Please fill out the following assessment to see if you could benefit from our services:
Are there any noticeable changes in your parent/relative's memory?
Are there visible changes in your parent/relative's physical appearance? (i.e. weight gain or loss, wearing the same clothes daily, overall disheveled appearance)
Does your parent/relative feel sad or lonely most of the time?
Has your parent/relative withdrawn from regular activities that he or she once enjoyed?
Does your parent/relative need assistance when walking, climbing stairs, or getting in and out of bed?
Does your parent/relative need assistance when dressing, bathing, etc.?
Are there activities around their home that your parent/relative need and/or want help with? (i.e. running errands, housekeeping, preparing meals)
Has your parent/relative noticed changes in their sleep pattern? (i.e. sleeping more or less than usual, disrupted sleep)
Are there any changes in your parent/relative's diet? (i.e. overeating or lack of appetite)
Is your parent/relative a new or expectant mother?
Is your parent/relative in the process of transitioning their care from a hospital or medical facility to their home?
Does your parent/relative take any medications?