Do I Need Help?

Is your loved one independent?

• Yes, but I worry about his/her driving.
• Yes, but not able to help himself/herself with a few tasks.
• Yes, but needs someone to check in.
• Yes, but I am concerned about him/her falling.
• No, he/she needs help with many tasks.

My loved one’s medications are under control

• Yes, but there are more than I can keep track of.
• Yes, but I am concerned about him/her getting confused.
• Yes, but I have to keep track of them.
• No, he/she is not managing them and has already had incidents.

My loved one is sociable and happy

• Yes, but recently there has been a change.
• Yes, but he/she isn’t as sociable or engaged anymore.
• No, he/she is housebound and seems depressed.

My loved one is in control of his/her mental faculties

• Yes, but I worry.
• Yes, but I see some confusion or difficulty.
• Yes, but is increasingly forgetful.
• No, he/she may be a danger to himself/herself or others.

My loved one is in control of his/her personal hygiene

• Yes, but I worry.
• Yes, but I see some difficulty with toileting,  walking or showering.
• No, he/she does not tend to personal hygiene needs.

My loved one is in control of his/her household

• Yes, but he/she needs an increasing amount of help.
• Yes, but I see his or her diet or habits changing negatively.
• Yes, but I see how he or she isn’t quite taking care of the house and managing the house as well as before.
• No, there are issues with the home that aren’t being addressed.