Advocate’s Check-Off Sheet

Resident’s Name: ________________ Advocate’s Name: _______________ Week of: _____________

				Mon.	Tue.	Wed.	Thur.	Fri.	Sat.	Sun.
Each Visit
Does the facility appear clean, odor free, well maintained?
Is resident clean and comfortable? (Are they wearing appropriate clothing for the seasons, well groomed, are they slumped over in the chair or sliding out of them, are they still in bed at 11AM, are they participating in activities?)
Check for wrinkles in the sheets? (Wrinkles in bed sheets or clothing can decrease circulation and cause skin problems)
Apply lotion to skin? (Dryness increases the chances of skin breaks and tears)
Look for red spots? (Report any sores to staff. Monitor on on-going basis and ask staff to report to you the steps they are taking to manage and heal sores)
Look for skin tears? (If resident is bed ridden are they being repositioned every two hours?)
Does resident’s skin look dry, unusually pale, sunken, flushed? (Dry, sunken skin can indicate dehydration. Dehydration will heighten the poor skin integrity plus put patients at risk for problems such as urinary track infections, confusion, disorientations)
				Mon.	Tue.	Wed.	Thur.	Fri.	Sat.	Sun.
Does the resident look like they are experiencing breathing problems? (Short, shallow and gasping can signify problems and possibly severe problems. Make Nurse Aware)
Check for swelling? (Report to Nurse any extreme swelling in feet, ankles, arms, etc. Discuss ways to alleviate swelling with staff).
Are residents nails properly maintained? (Are nails clean and smooth? If resident is a diabetic are they properly being attended to by a nurse or podiatrist?)
Check oral hygiene? (Make sure it is being addressed daily)
Has the resident lost any significant amount of weight? (If so, is staff addressing the issue?)
Offer water? Ounces taken?
Feed resident? How much eaten?
Report resident intake to nurse?

				Mon.	Tue.	Wed.	Thur.	Fri.	Sat.	Sun.
Weekly
Clothing tears & loose buttons?
Do you need to relabel items?