top of page

Self-Assessment

Home healthcare helps adults who need nursing care, rehabilitation therapies or assistance with daily activities enjoy happier, independent lives while remaining in their own homes.

 

Complete a brief questionnaire to determine if now might be a good time to consider home care for a loved one.

​

REFLECTING ON THE PAST FEW MONTHS, HAVE YOU NOTICED THAT YOUR LOVED ONE FREQUENTLY:

​

​​Experiences trouble communicating with others?

Yes or No

​

Has challenges getting in and out of bed?

Yes or No

​

Shows signs of confusion or disorientation?

Yes or No

​

Wears the same clothes repeatedly without washing?

Yes or No

​

Has difficulty navigating stairs or moving around the house?

Yes or No

​

Has cuts or bruises that might be evidence of a fall?

Yes or No

​

Fails to prepare and eat meals on a regular basis throughout the day?

Yes or No

​

Does not keep the kitchen stocked with food?

Yes or No

​

Forgets to take prescribed medications as directed?

Yes or No

​

Is losing weight?

Yes or No

​

Neglects personal grooming and hygiene?

Yes or No

​

Skips showers or baths?

Yes or No

​

Wears night clothes during the day?

Yes or No

​

Cannot safely operate a vehicle?

Yes or No

​

Has withdrawn from friends and other social activities?

Yes or No

​

Has lack of interests in hobbies and other activities?

Yes or No

​

Neglects household chores?

Yes or No

​

Allows mail, newspaper and other clutter to accumulate?

Yes or No

​

Forgets to pay bills?

Yes or No

Better Care Starts With You

bottom of page