Mobility issues/Bed sores/Informal supports

Mobility issues/Bed sores/Informal supports

Adding Informal supports to the PCSP

  • If PTP has informal support, it MUST be documented that the informal support is willing, able, and available. 
  • When informal support is assessed and available, note their name and relationship to the participant.
    • In both the PCSP and InterRAI
  • For each individual performing informal support; the hours of support, the days of the week (frequency) and specific tasks that the informal support agrees to perform and/or support must be documented.
    • Son Andrew Smith is available on Saturdays for 3hrs max to assist with shopping
    • Daughter Amelia Smith is available 3-4 times per week to assist with shopping, medical appointments and financial management
  • The informal support must verbally agree to the specific tasks that they will perform, the time they can commit and be available to perform those tasks, and their ability to perform the tasks independently and/or when other support may be necessary.
    • SC must speak to informal support (son daughter, neighbor, mother father) to verify that they agree to provide informal support. 
      • Daughter, Alla is willing, able, and is available to provide informal support by doing laundry on Monday, Wednesday, and Friday. 
  • If the informal support is not available in the assessment interview, contact must be made directly to affirm an agreement that the informal support is willing, able and available to perform the specific tasks.
    • To submit Assessment on time, talk to informal support before the visit or ask informal support to be present during the visit. 
  • ADD Informal Support to PCSP with detailed info and contact number
  • Select if the Informal support needs additional assistance to continue providing care
  • Add information on if Informal Support lives in the home with the participant
  • Select what days of the week the Informal Support provides care to the participant
    • ADD Informal Support to Service Plan section of the PCSP
      • In “Type of Service” Informal Support must be selected if the participant receive any care from informals, no matter how minimal
      • Select the Frequency of informal support
      • Write in the Amount of informal support provided
      • Select if the Informal is willing, able, and available to assist moving forward
      • Select what ADL/IADL’s the informal support will be assisting with
      • Provide contact information for the informal including the following
        • First and Last name
        • Relationship to participant
        • Informal’s date of birth
        • Informal’s address
        • Informal’s phone number
      • Select if you spoke with the informal support to confirm their ability to assist at the visit or telephonically outside of the visit

    Example of Service Plan portion of PCSP in FP for Informal Support:


    Informal Support- Willing, Able and Available-Must be added to the ADL’s and IADL’s

    • Managing Finances:
      • POA, son, Stanley is willing and able to assist as informal support with bill pay and balance checkbook as needed (1x a week)
    • Managing Medications:
      • Sister, Gabriella, is willing, able, and available to provide informal support by providing verbal reminders/administering proper medication, in the morning and afternoon daily. Gabriella lives with ptp. 
    • Phone Use:
      • Daughter, Alla is willing, able, and is available to provide informal support by making calls to PCP, specialists, and pharmacy as needed.
    • Ordinary Housework:
      • Daughter, Alla is willing, able, and is available to provide informal support by doing laundry on Monday, Wednesday, and Friday. HHA/formal support will assist with dusting, trash removal, and dishwashing. PTP is unable to complete housework due to severe arthritis and edema which limit the ability to stand for a long period of time.
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