department, and do not mistakenly assume it is free.
See what care and community teams can do
Institutions may incorporate care plans into case management processes, but they need to obtain consent from the older person and family members and protect privacy.
Developing a care plan must be based on assessment by qualified medical staff of the older person's function, cognition, and medication use; it cannot rely solely on family members' verbal accounts.
The plan should include elements such as health status, treatment, care needs, and emergency contact information, and should indicate the date it was made and the responsible person.
It is recommended to update once a year, or promptly when the older person's condition or medications change; updates need to be reviewed by medical/nursing staff.
Reducing emergency visits and hospitalizations may be used as a reference indicator for quality improvement, but specific outcomes cannot be promised to families.
The overseas Medicare coverage model cannot be directly copied. Institutions should align with local health insurance and long-term care insurance policies in China and clearly define service items and the basis for charging.
For family members caring for older adults with dementia or cognitive impairment, institutions should provide psychological support and referral channels and pay attention to caregivers' own health.
Implementation requires supporting systems: staff training, privacy agreements, family communication mechanisms, and regular reviews under professional supervision.
What needs local assessment
This content is compiled based on U.S. data and experience, for reference only in China. The U.S. Medicare program does not apply to mainland China; please do not treat it as current policy in China. A care plan cannot replace a doctor's diagnosis, treatment, and assessment; please consult professional medical staff before creating it. The statement in the text that it "may reduce emergency visits and hospitalizations" is a general statement and does not mean every older person will benefit. The differences in risks such as anxiety and depression among caregivers come from statistical data and do not apply to judging individuals. For specific medication and treatment adjustments, always follow the doctor's orders. Fact source: U.S. Centers for Disease Control and Prevention (Source: CDC). The original material is freely available on the CDC website. This website and the localization suggestions do not represent an endorsement by CDC, HHS, or the U.S. government; their images or logos have not been reproduced.
Sources
U.S. Centers for Disease Control and Prevention (CDC)Was this article helpful?
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