My Plan

What I want to happen

1

Instructions for carer

This book is intended to support your conversation around a

care plan if someone becomes very ill

The different sections are intended to help guide the

conversation

Please make sure you record their wishes as accurately as

possible in the Anticipatory Care Plan

This can be a very difficult conversation so feel free to pause

and come back to it as appropriate

2

About my Plan

My Plan will tell people what I would like if I get very ill

The people who are important to me

The things that are important to me

How I want people to look after me when I am very ill

3

Important things to know

I can change my Plan at any time

The Plan is about the care I would like

This Plan will need to be shared with people who are caring for me when I am very ill

4

All about me

5

All about me

My name is

I like to be called

6

How I like to communicate

Talking

Yes No

Signing

Yes No

Communication book

Yes No

7

Symbols or pictures

Yes No

Object of reference

Yes No

Other?

8

People that are important to me

This could be my family, friends, key worker, neighbour

9

Planning my care

10

Help with my decisions

When I am very ill, making decisions for myself can be hard

I can choose a person to help me make decisions

People that can help make decisions about your care may be:

Friend

Family member

Carer

11

People who will help make decisions about my care

Name

Name

Name

Name

Name

Name

Name

Name

12

Name

Do any of these people have

power of attorney or

Power of attorney or

Name

13

Other people who support me

Other people might be:

Keyworker

Health care worker

Mental health support worker

Name

Name

Name

Name

Name

Name

14

Things about my care

You might want to think about:

What you would like

What you do not want

Your family/carers involvement

15

Things to do with your medical treatment

Anything else about your care and support

16

Cardiopulmonary resuscitation

If your heart stops beating, sometimes doctors can make your heart start again This is called cardiopulmonary resuscitation or CPR

You can decide if you want the

doctor or nurse to try and restart

your heart if it stops (CPR)

17

What you decide will be written

down in a care plan and shared

with the doctors and nurses