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Does your loved one have difficulty with bathing, dressing, grooming, or using the restroom?
*
Frequently
Sometimes
Rarely
Never
Does your loved one have difficulty preparing meals, remembering to eat, or maintaining regular meals?
*
Frequently
Sometimes
Rarely
Never
Does your loved one have difficulty safely moving around the home, getting in and out of chairs or bed, or navigating stairs?
*
Frequently
Sometimes
Rarely
Never
Are you concerned that your loved one may fall, get injured, or be unsafe when alone at home?
*
Frequently
Sometimes
Rarely
Never
Does your loved one need help with laundry, dishes, cleaning, or keeping their living space organized?
*
Frequently
Sometimes
Rarely
Never
Does your loved one need reminders to take medications on schedule?
*
Frequently
Sometimes
Rarely
Never
Does your loved one spend significant amounts of time alone or seem likely to benefit from more companionship and social interaction?
*
Frequently
Sometimes
Rarely
Never
Have everyday activities that your loved one once handled independently become more difficult or now require assistance?
*
Frequently
Sometimes
Rarely
Never
Are family members or caregivers becoming overwhelmed, concerned, or unable to provide all the support your loved one needs?
*
Frequently
Sometimes
Rarely
Never
Total Score
Score guide: 0-9 = lower support needs, 10-18 = moderate support needs, 19-27 = higher support needs. If this feels like your situation, Graceful Homecare would be glad to talk with you about compassionate support options.
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