Plan now for choice & control at the end of life
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Personal care - considerations for your Advance Statement

General wishes

You may want to consider what being comfortable and cared for means to you.

I want to make the decisions even if I am very weak.

Category:

My Future

Statement of Preferences

Please enter a valid statement.
As this is a statement of preferences you can only use words such as wish, like, hope or prefer. Please edit the statement below (click the box to change the text) then click 'Add to Current Document' when ready.

I hate being cold and hope that I will be kept warm.

Category:

Personal Care

Statement of Preferences

Please enter a valid statement.
As this is a statement of preferences you can only use words such as wish, like, hope or prefer. Please edit the statement below (click the box to change the text) then click 'Add to Current Document' when ready.

I would hope to be kept clean at all times, with clean clothes as well.

Category:

Personal Care

Statement of Preferences

Please enter a valid statement.
As this is a statement of preferences you can only use words such as wish, like, hope or prefer. Please edit the statement below (click the box to change the text) then click 'Add to Current Document' when ready.

I want to talk about decisions with my family and then make decisions.

Category:

Personal Care

Statement of Preferences

Please enter a valid statement.
As this is a statement of preferences you can only use words such as wish, like, hope or prefer. Please edit the statement below (click the box to change the text) then click 'Add to Current Document' when ready.

Communication

You may have difficulty communicating, if this happens you may wish to name the person who should speak on your behalf.

If I am unable to communicate or having difficulty communicating, I would like .......... to speak on my behalf.

Category:

Personal Care

Statement of Preferences

Please enter a valid statement.
As this is a statement of preferences you can only use words such as wish, like, hope or prefer. Please edit the statement below (click the box to change the text) then click 'Add to Current Document' when ready.

My Care

 If you have difficulty seeing, are short or long-sighted, please add to the statement below.

I need glasses for reading and/or long distance, and may need them to recognise faces.

Category:

Personal Care

Statement of Preferences

Please enter a valid statement.
As this is a statement of preferences you can only use words such as wish, like, hope or prefer. Please edit the statement below (click the box to change the text) then click 'Add to Current Document' when ready.

If you have difficulty hearing please add to the statement below.

I am hard of hearing. I have hearing aids which do help a little. Please be patient, speak slowly and clearly, but donít shout.

Category:

Personal Care

Statement of Preferences

Please enter a valid statement.
As this is a statement of preferences you can only use words such as wish, like, hope or prefer. Please edit the statement below (click the box to change the text) then click 'Add to Current Document' when ready.

If you need assistance with walking or getting out of bed, please add this to the statement below.

I am not as mobile as I used to be. Please allow me to move at my own speed.

Category:

Personal Care

Statement of Preferences

Please enter a valid statement.
As this is a statement of preferences you can only use words such as wish, like, hope or prefer. Please edit the statement below (click the box to change the text) then click 'Add to Current Document' when ready.

Food and drink

This may include food and drink that you prefer, like or dislike, food allergies or sensitivities, the times you prefer to eat, and / or swallowing difficulties associated with particular types of food.

I would prefer food that is well flavoured and tasty, preferably mainly vegetarian.

Category:

Personal Care

Statement of Preferences

Please enter a valid statement.
As this is a statement of preferences you can only use words such as wish, like, hope or prefer. Please edit the statement below (click the box to change the text) then click 'Add to Current Document' when ready.

 

Clothing and washing

Your preferences for your appearance and clothing, including if you like to wear make up.

I hope to be well groomed and well dressed.

Category:

Personal Care

Statement of Preferences

Please enter a valid statement.
As this is a statement of preferences you can only use words such as wish, like, hope or prefer. Please edit the statement below (click the box to change the text) then click 'Add to Current Document' when ready.

Your preferences for bathing, showering or washing - you may have a specific routine or preferences around washing. For example, you may use different coloured or sized towels for different things, or you may have preferences for soap or shower gel and body lotions.

I would like to shower every day if possible.

Category:

Personal Care

Statement of Preferences

Please enter a valid statement.
As this is a statement of preferences you can only use words such as wish, like, hope or prefer. Please edit the statement below (click the box to change the text) then click 'Add to Current Document' when ready.

Any allergies and sensitivities you have - including things that may irritate the skin or affect your breathing.

I am sensitive to synthetic fibres and would prefer cotton sheets and blankets.

Category:

Personal Care

Statement of Preferences

Please enter a valid statement.
As this is a statement of preferences you can only use words such as wish, like, hope or prefer. Please edit the statement below (click the box to change the text) then click 'Add to Current Document' when ready.

 

Respect, privacy and dignity 

You may like to consider what respect means to you and this may include how you would like to be addressed.

I would be happy to be called by my first name by carers who had got to know me.

Category:

Personal Care

Statement of Preferences

Please enter a valid statement.
As this is a statement of preferences you can only use words such as wish, like, hope or prefer. Please edit the statement below (click the box to change the text) then click 'Add to Current Document' when ready.

You may like to consider what privacy means to you, and how any wish for privacy should be respected. This may include if you might prefer a male or female carer should you need assistance with personal care.

I would prefer a female carer to help me with washing and toileting.

Category:

Personal Care

Statement of Preferences

Please enter a valid statement.
As this is a statement of preferences you can only use words such as wish, like, hope or prefer. Please edit the statement below (click the box to change the text) then click 'Add to Current Document' when ready.

You may wish to describe what dignity means to you. For example if you were to experience incontinence of urine, incontinence of faeces, inability to feed yourself, inability to maintain adequate hydration, or inability to dress yourself.

If I became incontinent, that would be a loss of dignity.

Category:

Personal Care

Statement of Preferences

Please enter a valid statement.
As this is a statement of preferences you can only use words such as wish, like, hope or prefer. Please edit the statement below (click the box to change the text) then click 'Add to Current Document' when ready.

 

Other preferences and wishes 

You have completed this section. However, if you have additional wishes relating to your personal care, please select 'Add Statement' under 'Document Builder'.


Document Builder
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Please add your statement

Please enter a valid statement.