Caregiver wellness

Respite Care Planning Worksheet

Rest is not a luxury — it's what makes long-term caregiving possible. Let's plan for it.

About the care recipient

NamePrimary needs during respiteRoutine and scheduleLikes and dislikesThings that comfort themThings to avoid

Current medications + timesAllergies

NamePhoneRelationship

Doctor name + phoneHospital preference

Provider nameTypePhoneAvailable days/timesNotes

Date of next planned respiteDurationWho is coveringWhat I plan to do for myselfWhat I need to prepare before I go

The person I will ask first:What I will say:What I’m worried about asking (and why it’s okay to ask anyway):