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..

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

POINTS	1	2	3	4	5
Dressing	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	Independent 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
Medications	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
Walking	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
Mood	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.