A first-week checklist for new joiners in home healthcare and elder care

A caregiver's first morning is rarely in an office. She is sent to a flat in a third-floor walk-up, where an elderly man with a catheter, a bedsore on the sacrum and a daughter on the phone waits. If nobody has shown her the care plan, she is improvising.

This checklist is for agencies placing nurses, patient attendants, caregivers and physiotherapy assistants. It follows the pattern in the home healthcare hub and the notes on caregivers who work alone.

Before any form is signed, the supervisor sits with the joiner and reads two real care plans, with names hidden. Diagnosis, mobility level, diet, medication list, turning schedule, red-flag signs and the family contact list. The joiner learns what a good plan looks like, and what a lazy one omits.

Day 1  Care-plan reading. Handover diary format. Who to ring at 2 a.m. and what to say.
Day 1  Hand hygiene, gloves, mask, disposal of used dressings and diapers.
Day 2  Shadow a morning visit: bed bath, two-hourly turning, skin check at the heels and sacrum.
Day 2  Vitals: BP apparatus, pulse oximeter, glucometer. Write readings on the vitals chart, not on a scrap.
Day 3  Shadow a lifting and transfer: bed to wheelchair, gait belt, fall-risk check.
Day 3  Feeding: sitting angle, thickened liquids, Ryles tube feed if the role allows.
Day 4  Equipment: nebuliser, oxygen concentrator, suction machine, air mattress. Practise alarms.
Day 4  Medication administration record: read it, never alter it, report any gap.
Day 5  Supervised solo visit with the supervisor in the next room or on the phone.
Day 5  Debrief. Decide which roles and cases the joiner may take in week two.
Joiner ______   Supervisor ______   Family feedback noted Y / N

• Do not change, skip or double a dose, even when the family asks.
• Do not accept cash, gifts or loans from the household.
• Do not post anything about the patient on a family WhatsApp group beyond the agreed update.
• Do not stay silent about a fall, a fever, a new sore or a refused meal.

1. 1

   Night duty basics

   Twelve-hour nights with a sleeping patient still need hourly checks, and the joiner needs to know how to stay awake without leaving the room.

2. 2

   Dementia and sundowning

   Late-afternoon restlessness, wandering, calling for a spouse who has passed. Teach calm redirection, not argument.

3. 3

   Pressure ulcer prevention

   Turning, dry sheets, pillows under the calves, and when to photograph and report.

4. 4

   The family relationship

   Who is the decision-maker, who is the worrier, and how to give bad news early without alarming anyone.

Ask for a short voice note or message after every visit in week one. Arrival time, vitals, meals taken, bowel and bladder, skin check, mood, anything unusual. The supervisor replies the same day. Replies matter more than reports, because the joiner learns what counts as important. By week two, switch to the handover diary alone and call only for exceptions. Keep a simple tally of late arrivals, missed entries and family complaints, so the review in week three rests on notes and not impressions.

Watch, too, for the joiner who never calls. Silence is not competence. A new attendant who reports nothing for three shifts may be hiding a fall or fearing a scolding. Make asking for help look normal by praising the first honest escalation in front of the team.

Not every caregiver suits every flat. A joiner afraid of lifting should not start with a heavy post-hip-fracture patient. A vegetarian who cannot handle raw meat for a family cook-along may need a kitchen discussion. A young nurse unfamiliar with a joint family may need a briefing about the mother-in-law who supervises every move. Write the match on the first-week sheet, with the reason.

• Check the lift, the stairs and the bathroom for hazards before the first visit, and photograph them for the file.
• Ask the family about pets, visitors, house rules on shoes and phones, and prayer times.
• Carry the agency card, a torch, a spare pen and the emergency numbers on a laminated slip.
• Agree the travel route and the check-in message at arrival and departure.

Write one of three outcomes: ready for day shifts, ready for day and night shifts, or needs a second week of shadowing. Do not use polite vagueness. The next supervisor needs the truth. The same discipline helps with documentation and the service page on employee onboarding covers the wider approach.

To adapt the sheet to your own mix of nurses, attendants and caregivers, send your details through the requirements form.