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Assessing Your Loved One's Needs Print

Directions: This checklist is intended to identify areas of concern that you may want to monitor more closely or gather more information about
 
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Can your relative… Yes No   Comments
Dress and undress without help?  
Drive or use public transportation on own?  
Shop for groceries or clothing on own?  
Prepare meals?  
Take a bath or shower without help?  
Get in and out of bed without help?  
Be left alone during day?  
Pay bills and manage finances on own?  
Clean the house or apartment?Other:  
Manage household duties?  
Live alone comfortably and confidently?  
Remain active and interested in life and hobbies?  
Maintain a positive attitude?  
Walk, climb stairs and can get around the house easily?  
Care about own personal health and well-being?  
Manage own medications?  
Maintain a healthy weight?  
Take care of themselves?  
For any question where you answered "no", you should monitor that activity more closely or he/she may need additional care.

Suggestions:

• Talk with your loved one about your concerns to problem solve together or to ask for permission to speak with his/her physician.

• Consider meeting with a geriatric care manager to have a formal assessment performed.

• Look into home modifications and products that could help your loved one get around more easily.
 
 
 
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