Life Made Easy | Home Health Care

The following screening tool can help you determine which level of care is best for you or your loved one. For each category below, please select the description that best describes your candidate for senior care. Check only one choice per category. When finished, hit the "submit" button, and the next page will display your results.

Mobility

Capable of moving about independently. Able to seek and follow directions. Able to evacuate independently
in case of emergency.

Ambulatory with cane or walker. Independent with wheelchair but needs help in emergency.

Requires occasional assistance to move about, but usually independent.

Mobile, but may require assistance due to confusion, poor vision, weakness or poor motivation.

May require assistance when transferring from bed, chair or toilet.

Requires transfer and transport assistance. Requires turning in bed and in wheelchair.

Nutrition

Able to prepare own meals. Eats meals without assistance.

Can do some meal preparation, but needs main meal prepared daily.

Needs all meals prepared and served.

May require assistance getting to meals and or assistance when eating, such as opening cartons or cutting
food.

May be mostly or totally dependent on others for nourishment (includes reminders to eat and/or assistance
when eating).

Hygiene

Independent in all care including bathing, shaving, dressing.

May require assistance with bathing or hygiene or may require reminders or initiation assistance.

Dependent on others for most or all personal hygiene tasks.

Housekeeping

Independent in performing housekeeping functions (including bed making, vacuuming, cleaning and
laundry).

May need assistance with heavy housekeeping, vacuuming, laundry, changing linens.

Needs laundry and housekeeping services provided.

Dressing

Independent and dresses appropriately.

May require assistance with shoelaces, zippers, medical appliances or garments, or may require reminders,
motivation or initiation assistance.

Dependent on others for dressing.

Toileting

Independent and completely continent.

May have incontinence, a colostomy or catheter but is independent in caring for self through proper use of
supplies.

May have occasional problems with incontinence, colostomy or catheter care, or may require assistance in
caring for self through proper use of supplies.

May be unwilling or unable to manage own incontinence through proper use of supplies or may require
physical assistance with toileting on a regular basis.

Regularly and uncontrollably incontinent, dependent or unable to communicate needs.

Medications

Responsible for self-administration of medications.

Able to self-administer medications, but others may need to remind and monitor the actual process.

Family or home health agency has arranged a medication administration system with reminders and
monitoring by family members or others.

Cannot administer own medications, even with supervision. Medications must be administered by licensed
personnel.

Mental Status

Oriented to person, place and time. Memory is intact but may have occasional forgetfulness with no pattern
of memory loss. Able to reason, plan and organize daily events. Has mental capacity to identify
environmental needs and meet them.

May require occasional direction or guidance in getting from place to place, or may have difficulty with
occasional confusion that may result in anxiety, social withdrawal or depression. Orientation to time, place
or person may be minimally impaired.

Judgment may be poor. May not attempt tasks that are not within capabilities. May require strong
orientation assistance and reminders.

Disoriented to time, place and person, or memory is severely impaired. Usually unable to follow directions.

Behavioral Status

Deals appropriately with emotions and uses available resources to cope with inner stress. Deals
appropriately with others.

May require periodic intervention from others to facilitate expression of feelings in order to cope with
inner stress. May require periodic intervention from others to resolve conflicts and cope with stress.

May require regular intervention from others to facilitate expression of feelings and to deal with periodic
outbursts of anxiety or agitation.

Maximum intervention is required to manage behavior. May pose physical danger to self or others, or is
abusive or unacceptably uncooperative.

*Disclaimer: This Assessment Tool is meant to be used as a guideline only. Caregivers and seniors should consult with health & social professionals and the facilities themselves to make an appropriate choice.