BackWhen To Step In: An Assessment Tool
Article submitted by Barbara Root, RN and Amanda Root, founders & co-owners of Stellar Living Assistance, a non-medical home care company. For more info, please visit www.stellarliving.net or call 1-630-322-9383.
The following is a list of questions to ask yourself and/or your loved one. How the se questions are answered will give you better insight in determining if assistance is needed. (Hint: the more YES answers, the more indication help is necessary.)
Meals and Nutrition:
Is there a loss of interest in preparing meals?
Yes No
Is there a lack of appetite or loss of interest in eating?
Yes No
Have food dates on milk or meat expired?
Yes No
Are there many packages or cans of the same things?
Yes No
Is there spoiled food in the refrigerator?
Yes No
TOTAL: _______ Yes _______No
Mail and Bills:
Is mail piled up unopened or hidden away in drawers?
Yes No
Are there more than usual magazine subscriptions coming to the home?
Yes No
Do some of the bills come from unrecognizable sources?
Yes No
Are there disconnect warnings for utilities including gas, electric and phone?
Yes No
Have any utilities actually been shut off?
Yes No
TOTAL: _______ Yes _______No
Finances and Banking:
Are there new electronic debits showing up on bank statements?
Yes No
Are there numerous solicitation mailings from different groups? (This could be a sign of frequent giving-often inappropriately.)
Yes No
Is the checkbook illegible?
Yes No
Are bank statements being left unreconciled or unbalanced?
Yes No
Are there frequent checks not being written down?
Yes No
TOTAL: _______ Yes _______No
Memory:
Are they missing doctor appointments or forgetting to make them?
Yes No
Are they making mistakes with their medicines--to much, too little or not taking?
Yes No
Are they confusing medications in original containers with those laid out on a daily basis?
Yes No
Are there repeat prescriptions from more than one doctor or pharmacy?
Yes No
Are foods left cooking on the stove?
Yes No
Have pots been burned?
Yes No
Are small appliances being left on?
Yes No
TOTAL: _______ Yes _______No
Falls and Balance:
Have there been increased occurrences of falling--with or without injury?
Yes No
Are medicines causing dizziness or loss of balance?
Yes No
Are they refusing to use a prescribed cane or walker?
Yes No
Are there loose rugs or uneven flooring areas in their home?
Yes No
TOTAL: _______ Yes _______No
Sadness and/or Depression:
Have been many peer losses recently?
Yes No
Has the sadness gone on for a long time?
Yes No
Are they having trouble sleeping or sleeping more than usual?
Yes No
Have they stopped their usual social activities outside the home?
Yes No
TOTAL: _______ Yes _______No
Driving:
Have you noticed a change in their driving capabilities?
Yes No
Have been recent accidents or problems with driving?
Yes No
Do they get lost frequently?
Yes No
Do they get angry or irritable when you bring up a discussion about driving?
Yes No
TOTAL: _______ Yes _______No
Behavior:
Is the home as neat and clean as it used to be?
Yes No
Have they stopped attending church services or beauty/barbershop appointments?
Yes No
Are they more irritable or otherwise moody, teary or sad?
Yes No
Have they stopped taking interest in their previously enjoyed hobbies?
Yes No
Are they no longer in touch with friends either by phone, letters or visits?
Yes No
TOTAL: _______ Yes _______No
Conversation:
Do they repeatedly bring up the same issues of concern? (Could be an indication of where they need help but are reluctant to ask for outright.)
Yes No
Are they having more frequent trouble with "finding the right word"?
Yes No
Are they using the wrong words?
Yes No
Do they repeatedly tell the same story, ask the same question etc?
Yes No
Have neighbors, friends or other relatives spoken to you of their observations or concerns?
Yes No
TOTAL: _______ Yes _______No
TOTAL FOR ALL SECTIONS: _______ Yes _______No
If only one or two particular sections have more Yes than No answers these particular section(s) might be the only area(s) where your loved one needs help. If the majority of the Grand Total answers are Yes, then your loved one probably needs help in multiple areas of their daily living.
Please feel free to print as many copies as you might need.
- Barbara Root, RN and Amanda Root, founders & co-owners of Stellar Living Assistance, a non-medical home care company. For more info, please visit www.stellarliving.net or call 1-630-322-9383.