Health care facilities (clinic, emergency room, hospital) can cause fear for all people, but maybe more for persons with dementia. It can seem fast-paced and unfamiliar. When your loved one needs to go to a health care facility, it helps if the staff know about your loved one when healthy at home.

All About Me Form

Sometimes people living with dementia can’t tell us about themselves or what help they might need. As a family member/ caregiver, you can help provide more information about your loved one by filling out the “All About Me” form. If your loved one is able to help, please complete the form together. It should reflect how your loved one normally does when feeling well.

How All About Me Form is Used

The information collected on the “All About Me” form can be used by the entire health care team. This is true for staff at UW Health and Unity Point Health-Meriter. It helps the team personalize the care for your loved one.

Staff enter information from the form into your loved one’s medical record. This means you won’t have to fill out a new form each time your loved one needs medical attention. Staff may ask if there have been any changes and update as needed.

Please give the completed form to hospital staff or mail to the address on the bottom of the form.

Tips if Going to a Care Facility

Let staff know the best way to help your loved one when care is needed at another facility. Tell staff how to best reach you if there are changes or things they need to tell you. Other tips:

  • Make sure to bring glasses, hearing aids, and dentures. Make sure to label all items (or the containers) with your loved one’s name.

  • Bring non-valuable, well known items from home that may be comforting. Some ideas are family photos, favorite blanket, music player, music and/ or reading material.

  • Tell staff the best ways to avoid upsetting your family member.

  • Tell staff what helps if your loved one becomes confused and upset and what to do to make them feel safe.

  • When your family member leaves the care facility, it could take weeks to get used to a new routine or to go back to their old one.