Why a diary helps
The NHS Continuing Healthcare assessment records the person's actual day-to-day needs in 12 care areas of the Decision Support Tool, and looks at the nature, intensity, complexity and unpredictability of those needs. Care notes often say little more than "settled" or "had a good day". A diary shows how often help was needed, how long it took, how many people it needed and what happened when it was late.
The National Framework says a care provider can be asked to keep a detailed diary to show the nature and frequency of needs and interventions. Ask the care home or care agency to do that for the same week, and keep your own record of what you see. Take it to the meeting: our MDT meeting guide explains how the team uses it.
How to fill it in
- Write at the time, with the time of day, how long it took and how many people helped. Sign or initial each entry.
- Record the nights as well as the days: getting up, turning, calling out, falls, medicines and checks.
- Write down well-managed needs too, with what the care prevents. Well-managed needs are still needs.
- Note which of the 12 areas each entry belongs to, using the list in the diary. Our guide to the 12 DST care domains explains what each one covers.
- Be accurate. Write what happened, on the bad days and the better ones.
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The 12 areas: 1 Breathing · 2 Nutrition · 3 Continence · 4 Skin · 5 Mobility · 6 Communication · 7 Psychological and emotional · 8 Cognition · 9 Behaviour · 10 Medication and symptom control · 11 Altered states of consciousness · 12 Other
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Questions
Why keep a care diary before the CHC assessment?
The assessment looks at actual day-to-day needs: how often, how long, how many people and what happens if help is late. A diary written at the time gives the team specific evidence instead of general impressions. The National Framework says a care provider can be asked to keep a detailed diary to show the nature and frequency of needs.
How long should the diary cover?
At least 7 days and nights, ideally the week or two before the MDT meeting, so it shows current needs. If needs change from day to day, keep going for longer and note the bad days as well as the better ones.
Should I record needs that are well managed?
Yes. Well-managed needs are still needs. If something is under control only because of the care given, such as repositioning every few hours or one-to-one supervision, write down the care and what it prevents.
Can the care home keep the diary instead of me?
Both help. Ask the care home or care agency to keep detailed notes for the same week, with times, durations and how many staff were needed, and keep your own record of what you see on your visits.