What to keep in a care diary

Four people are involved in looking after someone at home, and each of them holds a different quarter of the picture in their head. The daughter knows about the appointments. The neighbour knows the back door sticks. The support worker knows which mornings are harder. The son who rings on Sundays knows what his father says when nobody is in the room.

None of them has the whole thing, and the quarters only meet in a crisis.

A care diary is the cheapest possible fix. It is a notebook on the kitchen bench.

What it is for

Three things, in order of how much they matter.

Catching patterns. Nobody can tell you whether the bad nights are getting more frequent from memory. Six weeks of two-line entries can.

Surviving handovers. A hospital admission, a new worker, a fortnight when the main carer is away. The diary is what makes the next person competent from day one instead of week three.

Making appointments useful. Ten minutes with a GP is worth far more when the answer to “how has it been?” is a page rather than a shrug.

What to write

Keep it short. A diary that takes five minutes a day gets abandoned in a fortnight. Two lines is the target.

• The date, and who wrote it. This sounds fussy and it is the field you will most want later.
• Anything different from usual. Slept badly, did not finish lunch, seemed brighter than she has been, walked to the letterbox for the first time in a month. Better than usual counts, and people almost always forget to write those down.
• Falls, near misses and new bruises. Every one, even the ones that came to nothing. This is the single most valuable column in the book and it is the one that turns a vague worry into something a doctor can act on. What to do after a fall at home covers the response itself.
• Appetite and fluids, roughly. Not a chart. “Ate about half” is enough.
• Any change to medications, and who made it. Who changed what, on what date. This one saves real trouble later.
• Appointments: the date, who was seen and what they said. Written the same day, while it is still accurate.
• Questions as they occur to you. Otherwise they arrive at 2am and are gone by the appointment.
• Who came, and when. Worker, cleaner, neighbour, physio.

What to leave out

Judgements. “Difficult today” tells the next reader nothing they can use, and it tells them something about the writer. “Did not want to shower, said the bathroom was cold” is a fact, it is more useful, and it comes with its own solution.

Also leave out anything you would not be comfortable with the person reading, because they should be able to read it. Private health details of other family members do not belong there either, since a book on a kitchen bench is read by whoever is in the kitchen.

Keeping it going past week three

This is where most care diaries die.

One book, one place, and the place is where things happen. The kitchen bench, next to the kettle. In a drawer means never.

Anyone can write in it. Family, the neighbour, the support worker, the person themselves. A diary that only one person is allowed to touch is that person’s diary, not the household’s.

Two lines on a quiet day. “Tuesday, nothing to report” is a real entry and it is what makes the busy entries mean something.

Read it back once a month. Twenty minutes, looking for the pattern rather than the day. This is the step that converts a pile of notes into something worth having, and almost nobody does it.

What it is not

It is not the emergency sheet. That is a single page on the fridge with the things an ambulance officer needs in thirty seconds, and it should exist separately. See the one-page emergency sheet for the fridge.

It is not your provider’s record either. We keep One Story so that everyone in the Care Circle works from the same picture rather than from whatever the last person remembered. The diary on your bench is the household’s side of that, and the two are better together: the things you write down between visits are exactly what we would otherwise have to guess.

It is not evidence, although it can become it. If something goes wrong and you need to raise it, a dated contemporaneous note is worth a great deal more than a recollection. How to raise a concern about your home care sets out that process.

Take it with you

To every appointment, alongside the medication list and the other things worth carrying, set out in what to take to a GP appointment.

A GP who asks how the last three months have been and receives an actual answer can do considerably more with the consultation than one who receives “oh, up and down”.

For assessments, funding and what support is available, start at myagedcare.gov.au.