Assessing Care Solutions

Sometimes as a senior or caregiver, it's tough to know where to start. The following questionnaire can help you determine the housing or personal care that best fits your personal scenario. Select the statement that best applies to you or your favorite senior's current ability under each category. Please choose just 1 explanation under each category. We'll match your answers with the solutions that can best accommodate you.


Dressing		Getting dressed in the morning is no problem, regardless of the weather.
		A little assistance with the finer points would be nice. Maybe a little help with shoelaces, zippers, garments, hooks, etc.
		Dependent on others for dressing.

Hygiene		Bathing? Check. Shaving? Check. Dressing? You get the point. No assistance needed.
		It’ll get done … with a little help or a few reminders.
		Most or all personal hygiene activities require assistance.

Mobility		Moves around with ease. And in the case of an emergency, evacuation procedures would be easy to follow.
		Relies on cane, walker, or wheel chair, and needs help in case of emergency.
		Mobile, but physical problems or confusion might make things difficult sometimes, so it’d be nice to have some help.
		Needs occasional assistance to move about, but can usually get around independently.
		Requires assistance transferring from chair, toilet, or bed.
		Requires full transfer and transport assistance, including turning in bed and wheelchair.

Toliet Needs		Completely continent and independent.
		Has incontinence, a colostomy, or catheter, but can take care of it without help.
		Occasional problems or requires assistance.
		Uncontrollable incontinence and inability to communicate needs.

Nutrition		Awesome at cooking and even better at eating.
		Can put together most meals, but needs help preparing the more difficult stuff.
		All meals need to be prepared and served by others.
		Requires assistance when eating (i.e. pouring, cutting, opening packages).
		Totally dependent on others for nourishment, including reminders and assistance.

Housekeeping		Can perform housekeeping functions, such as bed-making, vacuuming, cleaning and laundry.
		Needs assistance with housekeeping.
		Laundry and housekeeping services must be provided by others.

Medications		Can handle the self-administration of medications.
		Can handle self-administration, but needs reminders or monitoring.
		A medication administration system has been arranged with reminders and monitoring.
		Licensed personnel must administer medications.

Mental Awareness		Able to reason. Memory is all right, but has occasional bouts of forgetfulness.
		Requires guidance to get around. Has an occasional bout of confusion and disorientation.
		Requires orientation assistance and reminders due to poor judgment skills.
		Unable to follow directions. Orientation, memory, and judgment skills are severely impaired.

Behavior		Performs well in a social setting. Emotions are under control.
		Requires periodic assistance with coping with stress or other emotional issues.
		Requires regular assistance with coping with stress or other emotional issues.
		Poses potential for physical injury to self or others. Requires monitoring at all times.

Dressing

Hygiene

Mobility

Toliet Needs

Nutrition

Housekeeping

Medications

Mental Awareness

Behavior