Forms & Checklists

The information provided here is believed to be correct, but is not guaranteed. Me & My Caregivers does not provide legal, medical or other professional advice. Your should always consult with your own professional advisors to ensure that the information provided here is appropriate for your specific situation.

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The Health Care Proxy Quiz

Health Care Proxy Quiz from the Caregiving experts at Me & My caregivers

Take the following quiz and then ask your family members, doctor, and health care proxy (agent) to take it. They should answer the questions in the way they think you would answer. How well do they know your health care wishes? If your answers are not the same this is a clue that you should communicate your preferences more clearly. You can use the quiz to help start the discussion.

Download the Health Care Proxy Quiz here. (250 Kb) The Living Will is in Adobe PDF format.

Living Will

Every state in the United States permits some form of Living Will Directive or Advance Health Care Directive, either by statute or judicial decision. Each state, however, has a different statute or case law that allows it. This Living Will form may not be recognized in all states. Some states have unique laws that require the use of a specific form. Additionally, state laws change from time-to-time, and sometimes new requirements are created. You should check the particular requirements of your state periodically to make sure the terms of your Living Will are enforceable. CONSULT WITH AN ATTORNEY TO REVIEW YOUR LIVING WILL.

Download a sample Living Will here. (53 Kb) The Quiz is in Adobe PDF format.

Health Care Proxy and Durable Power of Attorney for Health Care

Every state in the United States permits some form of Living Will or Advance Health Care Directive, either by statute or judicial decision. Each state, however, has a different statute or case law that allows it. The Health Care Proxy and Durable Power of Attorney for Health Care form on this Forum may not be recognized in all states. Some states have unique laws that require the use of a specific form. Additionally, state laws change from time-to-time, and sometimes new requirements are created. You should check the particular requirements of your state periodically to make sure the terms of your Health Care Proxy and Durable Power of Attorney for Health Care are enforceable. CONSULT WITH AN ATTORNEY TO REVIEW YOUR HEALTH CARE PROXY AND DURABLE POWER OF ATTORNEY FOR HEALTH CARE.

Download a sample Health Care Proxy and Durable Power of Attorney for Health Care here. (25 Kb) This document is in Adobe PDF format.

Valuable Records Checklist

In today's society there are so many valuable documents and pieces of information it's hard to keep track of them all. This Valuable Records Checklist will help you organize the information and provide piece of mind.

Click here to download the Valuable Records Checklist. (799Kb) This document is in Adobe PDF format.

Top 25 Interview Questions You Should Ask a Potential Caregiver

Finding the right caregiver to take care of your loved is not always an easy task. Here are some key interview questions to help you get started. Be sure to take notes during the interview. Always check the references of at least two final applicants. Don't wait too long to make the offer, as good applicants may find another job. If the offer is accepted, the caregiver and the in-home helper should set a date to sign the contract and begin work. Both employer and employee should keep a copy of the contract.

Name, address, home phone number, cell phone number, and the best time to call.
Do you smoke?
Do you have a driver's license? If yes, do you have reliable transportation and insurance? How far from here do you live?
Do you have any CPR or first-aid training? Do you have any formal caregiving training?
Do I have your permission to run a background check?
What type of position are you looking for? After reviewing our job description, is this the type of position you are looking for?
Can you perform the duties required for this position?
Are you comfortable with pets?
Are you able to work the hours needed?
When are you available to start working?
Do you have any medical conditions to prevent you from heavy lifting? Would you be able to transfer someone from a wheelchair into a car or onto a bed?
If we are delayed, go out of town, or go on vacation would you be able and willing to adjust your schedule?
Where was your last job? How long were you there? Why did you leave? May we contact your past employer? Please provide contact name, phone number, and email address.
If meal preparation is needed, what kind of food do you cook? Have you had experience cooking for other people
How do you feel about caring for an elderly/disabled person? Or a person with memory problems?
How do you handle people who are angry, stubborn, or fearful?
What type of diagnoses have you cared for?
Is there anything in the job description that you are uncomfortable doing?
Give an example of a difficult situation you handled with a client. For instance, how did you handle refusing to take a shower?
What time commitment are you willing to make to stay on the job?
Will you keep daily records? Do you know how to use a computer?
Why should I hire you?
Are you willing to sign a contract saying you will not accept money or gifts from my parents?
How will you keep the family informed?
Can you give me two work related and one personal reference?

When you hire a caregiver be sure to provide an employment application, W-4 tax Form, job description, and summary of the care-receiver's condition. Ask the caregiver to provide written references, completed employment application, completed W-4 Form, and signed copy of job description, copy of driver's license, car registration, and insurance.

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