NEEDS ASSESSMENT SELECTOR
Fill out our needs assessment selector to help you determine where you need the most help. Submit the form to have one of our trained staff members contact you with the services we provide and pricing to support you and your family.
Active, requires no assistance/help – can go up and down stairs easily
Uses Cane
Cannot get in and out of wheelchair unassisted
Requires assistance to stand or transfer from bed to chair
Uses Walker
Uses wheelchair
Needs stand-by assistance to walk or move up and down stairs
Mostly in bed

No memory problems
Needs special supervision/night supervision
Forgetful, needs reminders
Wanders or tries to leave home at inappropriate times

No hearing issues
Hearing impaired, does not use devices
Hearing impaired, uses aids
Assist with placing/care of hearing aids

No vision problems
Blind or very low vision
Wears glasses
Needs assist/reminders with glasses/visual devices

No assistance needed
Help with bathing, dressing and hygiene
Stand-by assistance

No assistance, or uses assistive equipment
Bowel or bladder control issues
Needs assistance to/from toilet
Needs assist with using incontinence products

No assist with oral care
Total assist/reminders
Upper dentures
Partial dentures
Denture removal
Set up or help during oral care
Full dentures
Lower dentures
Denture cleaning
Denture placement

Speaks and understands clearly
Problems understanding
Problems speaking clearly
Limited ability to follow instructions

No issues
Needs assistance with food selection, special diet, cutting meat, etc.
Needs help with prep, setup or uses special equipment
Must be fed, does not help

Needs no help of any kind
Unable to help with household tasks, needs full assistance
Assistance with light tasks, tidying house, dusting etc.
Unable to help or provide direction to staff

Recent health crisis/hospitalization
2 or more falls last 6 months
Poor judgment, recent history of unsafe decisions
Recent loss of spouse/family member
History of behavioral or psychological issues unrelated to dementia
Needs monitoring/unable to manage money and cash resources

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For whom are you inquiring?