Living situation Lives alone Home with family or regular helpers Home with paid care Assisted living, memory care, or facility
Wandering pattern Early concern or near-miss Has left home or gotten lost Mostly nighttime confusion Repeated unsafe attempts to leave
Door or exit risk Rarely Sometimes Often or hard to redirect
Identification plan No wearable ID or wallet card yet Some ID, but not always used Current ID plan is in place
Caregiver coverage Mostly daytime coverage Around-the-clock coverage Known gaps in supervision Not sure yet
Transportation risk Not driving Still drives or asks to drive Walks outside alone Not sure
Home hazard review Not reviewed yet Some hazards or confusing areas Many hazards or unsafe exits Reviewed recently
Clinician discussion Not discussed yet Visit scheduled Care plan has started
Local support status Not contacted local support Some local support contacted Active local support in place
Emergency search plan Not written yet Written but outdated Written and shared with helpers
Use this to organize safety steps without entering private medical details.
Do not enter names, addresses, diagnoses, birth dates, Medicare numbers, account numbers, or private legal details. Keep personal emergency documents in a secure place and share them only with trusted helpers.
This planner is educational and organizational only. It is not medical, legal, emergency-response, insurance, benefits, or facility-placement advice. If someone is missing, in immediate danger, driving unsafely, or at risk of fire or injury, contact emergency services or the care team right away.
Useful references:
NIA wandering and getting lost ,
NIA home safety tips ,
Medicare cognitive assessment care plan ,
Eldercare Locator .
