Useful Downloads

Things You’ll Need

When moving your loved one into a Care Home, the forms below will be helpful in relieving some of the stress in choosing the right home, as well as ensuring a smooth transition into that new home. If you’re keeping your loved one at home, review the Home Safety Assessment Checklist to make sure that their home is safe.

Physician’s Report – REQUIRED

Prior to admission into a Care Home, the State of California requires this form to be completed by the Primary Care Physician, or attending Physician if in a medical facility, and provided to the Care Home of your choosing.

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Power of Attorney

In the State of California, a Power of Attorney allows an individual to make financial decisions in place of someone else. The Power of Attorney grants these powers and decision making to a trusted friend or relative who will be known as an “Agent”. The Agent can only make decisions as specified by the “Principle”. The Agent has a Fiduciary responsibility to act in the Principle’s best interests. Durable Power of Attorney, vs. a standard Power of Attorney means that the powers continue should the Principle become incapacitated and unable to make their own decisions.

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Advanced Health Care Directive

In the State of California, an Advanced Health Care Directive allows a person to name their Power of Attorney for Health Care as well as to choose the types of care they do or do not want to receive. The person can allow their Power of Attorney for Health Care to make medical decisions now or in the future should the person become incapacitated. In order for this form to be recognized as a legal document, it will require acknowledgment before a Notary Public or two qualified witness signatures.

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Other Helpful Resources

Making a move, or caring for a loved one at home can be stressful. These forms help to aid in your decision making process, or in reviewing that your loved one’s home is safe and the right place for them now.

Home safety and move-in checklists

Home Safety Assessment Checklist

Is your loved one’s home safe and free of tripping hazards? Review the Home Safety Assessment provided by the Department of Health and Human Services to see if any modifications are needed.

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Move In Checklist

Moving into a Care Community and need to know what to bring? Review our Move In Checklist to aid in your decision on what personal belongings should come with you, and which items are not recommended.

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Top 10 Questions to Ask 

Use this form to assist in screening care homes during your visits so you can gather key information to make the best decision for your loved one.

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