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Client Support Plan Download PDF

Getting to know you

Hope Health & Care Services appreciates that everyone is unique, please help us to get to know you by answering the following:

General Info

How is Enquirer related:

Living Arrangements: (Who Do You Live With?)


A bit about you and your goals and support needs

To help us understand you better, please fill the below:

NDIS Funding Info

Note: Providing your plan is not essential but is very helpful

About your weekly schedule

Time Monday Tuesday Wednesday Thursday Friday Saturday Sunday
6.00-7.00 am
7.00-8.00 am
8.00-9.00 am
9.00-10.00 am
10.00-11.00 am
12.00-1.00 pm
1.00-2.00 pm
2.00-3.00 pm
3.00-4.00 pm
4.00-5.00 pm
5.00-6.00 pm
6.00-7.00 pm
7.00-8.00 pm
8.00-9.00 pm
9.00-10.00 pm +

Mealtime Management

I have the following allergies/lntolerances and my favourite food is...

Mental Health

Functional Requirements

Activity Tick one Domestic and Parsonal Care Provide details of the aids and assistance required, from whom and when
Can maintain home without help (including laundry)
Need some assistance (cleaner, change light bulb)
Completely unable to do housework
No help needed (drives own car, or travels independently on public transport or by taxi)
Need some help (someone to drive or accompany when travelling)
Can only travel in specialised vehicle
Shopping (has transport)
Can take care of all shopping needs on own (including internet shopping)
Need some help (someone to accompany on most shopping trips)
Completely unable to do any shopping
Meal Preparation
No help needed (can plan, prepare, cook and ensrure nutrition)
Need some help
Completely unable to prepare meals and manage nutrition
No help needed
Some help needed (cutting up food, spreading butter, pouring drink, modified cutlery)
Completely unable to eat without help (spoon feeding)
Taking oral medication
No help needed (right dose and right time)
Need some help (someone prepares, reminds, pre-packed)
Completely unable to take own medicines without help
Handling money
No help needed (banking, paying bills, keeping track of finances)
Need some help (can manage day to day buying but needs help with paying bills)
Completely unable to manage money
No help needed (can make and receive phone calls including using assistive devices)
Needs some help
Completely unable to use telephone
No help needed (except use of stick)
Need some help (person, walker, crutches or self-propelled wheelchair including cornering)
Completely unable to walk or needs to be pushed in wheelchair
Transfer Bed/chair
No help needed
Need some help (person or equipment)
Unable to manage (unable to balance while sitting)
Bathing Showering
No help needed (get in and out of bath/shower and wash unaided)
Need some help (rails, shower chair, person lo shampoo hair) but can wash themselves
Completely unable to bath/shower on own
Oral care
No help needed (includes using electric toothbrush)
Need some help (prompting)
Completely unable to manage mouth care and cleaning teeth
No help needed
Need some help (zips, buttons, laces but can put on some garment)
Completely unable to dress
Grooming (makeup, hair, nails, shaving)
No help needed
Need some help
Completely unable to manage any grooming without help
No help needed (can get on and off, remove clothing and clean thoroughly)
Need some help
Completely unable to manage toileting without help

Health requirements

Activity Tick (as applicable) Outline condition, treatments, aids/assistance required, from whom and when
Have had a GP check up in the last 12 months
See a specialist regularly
Have a case manager/support coordinator
Vaccinations have been up to date and all existing documentation regarding vaccination is obtained
No written record of vaccinations (in which case, catch-up immunisation is recommended)
lmmunisations booked
Have had a dental check up in the last 12 months
See a dentist regularly
Dental check booked
Allied Health
Have had an allied health check up in the last '12 months by a physio, occupational therapist, psychologist or other allied health practitioner
See an allied health practitioner regularly
Allied health practitioner booked
Continent with regular bowel and bladder action
Constipation, diarrhoea or incontinence (using medication, supplements, pads)
Medical interventions (catheter, stoma bag)
Skin Integrity
No skin problems
Some skin problems (rash, skin treatments)
Pressure areas (currently have, at risk, or had in past)
No swallowing lssues
Some swallowlng problems (choking, coughing during normal meal, reduced appetite)
Maior swallowing difficulties (modified diet, feeding tube)
Muscular pain
No pain
Moderate pain
Severe pain
Nerve pain
No pain
Moderate pain
Severe pain
No falls in past 12 months
Less than 3 falls and no serious injury from a fall in past 12 months
More than 3 falls or a serious injury from a fall in the past year
Muscular issues (other than pain)
No problems
Some muscle weakness, tremor, spasms, spasticity or problems with balance
Serious muscle weakness, tremor, spasticity or problems with balance
Other health concerns
Visual disturbance
Temperature intolerance
Other comorbidities
I love cooking a
  • I like to watch cooking shows on TV
  • I like to buy good cook books
  • I like to prepare my own meals
  • I like to attend cooking classes regularly
  • I need a tv in my room with good reception.
  • I need a computer/tablet and high speed internet or Wi-Fi to buy books online.
  • I would like to have access to a kitchen to prepare my own meals 2 x per week
  • I need a maxi taxi and carer/staff member to take me to cooking classes once a month
Hobbies & Interests:
Rellgion & Spirituality
E.g. theatre, cafes, exhibition, drives, group activities
E.g. games, shopping, education, bookings
Education, Volunteering
Likes, dislikes
Likes, dislikes
E.g. exercise, gym, swimming, massage, yoga, meditation etc...
Food and alcohol:
Likes, dislikes, diets
Sex and intimacy

Behavioural requirements

what things are important for people to understand about you when caring for you? Provide Details Outline how you like this to be managed
Who makes the decisions?
What routines do you have?
What makes you happy?
What helps you relax?
What causes you stress?
What makes you frustrated?
What makes you angry?


We recognise the significance of matching the right staff member to meet your needs and consider a number of factors such as personality, language, culture and skill requirements. We encourage and support you to be involved in the process of matching your needs with the right staff We can also support you to access an advocate of your choice to support you in this process

Based on the above, what characteristics would you like to see in any staff member supporting you? Provide details Notes in relation to potential workers discussed with client who could provied supports (given preferences below and relevent training of workers to deliver such supports)
Muscular issues (other than pain)
Intrusive support?
Where the Client has specific needs which require monitoring and/or daily support, which Workers are appropriately trained to understand the Client's needs and preferences.

Conclusion: About Your support worker

Consent, internal checks and administrative requirements