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Senior Care Needs Assessment Tool

Are you worried about the safety of your senior loved one? Use our free Senior Care Needs Assessment Tool to determine if it’s time to explore senior living options.

Take Our Senior Care Needs Assessment
for a Personalized Recommendation

If you have questions or concerns about your loved one’s safety, use our free Senior Care Needs Assessment Tool for a personalized recommendation on whether it’s time to explore senior living options. To begin, simply fill out the form below and then complete the answers on the following screens.

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Your Contact Details

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Safety

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Mobility

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Nutrition

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Mental Status

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Toileting

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Communicating

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Medications

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Bathing, Dressing & Grooming

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Managing Finances

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Contact with Medical Providers

Thank You For Completing Our Care Needs Assessment.

Dear Dean Blunt,

We have reviewed the results of the assessment and have created a list of options and choices that best fit your needs, as indicated by your selections.

Here are the results for your records:

We recommend considering an Independent Living Community or an Assisted Living Community.

Independent and assisted living communities usually provide weekly housekeeping, one to three meals per day, transportation, social activities, daily communications, and an emergency call system. If your loved one wishes to remain in their own home, they may benefit from utilizing a non-medical in-home care agency.

We recommend considering an Assisted Living Community or an Assisted Living Home.

An assisted living community or home would include three meals per day, as well as personal care services such as medication management and assistance with daily living activities, in addition to housekeeping, transportation, daily communications, and 24-hour assistance.

We recommend considering an Assisted Living Community or an Assisted Living Home with personal or directed-care services in the areas that need the most attention.

An assisted living community or home would include three meals per day, as well as personal care services such as medication management and assistance with daily living activities, in addition to housekeeping, transportation, daily communications, and 24-hour assistance.

A person who is at high risk for falling, is bed bound, has a serious chronic illness or a dementia diagnosis may fair better in an Assisted Living Home.

We recommend considering an Assisted Living Home, a nursing home or skilled nursing facility.

Your loved one may require a level of care that many senior housing locations do not offer. Be sure to work with your Assisted Living Locators® care advisor to find the best fit for your senior’s needs.

We look forward to assisting you to navigate this important decision.

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Here is a copy of your assessment selections, for your records:

    Your information:

    First Name: Dean
    Last Name: Blunt
    Phone: (555) 555-1234
    Email Address: Example@test.com
    Zip Code: 90210
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