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CAREGIVER JOURNAL (Sunshine Health)

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CAREGIVER JOURNAL
--- SunshineHealth.com
C
aring
A
daptable
R
eliable
E
ncouraging
G
racious
I
ncredible
V
aluable
E
xceptional
R
espectable
Dear Caregiver,
Sunshine Health would like to thank you for partnering with us in caring
for your loved ones. You will play an important role in planning and
maintaining your loved ones’ care through Sunshine Health.
As part of our Caregiver Collaborations Program, we want to express our
gratitude by providing you this caregiver binder. Inside you will find useful
content and forms to record important patient/caregiver information,
plus a calendar for important dates and tips for caregivers. This binder
will help you to keep all your important caregiver information in one
convenient, easily accessible location. We hope that this material will
assist you in your journey as a caregiver.
The selflessness you demonstrate each and every day is inspiring.
Your hard work and dedication is so vital for your loved one’s well-being.
You are appreciated, and your work does not go unnoticed.
Thank you for the amazing job you do.
Sincerely,
“
Doctors diagnose, nurses heal and caregivers make sense of it all.
Brett H. Lewis
“
Table of Contents
MEMBERCAREGIVER BASIC INFORMATION
A. Member Basic Information
B. Caregiver Basic Information
C. Backup/Emergency Contacts
MEMBER MEDICAL INFORMATION
A. Doctor/Specialist Information
B. Medical Information
C. Other Agencies
D. Durable Medical Equipment
LEGAL INFORMATIONADVANCE DIRECTIVES
A. Legal Information/Advance Directives
B. Advance Directive Forms
EMERGENCY PLANNING
A. Emergency Disaster Planning
B. Disaster Preparedness
CAREGIVER RESOURCES
A. Important Phone Numbers
B. Tips/Tricks to Prevent Caregiver Burnout
C. Additional Resources and Tools
D. Calendars
E. Notes
MEMBERCAREGIVER
BASIC INFORMATION
A. MEMBER BASIC INFORMATION
B. CAREGIVER BASIC INFORMATION
C. BACKUPEMERGENCY CONTACTS
Member Basic Information
BASIC IDENTIFYING INFORMATION
First and Last Name:
Address:
Phone Number: Date of Birth: (dd/mm/yyyy)
BASIC MEDICAL INFORMATION
Primary Care Doctor Name: Phone Number:
Primary Diagnosis:
Current Medical Condition:
Current Allergies:
Any Special Needs:
Emergency Contact:
PRIMARY INSURANCE INFORMATION
Insurance Company:
Company Phone Number:
Company Address:
Policy Holder Name:
Member/Policy Number: Group Number:
SECONDARY INSURANCE INFORMATION
Insurance Company:
Company Phone Number:
Company Address:
Policy Holder Name:
Member/Policy Number: Group Number:
MEMBERCAREGIVER BASIC INFORMATION
“
Be patient with them; don’t try to correct them. Let them live
in whatever moment they are in ... and join them there.
Martha B.
“
MEMBERCAREGIVER BASIC INFORMATION
Caregiver Basic Information
BASIC IDENTIFYING INFORMATION
First and Last Name:
Relationship to Member:
Address:
Phone Number: Date of Birth: (dd/mm/yyyy)
CAREGIVING SCHEDULE
TIME: Sunday Monday Tuesday Wednesday Thursday Friday Saturday
 A.M. –  P.M.
 P.M. –  P.M.
 P.M. –  A.M.
CAREGIVING STRATEGIES
1. Stick to Daily Routines. Consistency and routines make days predictable and less confusing.
2. Create a Safe Home Environment. Remove clutter, use locks, create visual and written re-
minders, prevent falls.
3. Get Organized. Use smartphone alarms, label cupboards and clean closets.
4. Reduce Frustrations. Break down tasks, involve your loved one in meaningful activities that
reduce boredom and loneliness.
5. Be Patient and Flexible. Allow extra time, reduce distractions.
6. Focus on Individualized care. Remember the person, not the disease.
“
There is no cookie-cutter formula for caregiving.
Every situation has its different challenges and joys.
Anonymous
“
Backup/Emergency Contacts
PRIMARY EMERGENCY BACKUP
First and Last Name:
Relationship to Member:
Address:
Phone Number: Date of Birth: (dd/mm/yyyy)
BACKUP SCHEDULE (If Needed)
TIME: Sunday Monday Tuesday Wednesday Thursday Friday Saturday
 A.M. –  P.M.
 P.M. –  P.M.
 P.M. –  A.M.
SECONDARY EMERGENCY BACKUP
First and Last Name:
Relationship to Member:
Address:
Phone Number: Date of Birth: (dd/mm/yyyy)
BACKUP SCHEDULE (If Needed)
TIME: Sunday Monday Tuesday Wednesday Thursday Friday Saturday
 A.M. –  P.M.
 P.M. –  P.M.
 P.M. –  A.M.
MEMBERCAREGIVER BASIC INFORMATION
“
Caregiving is a constant learning experience.
Vivian F.
“
MEMBER MEDICAL
INFORMATION
A. DOCTORSPECIALIST INFORMATION
B. MEDICAL INFORMATION
C. OTHER AGENCIES
D. DURABLE MEDICAL EQUIPMENT
Doctor/Specialist Information
PRIMARY CARE PHYSICIAN
Name: Specialty:
Phone: Address:
Notes:
SPECIALTY PHYSICIAN
Name: Specialty:
Phone: Address:
Notes:
SPECIALTY PHYSICIAN
Name: Specialty:
Phone: Address:
Notes:
SPECIALTY PHYSICIAN
Name: Specialty:
Phone: Address:
Notes:
PHARMACY
Name: Specialty:
Phone: Address:
Notes:
PREFERRED HOSPITAL
Name: Specialty:
Phone: Address:
Notes:
MEMBER MEDICAL INFORMATION
“
Try to separate your emotions from the task at hand and always be kind.
Lynne B.
“
When to Take the MedicationWhen to Take the MedicationWhen to Take the MedicationWhen to Take the Medication
MEMBER MEDICAL INFORMATION
Medical Information
Other Diagnoses Primary Symptoms
Medication Name,
Dosage, Diagnosis
When to Take the Medication
Prescribing
Doctor
Start Date End Date
A.M. Noon P.M. Bedtime Other
“
Even in our darkest days, we do an important job,
whether anyone realizes (or appreciates) it, or not.
Anonymous
“
When to Take the MedicationWhen to Take the MedicationWhen to Take the MedicationWhen to Take the Medication
ADDITIONAL MEDICAL FORM
Medication Name,
Dosage, Diagnosis
When to Take the Medication
Prescribing
Doctor
Start Date End Date
A.M. Noon P.M. Bedtime Other
MEMBER MEDICAL INFORMATION
When to Take the MedicationWhen to Take the MedicationWhen to Take the MedicationWhen to Take the Medication
Additional Medical Form MEMBER MEDICAL INFORMATION
Medication Name,
Dosage, Diagnosis
When to Take the Medication
Prescribing
Doctor
Start Date End Date
A.M. Noon P.M. Bedtime Other
**Additional Medication Pages are available upon request
Other Agencies
SUCH AS: Hospice, Home Health Agencies, Volunteer Organizations;
and include what they do for the member.
AGENCY NAME:
Contact Person:
Address:
Phone Number:
Schedule/Services:
Notes:
AGENCY NAME:
Contact Person:
Address:
Phone Number:
Schedule/Services:
Notes:
AGENCY NAME:
Contact Person:
Address:
Phone Number:
Schedule/Services:
Notes:
MEMBER MEDICAL INFORMATION
“
When people say ‘I couldn’t do what you do,’ take it as a compliment.
They are telling you how very strong and how very special you are.
Anonymous
“
MEMBER MEDICAL INFORMATION
Durable Medical Equipment (If Applicable)
EXAMPLES: Wheelchair/Scooter Accessories and Batteries, Hospital Bed, Oxygen Supplies,
Catheter Supplies, Tube Feedings, Consumable Supplies, Trachea/Ostomy Supplies
Equipment/
Supplies
Provider Name
Provider
Phone Number
Serial Number
of Product
Reason for
Equipment
Other/Notes
“
Caregivers are often the casualties, the hidden victims.
No one sees the sacrifices they make.
Judith L. London
“
LEGAL INFORMATION
ADVANCE DIRECTIVES
A. LEGAL INFORMATIONADVANCE DIRECTIVES
B. ADVANCE DIRECTIVE FORMS
Legal Information/Advance Directives
Preparing for the “what ifs” in life might not be something we want to address, but it’s
something everyone should take very seriously. Below are some examples of Advance
Directives. You can insert copies of the legal documents if already completed, or use
the resources included to create/develop them.
A Power of Attorney (POA) is a document that allows members to appoint a person or organization to manage their
affairs should they become unable to do so. The person appointed becomes their agent (or attorney-in-fact), and the
person who makes the appointment is known as the principal. However, all POAs are not created equal. Each type gives
the principal’s attorney-in-fact/agent (the person who will be making decision on your behalf) a different level of control:
1. Durable Power of Attorney
Allows the agent to manage all the affairs of the principal should they become unable to do so. This POA does
not have a set time limit and becomes effective immediately upon the incapacitation of the principal. It also
expires upon the principal’s death.
2. Medical Power of Attorney
Grants authority to the agent to take specific control over the healthcare decision of the principal, should
they become incapacitated or unable to do so. This POA usually takes effect upon the consent of the presiding
physician, and it allows the agent to authorize all medical decisions related to the principal.
3. Special or Limited Power of Attorney
Used on a limited basis for one-time financial or banking transactions, such as the sale of a property. The agent
has no other authority to act on behalf of the principal, other that what is assigned to them in the limited power
of attorney.
The Do Not Resuscitate (DNR) Order ensures the wishes of a person who doesn’t want CPR or other life-sustaining
methods used if his or her heart or breathing stops are met. Here are some important things to keep in mind:
1. The DNR order must be signed by a doctor.
2. If you are a family member caregiver, you may also need to sign the order.
3. The DNR order will still be in effect, even if no healthcare proxy has been chosen.
4. There is also an Out of Hospital DNR order that tells emergency staff not to perform CPR if the member’s heart
fails while at home. This order must also be signed by a doctor.
The Florida Designation of Healthcare Surrogate lets members name a competent adult to make decisions about
their medical care, including decisions about life-prolonging procedures, if they can no longer speak for themselves. The
designation of healthcare surrogate is especially useful, because it appoints someone to speak for the member any time
they are unable to make their own medical decisions—not only at the end of life. The healthcare surrogate’s powers go
into effect when the member’s doctor determines that he or she is physically or mentally unable to communicate a willful
and knowing healthcare decision.
The Florida Living Will lets members state their wishes about healthcare in the event that they are in a persistent
vegetative state, have an end-stage condition or develop a terminal condition. The living will goes into effect when the
member’s physician determines that they have one of these conditions and can no longer make their own healthcare
decisions. The living will also allows members to express their organ donation wishes.
LEGAL INFORMATIONADVANCE DIRECTIVES
LEGAL INFORMATIONADVANCE DIRECTIVES
Whom should members appoint as their surrogate/POA?
The surrogate/POA is the person members appoint to make decisions about their healthcare should they become unable
to make those decisions themselves. The surrogate/POA may be a family member or a close friend who’s trusted to make
serious decisions. The person named as surrogate should clearly understand the member’s wishes and be willing to
accept the responsibility of making healthcare decisions for them.
Members can also appoint a second person as their alternate surrogate. The alternate will step in if the first person
named as a surrogate is unable, unwilling or unavailable to act for them.
How do I make my Florida Advance Directive legal?
The law requires that members sign their Advance Directive in the presence osf two adult witnesses, who must also sign
the document. If physically unable to sign, the member may have someone sign for them, in their presence and at their
direction, and in the presence of their two witnesses.
The surrogate and alternate surrogate cannot act as witnesses to this document. At least one of the member’s witnesses
must not be his or her spouse or a blood relative.
Should members add personal instructions to their Florida Advance Directive?
One of the strongest reasons for naming a surrogate is to have someone who can respond flexibly as medical situations
change and deal with unforeseen situations. If members add instructions to this document it may help their surrogate
carry out their wishes, but they should be careful not to unintentionally restrict their surrogate’s power to act in their
best interest. In any event, members should be sure to talk with their surrogate about their future medical care and
describe what they consider to be an acceptable “quality of life.”
Legal Help
It is wise to speak with a lawyer about these documents and certain financial concerns. A lawyer can help set up a will or
estate plan, as well as give advice on key matters in the life of your care recipient.
Document Completed Location of Originals
Do Not Resuscitate Order
Power of Attorney
Healthcare Surrogate
Healthcare Proxy
Living Will
**Please see plastic sleeve to keep copies of legal documents in case of an emergency.
If there are no Advance Directives in place, www.floridahealthfinder.gov has specific Healthcare Advance Directives forms
available to download. Please see the form section of this binder for available forms. The Sunshine Health Plan Member
Handbook also contains Healthcare Advance Directive Living Will Form for access.
“5 Wishes” is also an available resource. To obtain a copy, please call 1-888-5-WISHES or 1-888-594-7437 or visit
the website: www.agingwithdignity.org for a downloaded form.
“
Don’t dwell on the disease. Value the moments, the pearls of wisdom, their smile and humor.
Anonymous
“
Advance Directives
LIVING WILL
Declaration made this day of , (20 ), I ,
willfully and voluntarily make known my desire that my dying not be artificially prolonged under the
circumstances set forth below, and I do hereby declare that, if at any time I am incapacitated and:
(initial) I have a terminal condition, or
(initial) I have an end stage condition, or
(initial) I am in a persistent vegetative state, and if my primary physician and another consulting
physician have determined that there is no reasonable medical probability of my recovery from such a
condition, I direct that life-prolonging procedures be withheld or withdrawn when the application of such
procedures would serve only to prolong artificially the process of dying, and that I be permitted to die
naturally with only the administration of medication or the performance of any medical procedure deemed
necessary to provide me with comfort care or to alleviate pain.
It is my intention that this declaration be honored by my family and physician as the final expression of my
legal right to refuse medical or surgical treatment and to accept the consequences for such refusal.
In the event that I have been determined to be unable to provide express and informed consent regarding the
withholding, withdrawal, or continuation of life-prolonging procedures, I wish to designate, as my surrogate to
carry out the provisions of this declaration:
Name: Address:
Phone:
I understand the full importance of this declaration, and I am emotionally and mentally competent to make
this declaration.
Additional Instructions (optional):
Witness Signatures:
Signature Signature
Printed Name Printed Name
Address Address
Phone Phone
LEGAL INFORMATIONADVANCE DIRECTIVES
DESIGNATION OF HEALTHCARE SURROGATE
I , designate as my healthcare surrogate under S. 765.202, Florida Statutes:
Name: Address:
Phone:
If my healthcare surrogate is not willing, able, or reasonably available to perform his or her duties, I designate
as my alternate healthcare surrogate:
Name: Address:
Phone:
INSTRUCTIONS FOR HEALTHCARE
I authorize my healthcare surrogate to: (Initials required in blank spaces below.)
Receive any of my health information, whether oral or recorded in any form or medium, that:
1. Is created or received by a healthcare provider, healthcare facility, health plan, public health provider,
employer, life insurer, school or university, or healthcare clearinghouse; and
2. Relates to my past, present, or future physical or mental health or condition; the provision of
healthcare to me; or the past, present, or future payment for the provision of healthcare to me.
I further authorize my healthcare surrogate to:
Make all healthcare decisions for me, which means he or she has the authority to:
1. Provide informed consent, refusal of consent, or withdrawal of consent to any and all of my healthcare,
including life-prolonging procedures.
2. Apply on my behalf for private, public, government or veteran’s benefits to defray the cost of healthcare.
3. Access my health information reasonably necessary for the healthcare surrogate to make decisions
involving my healthcare and to apply for benefits for me.
Specific instructions and restrictions:
LEGAL INFORMATIONADVANCE DIRECTIVES Advance Directive Forms
While I have decision-making capacity, my wishes are controlling and my physician and healthcare providers
must clearly communicate to me the treatment plan or any change to the treatment plan prior to its
implementation.
Designation of Healthcare Surrogate LEGAL INFORMATIONADVANCE DIRECTIVES
To the extent that I am capable of understanding, my healthcare surrogate shall keep me reasonably
informed of all decisions that he or she has made on my behalf and matters concerning me.
This healthcare surrogate designation is not affected by my subsequent incapacity except as provided in
Chapter 765, Florida Statutes.
Pursuant to section 765.104, Florida Statutes, I understand that I may, at any time while I retain my
capacity, revoke or amend this designation by:
1. Signing a written and dated instrument which expresses my intent to amend or revoke this designation;
2. Physically destroying this designation through my own action or by that of another person in my presence and
under my direction;
3. Verbally expressing my intention to amend or revoke this designation; or
4. Signing a new designation that is materially different from this designation.
My healthcare surrogate’s authority becomes effective when my primary physician determines that I am
unable to make my own healthcare decisions unless I initial either or both of the following boxes:
If I initial this box [ ] my healthcare surrogate’s authority to receive my health information takes effect
immediately.
If I initial this box [ ] my healthcare surrogate’s authority to make healthcare decisions for me takes
effect immediately. Pursuant to section 765.204(3), Florida States, any instructions of healthcare decisions
I make, either verbally or in writing, while I possess capacity shall supersede any instructions or healthcare
decisions made by my surrogate that are in material conflict with those made by me.
SIGN AND DATE THE FORM HERE:
Date:
Address:
City, State
SIGNATURES OF FIRST AND SECOND WITNESSES
Print Name:
Address:
City, State:
Signature:
Date:
Sign Your Name
Print Your Name
Print Name:
Address:
City, State:
Signature:
Date:
EMERGENCY
PLANNING
A. EMERGENCY DISASTER PLANNING
B. DISASTER PREPAREDNESS
Emergency Disaster Planning
Are you currently registered with an
Emergency Shelter in case of an emergency
Yes No
If Yes, name of the location:
After a disaster, let your friends and family know you are okay by registering at “Safe and Well”
at https://safeandwell.communityos.org/cms// or by calling 1-800-733-2767.
You can also give them a call, send a quick text or update your status on social networking sites.
EMERGENCY PLANNING
Emergency checklists
EMERGENCY CONTACT PAGE
All Emergencies:
Fire Department
(Non-Emergency):
Family Doctor:
911 Police (Non-Emergency):
Ambulance Agency:
Poison Control Center: 1-800-222-1222
Member Name:
Home Address:
Family Member’s
Contact Information:
Family meeting place
outside the neighborhood:
ESCAPE ROUTES AND MEETING PLACES
Water — one gallon per person, per day
(3-day supply for evacuation and 2-week supply for home)
Food — it is a good idea to include foods that
do not need cooking (canned, dried, etc.)
(3-day supply for evacuation and 2-week supply for home)
– Remember the manual can opener
Flashlight with extra batteries and bulbs
(do not use candles)
Battery-operated or hand-crank radio
First aid kit and manual
Medications (7-day supply) and medical items
Multi-purpose tool
(several tools that fold up into a pocket-sized unit)
Sanitation and personal hygiene items
(toilet paper, plastic garbage bags)
Copies of personal documents
(medication list and pertinent medical information,
deed/lease to home, birth certificates, insurance policies)
Cell phone with an extra battery and charger(s)
Family and friends’ emergency contact information
Cash and coins (ATMs may not be accessible)
Emergency blanket
Map(s) of the local area
Whistle (to attract the attention of emergency personnel)
One change of clothing
Pet supplies (including food and vaccination records)
Extra set of keys (car, house, etc.)
Pack of cards to provide entertainment
and pass the time
EMERGENCY PLANNING
ESCAPE ROUTES AND MEETING PLACES
Plan the best and quickest escape routes out of your home and evacuation routes out of your neighborhood.
Decide on a meeting place outside your neighborhood, in case you cannot return home.
If you or someone in your household uses a wheelchair, make sure all escape routes from your home are
wheelchair accessible.
Know the safe places within your home, in case you need to shelter during extreme weather events (e.g., tornado).
Practice your escape drill every six months.
Plan for transportation, if you need to evacuate to a shelter.
**Please ask your Care Coordinator for a copy of the Special Needs Shelter Application for your area,
as well as a map of available shelters and evacuation zones.
IMPORTANT NUMBERS IN CASE OF DISASTEREMERGENCY
FEMA Disaster Assistance/Registration: --
TTY: --
FEMA Fraud Hotline: --
State of Florida Emergency Info, -hour hotline: -- Safe and Wellness Helpline
(To see if people are OK or in a shelter):
--
Red Cross Food, Shelter and Financial Assistance: -- Department of Children
and Families Information:
--
Elder Helpline: -- Verify Contractor License: --
If No Emergency Plan Is Available:
The saying goes, “Fail to Plan, Plan to Fail.” If you haven’t prepared for the possibility of a disaster,
the results can be devastating. That’s what Emergency Planning is all about.
Emergencies can come from many directions. They can be caused by natural disasters, such as
hurricanes, floods, earthquakes ... even snowstorms. Fires and explosions can be caused by anything
from sparks from a piece of equipment to throwing a cigarette on the floor.
You need to plan ahead, anticipate what could go wrong, and know what you need to do to minimize
the impact of emergency situations.
“
Remember, even if they don’t seem to know you, you still know who they are.
Joanne P.
“
Disaster Preparedness
Emergencies and disasters can strike quickly, without warning, and can force you to evacuate
your neighborhood or be confined to your home. What would you do if your basic services—
water, gas, electricity or communications—were cut off?
Learn how to protect yourself and cope with disaster by planning ahead. Even if you have
physical limitations, you can still protect and prepare yourself.
Local officials and relief workers may not be able to reach everyone right away. You can deal with
disaster better by preparing in advance and by working with those in your support network: your
family, neighbors and friends as a team. Knowing what to do is your responsibility.
THE THREE STEPS TO PREPAREDNESS
1. Get a Kit – Disasters can happen at any moment. By planning ahead you can avoid waiting
in long lines for critical supplies, such as food, water and medicine, and you will also have
essential items if you need to evacuate.
•
For your safety and comfort, have a disaster supplies kit packed and ready in a designated place
before a disaster hits.
• Assemble enough supplies to last for at least three days.
• Store your supplies in one or more easy-to-carry containers, such as a backpack or duffel bag.
• You may want to consider storing supplies in a container that has wheels.
• Be sure your bag has an ID tag.
• Label any equipment, such as wheelchairs, canes or walkers, that you would need with your name,
address and phone numbers.
• Keeping your kit up-to-date is also important. Review the contents at least every six months or as
your needs change.
• Check expiration dates and shift your stored supplies into everyday use before they expire. Replace food,
water and batteries, and refresh medications and other perishable items with “first in, first out” practices.
2. Make a Plan – The next time disaster strikes, you may not have much time to act. Planning
ahead reduces anxiety. Prepare now for sudden emergencies and remember to review
regularly for changes.
Meet With Your Family and Friends
• Explain your concerns to your family and others in your support network, and work with them as a team to
prepare. Arrange for someone to check on you at the time of a disaster. Be sure to include any caregivers
in your meeting and planning efforts.
• Assess yourself and your household. What personal abilities and limitations may affect your response to
a disaster? Think about how you can resolve these or other questions, and discuss them with your family
and friends. Details are important to ensure your plan fits your needs. Then, practice the planned actions
to make sure everything “works.”
EMERGENCY PLANNING
Disaster Preparedness EMERGENCY PLANNING
2. Make a Plan, continued
Family Communication Plan
• Carry family contact information in your wallet.
• Choose an out-of-town contact person. After a disaster, it is often easier to make a long-distance call than
a local call from a disaster area.
Community Disaster Plan
• Ask about the emergency plan and procedure that exists in your community.
• Know about the community response and evacuation plans, including the community’s plan for evacuating
those without private transportation.
• Make arrangements with a neighbor who could drive you.
• Know the escape routes and meeting places (See checklist on the next page).
Post-Emergency Phone Number Near Your Phones
• Post emergency numbers near all of your phones. Include the numbers of those in your support network.
Remember that in some emergencies telephone lines might not be working. Consider having alternative plans
for contacting those in your network.
Plan for Those With Disabilities
• Keep support items like wheelchairs and walkers in a designated place so they can be found quickly. This step
is essential for those who have home-health caregivers, particularly for those who are bed-bound.
Utilities
• Talk to your utility company about emergency procedures and know how and when to turn off water, gas and
electricity at the main switches or valves. Share this information with your family. Keep any tools you will need
nearby. Turn off the utilities only if you suspect the lines are damaged, you suspect a leak or if local officials
instruct you to do so. (Note: If gas is turned off for any reason, only a qualified professional can turn it back on.
It could take several weeks for a professional to respond. Heating and cooking would need alternative sources.)
Smoke Alarms and Carbon Monoxide Alarms
• Test your smoke alarms and carbon monoxide alarms regularly. Consider strobe or vibrating alert systems
that might meet your needs. Change the batteries in all alarms at least once a year or according to the
manufacturer’s instructions.
Insurance Coverage
• Talk with your insurance agent to be sure that you have adequate insurance coverage. Homeowners insurance
does not cover flood damage and may not provide full coverage for other hazards.
Vital Records and Documents
• Keep copies of vital family records and other important documents, such as birth and marriage certificates,
Social Security cards, passports, wills, deeds, and financial, insurance and immunizations records in a safe
location, like a fire safe or safe-deposit box.
Hearing Aids/Cochlear Implants
• If you wear hearing aids or assistive devices, consider storing them in a bedside container that is attached to
your nightstand using Velcro. Some disasters (e.g., earthquakes) may shift items that are not secured, making
them difficult to find quickly.
3. Be Informed
Community Warning Systems
Know how local authorities will warn you of a pending or current disaster situation and how they will
provide information to you before, during and after a disaster.
Friends, Family Caregivers and Neighbors
Before a disaster happens it is a good idea to have a conversation with those in your support network:
your friends, family and neighbors. Let them know your needs in an emergency situation; ask them
how they could assist with your plan and whether they would be willing to help. Consider that during
some emergencies, travel is severely limited and they may not be able to get to you.
Local Neighborhood Emergency Teams
Connect with a group in your local neighborhood. Some of these could include CERT (Community
Emergency Response Team), a neighborhood watch, community block associations, faith-based
organizations, etc. Even if you feel you cannot become a member, let them know your needs and
ask them how they could assist with your disaster plan. If available, take advantage of advance
registration systems in your area for those who need help during community emergencies.
Local Volunteer Fire Departments
Connect with your local volunteer fire department and let them know your needs (especially if you
live in a rural area). Discuss with them how they might be able to assist in your disaster plan.
Local EAS (Emergency Alert System)
Certain television and radio stations will broadcast emergency messages from local authorities.
Find out which stations broadcast on the Emergency Alert System (EAS).
NOAA Weather Radio/All-Hazard Alert Radio
These special radios provide one of the earliest warnings of weather and other emergencies and can
be programmed to alert you to hazards in your specific area. Call your local National Weather Service
office or visit www.nws.noaa.gov for more information.
Door-to-Door Warning From Local Emergency Officials
In some emergencies local responders may come door-to-door and deliver emergency messages
or warnings. Listen carefully and follow their instructions!
Senior Living and Assisted Living Communities
If you live in a senior community, become familiar with any disaster notification plans that may
already exist. Talk to your community management or resident council about how you can all be more
prepared together.
EMERGENCY PLANNING Disaster Preparedness
Disaster Preparedness EMERGENCY PLANNING
WHEN DISASTER STRIKES
Sheltering in Place vs. Staying at Home
In some emergencies, such as a chemical emergency, you would need to know how to seal a room for safety on
a temporary basis. This is called “shelter in place.” In some cases, you may be told to “stay at home.” This means
stay where you are and make yourself as safe as possible until the emergency passes or you are told to evacuate.
In this situation, it is safer to remain indoors than to go outside. Stay in your home and listen to instructions from
emergency personnel. Listen to your television or radio for emergency messages. Be prepared to be on your own
and have additional food and water for seven to 14 days.
If You Need to Evacuate
Coordinate with your family and home care provider for evacuation procedures.
• Try to carpool, if possible.
• Wear appropriate clothing and sturdy shoes.
• Take your disaster supplies kit – “Go Bag.”
• Lock your home.
• Use the travel routes specified or special assistance provided by local officials. Don’t take any shortcuts,
as they may be unsafe.
• When you arrive at a shelter, notify the shelter management of any needs you may have. They will do their
best to accommodate you and make you comfortable.
• Let your out-of-town contact know when you leave and where you are going.
• Make arrangements for your pets.
Public Shelters
Relief organizations, like the American Red Cross, may open shelters if a disaster affects a large number
of people or the emergency is expected to last several days.
Be prepared to go to a shelter if:
• Your area is without electrical power.
• Floodwater is rising.
• Your home has been severely damaged.
• Police or other local officials tell you to evacuate.
Immediately After a Disaster
• If the emergency occurs while you are at home, check for damage using a flashlight. DO NOT light
matches or candles or turn on electrical switches. Check for fires, chemical spills and gas leaks.
• Shut off any damaged utilities.
• Check on your neighbors, especially those who are elderly or have disabilities.
• Call your out-of-town contacts and let them know you are okay.
• Stay away from downed power lines.
• Do not drive through flooded roads.
• Monitor local broadcasts for information about where you can get disaster relief assistance.
Financial Exploitation/Scams
Unfortunately, after a disaster there may be some people who will try to take advantage of your vulnerability.
Beware of high-pressure sales, disclosing personal financial information (account numbers and credit card
information) and services provided with no written contract.
EMERGENCY PLANNING Disaster Preparedness
Disaster Preparedness EMERGENCY PLANNING
Don’t Leave Home Without Them!
AN EVACUATION SHELTER IS NOT INTENDED TO BE COMFORTABLE. SHELTERS ARE VERY CROWDED.
You should prepare to bring items to help make your stay more comfortable.
WHEN EVACUATING TO A SHELTER, BRING THE FOLLOWING ITEMS:
1. All Required Medications and Medical Support Equipment
• Wheelchair/walker, oxygen, dressings, feeding and suction equipment, diapers, etc.
• Any specific medication or care instructions (TWO WEEK SUPPLY)
• Name and phone number of physician/home healthcare agency/hospital where you
receive care
2. Dietary Needs – You need to bring nonperishable food to survive for 72 hours per person
3. Food and Water/Liquids – Snacks, fruit juice, Gatorade, water, fruits, crackers (72-hour supply)
4. Sleeping Gear – Bring your own pillows, sheets, blankets, portable cot or air mattress, chaise
lounge, folding chairs, or sleeping bags for each person. Evacuation shelters tend to be cold, so
bring a blanket or sweater to keep warm. COTS OR BEDS ARE NOT PROVIDED AT THE SHELTER.
5. Important Papers – Wills, deeds, licenses, insurance policies, home inventory, doctor’s orders,
Do Not Resuscitate, Living Will.
6. Identification – With photo and current address, medical identification card.
7. Cash – Check cashing/credit card services may not be available for several days after the
storm. BUT: Don’t bring too much! There will be no place to secure money or valuables at the
evacuation shelter.
8. Comfort Items – Small games, cards, books, batteries, manual can opener, etc.
9. Personal Hygiene Items – Toothbrush, toothpaste, deodorant, towels, brush/comb, dentures,
glasses, eye drops, hearing aids and batteries, etc.
10. Extra Clothing – A one-week supply of comfortable clothing and extra sets of underwear and socks.
CAREGIVER
RESOURCES
A. IMPORTANT PHONE NUMBERS
B. TIPSTRICKS TO PREVENT CAREGIVER BURNOUT
C. ADDITIONAL RESOURCES AND TOOLS
D. CALENDARS
E. NOTES
Important Phone Numbers
SUNSHINE HEALTH MEMBER SERVICES: 
Member Services is able to answer questions related to multiple different services,
which include the following:
• Nurse Advice Line
• Dental and Vision Questions/Problems
• Pharmacy Questions/Problems
• Language Assistance
• Non-Emergency Transportation Services
• CMS Delivery Issues, HHA/Provider Questions or Problems
Member Services Representatives are trained professionals who are able to address issues or
concerns. If for whatever reason they are unable to assist you, they will reach out to your assigned
Care Coordinator to make contact with you.
LOCAL CAREGIVER SUPPORT GROUPS
• Family Caregiver Alliance – National Center on Caregiving is an available resource
that provides online help to families and caregivers by identifying support groups.
www.caregiver.org/support-groups
• Today’s Caregiver provides local resources, and you are able to search for your state
and city to find local in-person groups to attend.
www.caregiver.com
For more local information on support groups in your area, reach out to your assigned Sunshine
Health Plan Care Coordinator who can assist in finding suitable groups in your area.
CAREGIVER RESOURCES
YOUR ASSIGNED CARE COORDINATOR IS:
Important Phone Numbers CAREGIVER RESOURCES
In Case of an Emergency: 911
Medicare
www.Medicare.gov
1-800-MEDICARE
Medicaid
www.Medicaid.gov
1-888-367-6554
AARP
www.aarp.org
1-888-689-2277
Disability
www.disability.gov
Social Security Administration
www.ssa.gov
1-800-772-1213
Area Agency on Aging
www.agingcare.com
Department of Elder Affairs
www.elderaffairs.state.fl.us
1-800-96-ELDER
Alzheimer’s Association
www.alz.org
1-800-272-3900
Parkinson’s Association
www.parkinson.org
1-800-4PD-INFO
Sunshine MMA
www.sunshinehealth.com
1-866-796-0530
Florida LTC Ombudsman Program
http://ombudsman.myflorida.com
1-888-831-0404
Abuse, Neglect and Exploitation
1-800-96-ABUSE
1-800-962-2873
“
Know you are blessed to have another day with your
loved one, because one day they won’t be there.
Debbie M.
“
Tips/Tricks to Prevent Caregiver Burnout
THE CAREGIVER’S SURVIVAL GUIDE
You can only care for another person as well as you care for yourself. Imagine yourself as a parent on
a faltering plane. When the oxygen masks drop, you put yours on first, then your child’s. The same
thing goes for a caregiver. To be a good caregiver, you need to take care of your own health.
1. Keep your routine.
If you normally get up and stretch and shower before sipping coffee as you get dressed and
watch the news, don’t stop. Even if you’re more anxious about catching the doctor than
catching up with the latest world events, stick with what’s most familiar. It will calm you and
your family, especially if you still have children living at home.
2. Get serious about self-care.
Don’t skip your regular checkups! Make sure you get your annual exam, and tell your doctor
you’re caring for a sick loved one. Even better, ask to have your necessary tests performed at the
same medical center where you take your loved one, and try to schedule them on the same day.
3. Find an enjoyable physical pursuit.
I know, I know—you’ve had it drummed into your head to exercise! But do find a form of exercise
you enjoy—whether it’s swimming, walking, biking, dancing or watching a movie while walking
or jogging on a treadmill. Exercise increases the production of powerful feel-good endorphins,
which can counteract the stress hormones that your body is probably producing more of.
4. Reward yourself.
Make a list of the little things you enjoy—whether it’s getting a manicure, having a latte and
reading the paper at the local coffee shop or even shopping—and commit to doing one every
day. You need to take a break from the anxiety and reward yourself for the superb care you give
your loved one. Above all, don’t feel guilty about wanting to feel good.
5. Breathe!
Whenever we’re anxious, our breathing becomes shallow and our lungs never quite fully inflate.
So there isn’t enough force to carry oxygen around to all of the cells in our body that are hungry
for regeneration. This deprives the brain of the anti-stress hormones it needs to function
calmly and clearly. Just 10 minutes of slow, deep meditative breathing will help slow your
heart rate, calm your emotional state and make it easier to think clearly. Whenever you feel
overwhelmed by caregiving responsibilities, take time out to sit calmly and do this.
CAREGIVER RESOURCES
Tips/Tricks to Prevent Caregiver Burnout CAREGIVER RESOURCES
The Caregiver’s Survival Guide, continued
6. Watch out for symptoms of depression.
Caring for a sick or aging loved one can be draining—and that’s completely normal. Unfortunately,
it can also pave the way for depression; those caring for someone with dementia are thought to be
especially vulnerable. In fact, the Family Caregiver Alliance surveyed California caregivers of adults
with chronic health problems and found that 45 percent of them had symptoms of depression. Even
more reason to take steps to protect your health. Signs of a potential problem: Are you unable to
sleep (or are you sleeping too much)? Do you have no appetite (or are you eating all the time)? Do
you feel pessimistic about the future? Do you no longer enjoy activities you once did, like going to
the movies or socializing with friends? If any of these symptoms have persisted for more than two
weeks, it’s time to consult a doctor or therapist.
7. Pamper yourself.
Raise your spirits while you lower your blood pressure. Get a massage. Get a pedicure. Take a
long candlelit bubble bath. Enjoy a nice dinner out. Anything that relaxes you and makes you feel
special will go a long way in defeating stress.
8. Stay organized.
Try to manage your time as best as you can. Write to-do lists and use calendar reminders.
Make a list of priorities and address those first. Don’t be afraid to assign tasks to others in the
family to help with the caregiving.
9. Learn company policies.
For those working caregivers, read the employee handbook or speak with HR regarding time off
for caregiving. Your company may have an Employee Assistance Program (EAP) that provides
benefits for care for an elderly parent or relative.
“
Each night before bed, look at yourself in the mirror and know
that you are an exceptional person for what you do for others.
Anonymous
“
Calendars
MONTHLY PLANNER
MONTH:
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
CAREGIVER RESOURCES
Monthly Planner CAREGIVER RESOURCES
MONTH:
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
**Additional Monthly Calendars are available upon request
“
Be kind to yourself and don’t take on the guilt. Just do your best ... but remember you can’t do it all.
Christine H.
“
WEEKLY PLANNER
WEEK OF:
Monday Tuesday Wednesday
Thursday Friday
Notes
Saturday Sunday
CAREGIVER RESOURCES
Weekly Planner CAREGIVER RESOURCES
WEEK OF:
Monday Tuesday Wednesday
Thursday Friday
Notes
Saturday Sunday
**Additional Weekly Planners are available upon request
“
Try to laugh through your tears and appreciate the little
moments and small joys, which will stay with you always.
Joanne B.
“
Notes
CAREGIVER RESOURCES
Notes CAREGIVER RESOURCES
CAREGIVER RESOURCES Notes
“
Caring is having faith that you are doing all you can.
Anonymous
“
CAREGIVER
JOURNAL
--- SunshineHealth.com
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