Our Services / Caregiver Needs Assessment
Does your loved one need assistance? Is your mom struggling to remember to take her medications? Is your dad becoming unsteady on his feet, at risk of falling, or showing signs of confusion? These could be warning signs that additional care is needed at home.
The questionnaire below is designed to help you identify when it’s time for extra support. This checklist can guide you in determining whether in-home care is appropriate or if transitioning to a retirement home may be necessary.
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 grocery shopping | 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 |
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.
We understand the challenges in choosing an at home health provider. Our team is happy to help. Call us to speak to a local team member or schedule an in-person appointment.
We understand the challenges in choosing an at home health provider. Our team is happy to help. Call us to speak to a local team member or schedule an in-person appointment.
Dallas
972-658-4001
Plano
972-658-0566
Personal Care Services
We will assist your loved ones with bathing, toileting, dressing, and overall personal hygiene.
Caring Heart Senior Assistance
Our services are centered around compassion, skilled caregiving, and trust.
Companionship
Approved Home Care’s caregivers are here to provide companionship in and out of the home.
Respite
Respite Care is an essential element of caring for your loved one and maintaining your own health.
Medication Reminders
We bring peace of mind with timely medication reminders, following the doctor’s instructions to support your loved one’s recovery.
Housekeeping
We take care of daily chores, watch out for safety hazards, change the beds, do laundry, dishes, vacuuming, mopping, and dusting.
Meal Preparation
We make your loved one their favorite meals, and follow diet and nutrition guidelines.
Transportation
We provide driving to and from doctor’s appointments, take to meet up with friends, run errands, shop and more.
Concierge Services
We offer personalized non-medical home care for all ages to meet your unique needs.
Caregiver Needs Assessment
Helping families determine when additional in-home care or assisted living may be necessary
When you fill out this form you can expect an email or a phone call from a key member of our staff. We can discuss your needs and plans.
Call Us: 972-658-4001
401 Hemphill St
Suite 428
Fort Worth, TX 76104
We are open from Monday – Friday
9:00 am – 5:00 pm
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