Aged Care Assessment Preparation Guide

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Aged Care Assessment Preparation Guide* This field is required.Answer the following simple questions about your home care needs and we'll prepare a personalised summary that will greatly assist with your upcoming aged care assessment. Let's get started...First of all, what's your assessment situation?

My first aged care assessment

A reassessment for more support

I'm just getting prepared for the future

I'm not sure

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What is your reason for assessment?* This field is required.

My health or abilities have deteriorated

I need more help with everyday activities

My family is struggling to support me

I've experienced a significant health event

I'm concerned about my safety

I want to plan ahead

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Which everyday activities do you find difficult?* This field is required.

Showering, dressing or toileting

Walking or getting around

Preparing meals

Cleaning or laundry

Shopping or transport

Taking medication or managing health

Memory, thinking or decision-making

None of these

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Change over the past 12 months* This field is required.

Stayed about the same

Gradually become worse

Significantly become worse

Varies from day to day

Improved

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How much assistance do you need overall?* This field is required.

I manage independently, but with difficulty

I occasionally need assistance

I regularly need assistance

I need substantial assistance every day

It varies considerably

I don't need assistance

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Are you currently receiving government funded home care services?* This field is required.

Yes

No

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What type of government funded home care services do you currently receive?Select all that are applicable

Domestic assistance (house cleaning)

Shopping support

Social Support

Personal care (eg showering)

Meals

Allied Health (eg. Physio, Podiatry, etc)

Gardening

Other

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How often do you receive Domestic Assistance (house cleaning)?

Weekly

Fortnightly

Other

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How often do you receive Personal Care (showering support)?

Once per week

2-3 times per week

Other

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How often do you receive Shopping Support?

Weekly

Fortnightly

Other

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How often do you receive Social Support?

Weekly

Fortnightly

Other

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What happens when you do not receive help?* This field is required.

I manage safely without it

I struggle or become exhausted

Tasks are left undone

I attempt activities that may be unsafe

Family or friends have to step in

I go without essential care

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In the past 12 months, which of these have you experienced?* This field is required.

Falls

Hospital admission or emergency treatment

New or worsening medical condition

Increasing difficulty with mobility

Increasing memory or confusion problems

None of these

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What are your main safety concerns at the moment?* This field is required.

Falling or being unable to get up

Showering or moving around safely

Managing medication

Preparing meals safely

Being alone during an emergency

Confusion or memory-related risks

No significant concerns

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Who currently provides you with unpaid assistance?* This field is required.

My spouse or partner

My children

Other family members

Friends or neighbours

Nobody

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How much do you depend on this unpaid assistance?* This field is required.

I could manage safely without it

It makes everyday life easier

I would struggle considerably without it

I could not manage safely without it

I don't receive unpaid assistance

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Which of the following changes are likely in the unpaid support you receive?* This field is required.

My carer has health problems

My carer is becoming exhausted

My carer may become less available

My carer is moving away or returning to work

No expected changes

I'm unsure

I don't receive unpaid assistance

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Where do you need more assistance?* This field is required.

Personal care

Cleaning, laundry or gardening

Meals and shopping

Transport

Nursing or allied health

Safety or supervision

Respite for my carer

My current assistance is sufficient

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What matters most to you right now?* This field is required.

Remaining in my own home

Staying safe

Maintaining my independence

Reducing pressure on my family

Managing my health

Staying socially connected

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Which of these best describe your priorities?* This field is required.

My increasing daily difficulties

My health and mobility problems

My safety concerns

My dependence on family support

My family's changing ability to help

The assistance I'm not currently receiving

My ability to remain independent at home

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Name* This field is required.

First Name

Last Name

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Email* This field is required.

example@example.com

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Reserve a time for your Personal Home Care ReviewEach week, our VillageLocal aged care specialists set aside a limited number of appointments to help people review their Assessment Preparation Guide and talk through their current home care arrangements. While we're preparing your personalised guide, we can reserve one of these appointments for you. It's a chance to ask questions, discuss any concerns about your current home care support and explore ways to make the most of your funding. Would you like us to reserve a time for you?

YESNO

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Phone Number

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Appointment