Take Our Care Survey

It may be time for you to consider in-home care for your loved one. Our short Care Survey may help you to better understand whether the time may have come to pursue care options for your loved one. Just answer “Yes” or “No” for each of the questions below.

Check "Yes" or "No" for the questions below: *

	Yes	No
Is your loved one wearing clothing that is dirty or has food stains?
Does your loved one wear his/her nightclothes during the day?
Does your loved one wear the same outfit day after day?
Is it apparent your loved one is not showering or bathing?
Does your loved one fail to comb/style their hair or brush their teeth?
Is your loved one losing weight?
Is there unusual tearing or bruising of the skin that may indicate a fall?
Does your loved one fail to recognize you or know your name?
Does your loved one fail to speak normally or have trouble communicating?
Are there signs of confusion such as not knowing the date, where he/she is, or, the season of the year?
Has your loved one withdrawn socially or is he/she less communicative?
Are there foul smells coming from the refrigerator and cupboards?
Are the cupboards void of nutritious food?
Is the home cluttered and does it have newspapers and mail accumulated?
Are you finding expired medications or medications that are not being taken?

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