Caregiver Needs Assessment

Does you loved one need assistance?  Is Mom is having difficulty to remember to take her medications?   Is Dad losing his balance, is he a fall risk, is he becoming confused.  What warning signs are signaling that additional care is needed in the home?

The questionnaire below can help you recognize when additional care is needed. This check list can be helpful if  you are unsure whether a loved one is ready for a caregiver in the home or a move to a retirement home is necessary..

How can a caregiver help? “Click Here”

Complete the ten questions below, then total.  Your total number will provide recommendations below.








Needs hands-on assistance

Needs assistance

with all personal care

Requires help with dressing

Can dress, but clothes must be selected

Independent and able to dress themselves

Bathing and Toileting

Requires complete assistance

Requires help when undressing

Functions with minimal assistance

Functions with supervision and some assistance

 Independent – Able to toilet and bathe.

Control (Continence)
of Bladder and Bowels

Incontinent – unable to control bladder or bowels

Accidents are common

Occasional incontinence – requires some assistance

Occasional Incontinence, able to care for self

Control and Continent  – no bladder or bowel issues

Eating and Nutrition

Requires total feeding and assistance

Better eating habits when fed,  currently losing weight

Not eating enough. Only consumes partial meals

Reduced hunger  – still eating properly

Good appetite, Good Eating habits, and good nutrition

Meal Preparation

Unable to cook or prepare meals

Needs assistance cooking or delivered meals

Prefers or needs assistance cooking, but needs help

Can cook but needs assistance with grocery shopping


Cooks and shops for groceries

Household Chores

Complete assistance with cleaning and household chores

Regularly needs housekeeping help and assistance

Regularly needs housekeeping help and assistance

Requires occasional help with household

Independently completes household chores


Unable to self administer

Consistently requires reminders

Requires medication reminders from time to time

Takes medications without reminders

Schedules and takes medications with no assistance


Fall Risk

Needs help with transfers

Uses a wheelchair and requires help

Walker or Cane – with no help

Walks Independent -no walker or cane

Mental Status

Forgetful and confused – does not know date or time

Makes poor decisions, safety is a concern – some confusion

Needs redirection frequently

Makes good decisions but struggles occasionally

Oriented and Alert – no memory issues


Becomes agitated and angry frequently  – depression issues

Can be sad, and depressed

Apathy, lost purpose of life, anger from time to time

Typically upbeat and positive, but loss of joy in life

Positive attitude – enjoys life

Recommended Options (Based on tabulated score):

Below 25 – In Home Care, Nursing Home or Skilled Nursing Care

25 to 29– In Home Care, Nursing Home, Assisted Living  or Skilled Nursing

30 to 39 – In Home Care

40 to 50 – In Home Care or Live at Home Independently

You can narrow your search and find just the right care for your loved one by working with one of our Free professional eldercare advisors. Don’t make this important decision alone… talk to an elder care expert today!

Please note that the above assessment is for use as an assessment tool to facilitate thought and discussion only and does not constitute a formal recommendation. Each case must be evaluated individually.