Clemens Health | Overnight and on-call arrangement comparison
Updated 2026-10-05 | (651) 354-1196

Complete one copy per proposal. Leave response methods and availability unknown until the responsible team verifies them.

Service and purpose
What exact service and need are being discussed?
Illustrative entry: Overnight assistance and an on-call need are separate entries.
Your notes: ________________________________________

Physical presence
When is a worker scheduled in the home?
Illustrative entry: Do not infer this from the words 24-hour.
Your notes: ________________________________________

Request method
How does the person reach help?
Illustrative entry: Ask about the agreed accessible contact route.
Your notes: ________________________________________

Response arrangement
Who responds and through which method?
Illustrative entry: Provider to explain the person-specific arrangement.
Your notes: ________________________________________

Uncovered need
Which routine assistance is not addressed?
Illustrative entry: Scheduled overnight task remains a separate question.
Your notes: ________________________________________

Failure or change
What if the usual arrangement cannot operate?
Illustrative entry: Obtain the approved backup contact instructions.
Your notes: ________________________________________

Confirmation
Who verified service choice and delivery?
Illustrative entry: Case manager reviews service; provider confirms delivery.
Your notes: ________________________________________

Illustrative example
A family hears that a provider offers 24-hour emergency assistance and assumes a worker will sleep in the home. The comparison sheet prompts a question about physical presence. They learn that the proposal concerns an on-call response, while routine nighttime assistance remains a separate planning question. The team reviews both needs instead of scheduling around an assumed overnight worker. They also clarify which contact is for ordinary coordination. The example illustrates clarification, not a recommendation that one service is always better.

Next step
Ask the case manager to compare actual needs, then obtain a provider explanation of presence, contact and response.

This is an optional discussion worksheet, not an official assessment, authorization, service plan, or emergency plan. Keep completed copies private and share through an agreed channel.