Care Mapping

How to Make a Care Plan for a Loved One

Put the whole plan in one place, before a crisis forces the conversation.

Book a free 15-minute call

Based in Wake Forest, NC. Care coordination and coaching by phone and video, nationwide. Therapy for North Carolina residents.

What is a care plan?

When someone you love needs care, the details pile up fast. Doctors, pills, bills, rides, forms. Who is doing what? Where are the papers? What would Mom want?

A care plan answers those questions in writing. It keeps everyone on the same page, and it helps you act fast when something changes. This page covers what to put in a plan, how to talk about it as a family, and how we can help you build one.

A care plan is a written guide to one person's care. It lists their health needs, daily routines, the people who help, and the choices they have made about their own care. It also says what to do in an emergency.

The paper is only half of it. The other half is the conversation. Making a plan gets your family talking about wishes, roles, and money before a hospital stay makes those talks harder.

A care plan or a Care Map: which do you need?

You can write a care plan on your own, and the rest of this page shows you how. A Care Map is the plan we build with you. Here is how they differ.

How they compareA care plan you writeAn Ellipses Care Map
Who builds itYou and your familyYou and an Ellipses care coordinator
Where it startsA blank page or a templateThe Domain Assessment: we go through all nine areas with you and score each one
What it showsWhat you think to write downHow complex things are, and where help is needed most
What comes firstYou decideWhat matters most right now, and your top three priorities
PeopleYou list themYour support network, and who to call
ResourcesYou search for themResources matched to your needs, sorted by type
Next stepsOpen-endedInteractive checklists for this week, this month, and the next 3 months, checked off with your care coordinator
Where it livesPaper or a shared fileYour secure client portal, open anytime
Keeping it currentUp to your familyOn a monthly plan, we re-evaluate your Domain Assessment and Care Map every 90 days

When a plan you write is usually enough

  • Care needs are simple and not changing much.
  • One or two people share the work, and they agree on it.
  • You already know the doctors, the benefits, and the paperwork.
  • You want to get organized before anything changes.

When a Care Map makes sense

  • A new diagnosis, a serious injury, or a hospital stay has changed everything at once.
  • Several doctors, therapists, or services are involved.
  • Money, insurance, or legal questions are piling up.
  • Family members disagree, live far apart, or one person is carrying it all.
  • You have a plan, but it is not working and you are not sure why.
  • An attorney or case manager needs a clear written plan, such as after an injury.

Both beat having no plan. Many families start with their own, then call us when things get harder.

Who needs one?

A plan helps any family that is:

Caring for an aging parent

Living with a long-term condition like Parkinson's, MS, ALS, or dementia

Recovering from a serious injury, such as a brain injury

Facing a serious or terminal illness

Sharing care among several people, or caring from far away

You do not need a diagnosis to start. Many adults make a plan for themselves while they can still say what they want.

What to include in your plan

A good plan covers the whole person, not just the medical side. When we work with a family, we look at nine areas in our Domain Assessment. These areas are built on the social determinants of health: the everyday conditions, like money, home, and support from others, that shape health and well-being. They also make a good checklist for your own plan.

Medical care and rehab

Diagnoses, doctors and their phone numbers, current medicines, allergies, upcoming visits

Daily living and mobility

Help needed with meals, bathing, dressing, getting around, and rides

Memory, thinking, and behavior

Changes you have noticed, and what helps on hard days

Emotional and mental health

Mood, stress, and any counselor or support group

Caregiver support

Who helps, how often, and who fills in when the main caregiver needs a break

Money and insurance

Insurance cards, benefits, who pays which bills, and where accounts are

Legal planning and decisions

Which legal papers exist, where they are kept, and who can make decisions

Home safety

Fall risks, grab bars, lighting, and smoke alarms

Social life and community

Friends, faith groups, hobbies, and outings that keep life full

Put a one-page emergency sheet at the front. List who to call first, the medicine list, the main doctor, and where the legal papers are. If someone has to call 911, this is the page they grab.

The legal papers

Most care plans point to four kinds of legal papers. The names and rules vary by state.

Durable power of attorney

Names someone to handle money and legal matters if the person cannot.

Health care power of attorney

Names someone to make medical choices if the person cannot speak for themselves.

Living will or advance directive

Writes down the person's wishes about treatment near the end of life.

HIPAA release

Lets doctors share health information with the people it names.

An attorney can tell you which forms your state uses and help you complete them. Ellipses does not give legal advice. We can help you see what you have, what is missing, and who to call. See Legal & Ethical Guidance

Talk about it as a family

A plan only works if the family uses it. A few habits help:

Include the person receiving care.

It is their life and their plan. Ask what matters most to them, and write it down in their words.

Name who does what.

"We'll all pitch in" often means one person ends up doing it all. Write down each task and who owns it.

Meet on a schedule.

A short monthly call keeps everyone current and catches problems early.

Share one copy.

Keep the plan where everyone can find it, on paper and online.

Keep it current

Look over the plan at least once a year. Update it sooner after:

A new diagnosis or a hospital stay

A change in medicines

A move

A change in who is giving care

How Ellipses helps

Making a plan takes time, hard talks, and a lot of phone calls. That is the work we do with families: from overwhelmed to organized.

1

A free 15-minute call

Tell us what is going on, by phone or video.

2

Your Domain Assessment

In your first session, we go through all nine areas with you.

3

Your Care Map

You get a written plan that shows what is in place, what is missing, and what to do next. It has interactive checklists for what to do this week, this month, and over the next 3 months. You and your care coordinator check items off together.

Then you choose how much help you want:

Care Roadmap

A one-time Domain Assessment and written Care Map. Your family carries it out.

Care Copilot

Monthly check-ins and research to help you carry out your Care Map.

Care Management plans

A coordinator works with your providers, handles scheduling, and meets with you monthly. Comprehensive Care Management adds crisis planning and works with your attorney.

Free tools to get started

The Conversation Project

Free guides for talking with family about care wishes.

Visit The Conversation Project

CaringInfo

Plain-language guides to advance care planning, from the National Alliance for Care at Home.

Visit CaringInfo

Eldercare Locator

Finds your local Area Agency on Aging for caregiver help. Call 1-800-677-1116.

Visit Eldercare Locator

AARP Family Caregiving

Tools and guides for family caregivers.

Visit AARP Family Caregiving

Common questions

What is a care plan?

A written guide to one person's care. It covers health, daily needs, who helps, money, legal papers, and what to do in an emergency.

Do we need a lawyer?

For the legal papers, an attorney is the right person. Your family can write the rest of the plan. We can help you see what is missing and find the right kind of attorney.

How often should we update it?

At least once a year, and any time health, medicines, living situation, or caregivers change.

Is the first call really free?

Yes. It is a 15-minute call by phone or video, at no cost and with no obligation.

You might also find helpful

More ways we support families and caregivers.

From overwhelmed to organized.

You do not have to figure this out alone. Start with a free 15-minute call, and we will help you take the first step.

Book a free 15-minute call

Or call (984) 362-8904