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Assessment Tool


This Assessment Tool will give you a general idea about which type of housing or care may be most appropriate for you or your loved one. For each category below, please select the description that may be most appropriate.

SAFETY:

Safe to be alone without supervision for 24 hours at a time.
Needs regular contact, unsafe to be alone for more than 24 hours. Has fallen recently or >3 times in the past year.
Requires frequent contact, may need close supervision.

MOBILITY:

Moves about independently, may use cane or walker. Would be able to evacuate self in case of an emergency.
Requires occasional assistance to move about, usually independent. May need assistance to evacuate self in case of emergency. May use cane, walker, or wheelchair.
Requires total assistance with getting up. Unable to get assistance in case of emergency.

NUTRITION:

Able to prepare own meals. Eats without assistance.
Can prepare simple meals/snacks, needs assistance with main meal. May have meals delivered.
Unable to prepare meals. May need feeding assistance.

MENTAL STATUS:

Normal mental function, occasional forgetfulness. Able to identify environmental needs and meet them.
May have occasional confusion. Needs some reminders for orientation. May show early signs of dementia or Alzheimer's disease.
May require strong orientation, assistance and reminders. Memory may be severely impaired.

TOILETING:

Independent and completely continent. Or independent in caring for self through proper use of supplies.
May have occasional problems with incontinence. May use bedside commode at night. May require assistance in caring for self with proper use of supplies.
Incontinent. May be unable to communicate needs.

COMMUNICATION:

Able to use phone independently. Able to look up numbers and receive phone calls without assistance.
Able to call emergency numbers, may need assistance looking up numbers and dialing. May have poor speech.
Unable to use telephone independently.

MEDICATIONS:

Responsible for self-administration of medications safely.
Able to self administer medication or may need to be reminded. Family or nurse may need to arrange medications and assist. May forget to take scheduled medications.
Cannot administer own medications even with supervision.

BATHING, DRESSING, AND GROOMING:

Independent all three areas.
May require assistance with one or two personal activities.
Dependent on others for two or more personal activities.

FINANCES:

Independent. May need some assistance shopping and paying bills.
Difficulty with shopping or performing light housework. Needs assistance with checkbook and paying bills. At high risk for senior fraud.
Completely dependent on others for financial matters, housekeeping, and shopping.

PHYSICIAN CONTACT:

Able to set up appointments and visit doctor's office as needed.
Chronic health concerns, may benefit from on-site access. Difficulty setting up own appointments and getting to physician office.
May require oversight of medical personnel on a regular basis.

Please press the Calculate button to determine your needs value.