Forms for Planning Ahead

Caring Conversations

Source: Center for Practical Bioethics

Description:

Online tool to help individuals and their families share meaningful conversation while making practical preparations for end-of-life decisions.


Checklist for Communicating Clearly with Your Doctor

Source: IlluminAge Communication Partners

Description:

Planning ahead before going to your healthcare provider helps ensure a productive visit. Bring this form along to help you remember instructions. Includes advance directives information.


Checklist for Older Drivers

Source: IlluminAge Communication Partners

Description:

Points for seniors and families to consider; is it safe to continue driving? What alternative transportation is available?


Checklist for Reducing Your Risk of Falling

Source: IlluminAge Communication Partners

Description:

Steps for seniors and family caregivers to consider as part of a conscious effort to reduce the risk of falls.


Checklist for Selecting and Working with a Geriatric Care Manager

Source: IlluminAge Communication Partners

Description:

Form to use while deciding how you might use the services of a geriatric care manager; choosing a qualified individual; working effectively with the GCM you select.


Consumer's Toolkit for Health Care Advanced Planning

Source: American Bar Association

Description:

Information and forms for making a health care advance directive (such as a living will or durable power of attorney for health care)


Factsheet: Let's Talk! Top 10 Things to Discuss with Your Parents

Source: IlluminAge Communication Partners

Description:

Ten things seniors and loved ones should think about when planning for the future.


Funeral or Memorial Service Planner

Source: IlluminAge Communication Partners

Description:

Checklist covers type of service, arrangements to be made, content of service and participants.


Home Repairs and Modifications Checklist

Source: IlluminAge Communication Partners

Description:

Check for ways to make your home safer and more functional. Includes checklist for hiring a contractor.


Is It Time to Move? Retirement Housing Planning Sheet

Source: IlluminAge Communication Partners

Description:

Questions for seniors and family to ask when weighing the pros and cons of moving to a retirement community.


Medicare Authorization to Disclose Personal Health Information Form

Source: Medicare.gov

Description:

Form can be used for healthcare representatives, family caregivers


National Clearinghouse for Long-Term Care Information

Source: U.S. Department of Health and Human Services

Description:

Site provides a wide range of information and options to help consumers plan for future long-term care needs


Nursing Facility Move-In Checklist

Source: IlluminAge Communication Partners

Description:

Three-part form to help you or your loved one make a smooth transition to living and receiving care in a nursing facility.


Resident/Family Care Conference Worksheet

Source: IlluminAge Communication Partners

Description:

Form for organizing your notes before and during a nursing home care conference.


Sample Combined Advance Healthcare Directive Form

Source: IlluminAge Communication Partners

Description:

Form includes introduction to healthcare directives, appointing a healthcare representative, creating a personal values statement and more.


State-Specific Advance Directives Documents

Source: National Hospice and Palliative Care Organization

Description:

Caring Connections provides free advance directives and instructions for each state that can be opened as a PDF.


Your Home Fire Safety Checklist

Source: U.S. Consumer Product Safety Commission

Description:

Checklist for home inspection, fire prevention, escape planning