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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Has withdrawn from friends and other social activities?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

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