'What I Need to Thrive'

Click the button above to download the "What I Need to Thrive" form. This form was developed by The Greater Trail Hospice Dementia Project.

This form helps communicate your loved one’s needs to health care workers.

Purposes

1. To foster a gentle, supportive hospital experience,

2. To lessen stigma for your loved one with dementia,

3. To decrease the incidence of delirium in hospital,

4. To avoid the use of unnecessary medication/use of restraints,

5. To communicate pertinent, detailed care needs to medical staff,

6. To prevent unnecessary decline in mobility during hospital stays,

7. To maintain your loved one’s current level of independence.

How to use this form

This form is intended to accompany your loved one to the hospital but could also be used in the home by care support workers or emergency services. Keep this form in your red PRIME Kit located in your fridge door. Alternatively, use your Greensleeve envelope which is magnetized to the front of your fridge. Ambulance attendants are trained to look for both information kits in the home. Use a pencil to complete this form so that it can be updated regularly. Include their current abilities and how you have adapted your care to meet their needs. Set yourself a reminder to review this form every three to four months. Bring this form to the hospital upon admission and ask the nurse to make a copy of it for their use. Keep the original.

To obtain a PRIME kit, contact Jayme Fowler at beavervalleycrn@gmail.com, or call: (250) 512-1231

To obtain a Greensleeve envelope, contact Trail & District Hospice at info@trailhospice.org