Is Assisted Living Right for Your Loved One?

Assisted Living Assessment

We realize it can be difficult to determine whether a loved one requires the care, security and socialization provided by an assisted living environment. To help you determine the best course of action for your loved one, we’ve developed this short Assisted Living Assessment. If you don’t know the answers to some of the questions, feel free to provide your best estimate.

Name of person completing assessment(Required)
Location of individual being assessed(Required)
Enter city or zip code where person currently resides
Can your loved one manage which pills should be taken at what time?(Required)
Does your loved one maintain an adequate food supply and are they able to prepare nutritious meals?(Required)
Is your loved one able to perform routing bathing and grooming and are they able to keep up with laundry?(Required)
Can your loved one still maintain general housekeeping and lawn care?(Required)
Is your loved one able to understand you when you speak at a normal volume? Can they hear critical alerts like the doorbell, phone, smoke alarms?(Required)
Is your loved one's vision compromised to the point where driving or moving around the house presents potential for injury?(Required)
Does your loved one have bruises, dry skin or skin tears - possible signs of running into objects due to balance or vision problems?(Required)
Does your loved one suffer from dementia, Alzheimer's or any other age-related cognitive issues?(Required)
Does your loved one seem sad, depressed or uninterested in activities that previously gave them fulfillment?(Required)
Is your loved on a U.S. Military Veteran of the spouse/widow of a Veteran?(Required)
Check any conditions which apply to the individual being assessed(Required)

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