Assisted Living Locators Senior Needs Assessment Quiz

Senior Needs Assessment

Questions or concerns about the safety of your loved one?
Is it time to explore senior living options for your loved one?

Take our Senior Needs Assessment for a general recommendation.
Question 1 of 10

Safety

  1. Safe to be alone without supervision for 24 hours at a time.
  2. Needs regular contact, unsafe to be alone for 24 hours.
  3. High risk of falling. Requires frequent contact and close supervision.
Question 2 of 10

Mobility

  1. Moves about independently, may use cane or walker. Would be able to evacuate themselves in case of an emergency.
  2. Requires occasional assistance to move about, usually independent, (with or without cane or walker). May need assistance to evacuate themselves in case of emergency.
  3. Requires total assistance with getting up. Would require assistance to evacuate in case of emergency.
Question 3 of 10

Nutrition

  1. Able to prepare own meals. Eats without assistance.
  2. Can prepare simple meals/snacks, but needs assistance with main meal. May have meals delivered.
  3. Unable to prepare meals. May need feeding assistance.
Question 4 of 10

Mental Status

  1. Normal mental function, occasional forgetfulness. Able to identify environmental needs and meet them.
  2. May have occasional confusion. Needs some reminders for orientation. May have Mild Cognitive Impairment or early signs of dementia or Alzheimer’s.
  3. Has an Alzheimer’s or other dementia diagnosis. Requires strong orientation, assistance, and reminders. Memory may be severely impaired.
Question 5 of 10

Toileting

  1. Independent and completely continent. Or independent in caring for themselves through proper use of supplies.
  2. May have occasional problems with incontinence. May use bedside commode at night or incontinence supplies. May require assistance in caring for themselves with proper use of supplies.
  3. Incontinent. May be unable to communicate needs.
Question 6 of 10

Communicating

  1. Able to use phone on their own. Able to look up numbers and receive phone calls without assistance.
  2. Able to call emergency numbers, may need assistance looking up numbers and dialing. May have poor speech.
  3. Unable to use a phone on their own.
Question 7 of 10

Medications

  1. Responsible for self-administration of medications safely.
  2. Able to self-administer medication or may need to be reminded. Family or nurse may need to arrange medications and provide assistance. May forget to take scheduled medications.
  3. Unable to administer own medications even with supervision.
Question 8 of 10

Bathing, Dressing & Grooming

  1. Can independently get bathed, dressed & ready for the day.
  2. May require assistance in a couple of areas.
  3. Dependent on others for more than two areas.
Question 9 of 10

Managing Finances

  1. Independent. May need some assistance shopping and paying bills.
  2. Difficulty with shopping or performing light housework. Needs assistance with checkbook and paying bills. At high risk for senior fraud.
  3. Completely dependent on others for financial matters, housekeeping, and shopping.
Question 10 of 10

Contact with Medical Providers

  1. Able to set up appointments and visit doctors’ offices as needed.
  2. Chronic health concerns, may benefit from on-site access. Difficulty setting up own appointments and getting to physicians’ offices.
  3. May require oversight of medical personnel on a regular basis.

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Your Assisted Living Locators Senior Needs Assessment Quiz results

Thank you for completing our Senior Needs Assessment.

Dear ,

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 are ready to review the options available to you in your area.

Meet Patty, your Local Senior Care Advisor

Patty can be reached at 555-555-5555.
Click here to learn more about .
We look forward to assisting you to navigate this important decision.

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

Your information:

Name:
Zip Code:
Phone:



, know that you are not in this alone, Assisted Living Locators is here and ready to help. Warmly,

Your information was submitted. Thank you.

Ready to talk to your local advisor about next steps? Click here.