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Checklists - Assessing Needs

As a family member ages, we often don't notice the subtle changes in functioning. When a crisis situation occurs, we then must think back to past behaviors and functioning to determine how the situation became so critical.

For a caregiver, checklists can help you to think about your family member in a practical and functional way. Completing the checklists can help you to determine what services may be needed and the level of care that will best suit the needs of your family.

Ask yourself these questions about your family member. Be honest.

Do you have concern about your family member in these generalized areas? Yes No
Driving
Vision
Hearing
Socializing
Memory
Decision Making/Judgment
Balance
Strength
Energy
Health
Overall Ability to Function Independently

 

From your observations, generally evaluate how your family member performs in these areas:
Activity Can Do Independently Needs Some Help Needs a Lot of Help
Walking
Rising from a seated position
Getting out of bed
Getting in or out of a car
Preparing a meal
Eating a meal
Toileting
Bathing
Getting dressed
Personal hygiene
Doing laundry
Using the telephone
Taking medications
Paying bills
Keeping track of finances
Driving
Shopping
Home maintenance
Household cleaning
Problem solving

 

Check whether your family member has the following medical conditions:
Medical Condition Yes No
Alzheimer's Disease
Dementia
Depression
Diabetes
Stroke
Heart Disease
High Blood Pressure
Arthritis
Bladder or Bowel Condition
Cancer
Mental Illness
Parkinson's Disease
Osteoporosis
Emphysema
Dental Disease
Hearing Loss
Vision Loss
Other:  
Other:  


Mobility

Which of the following describes the condition of your family member? Yes No
walks independently
occasionally needs assistance
uses a cane
uses a walker
uses a wheelchair


Transportation

Which of the following describes the condition of your family member? Yes No
has a car and can drive it
has a car and cannot drive it
has a car and shouldn't drive it
doesn't have a car
has transportation through friends
has public transportation available
uses private for-pay transportation
needs transportation


Cognitive

Which of the following describes the condition of your family member? Yes No
has no noticeable memory problems
occasionally is forgetful
frequently forgets information about friends, family, news events, etc.
frequently forgets things such as locking the door, turning off the stove, medication, etc.
gets confused
gets lost
wanders during the night


Social and Emotional

Which of the following describes the condition of your family member? Yes No
has lots of friends and sees them regularly
has lots of friends but doesn't see them regularly
doesn't have many friends
is involved in activities outside the home
seems lonely
seems depressed
seems impatient
seems angry
seems stressed


Falls

Which of the following describes the condition of your family member? Yes No
has had a recent fall
has had a fall that caused an injury
seems unsteady
should be using a cane or walker but doesn't
has many throw rugs in the home
has hardwood floors in the home

 

 

Now that you have answered the questions, take a good look at your answers. If you see a lot of areas where your family member needs assistance, you may want to talk to a professional to help you make wise choices. There is no magic number of problems that should prompt you to get assistance. Each family is different and each person has a different level of tolerance. But use these checklists to help you to see if there seem to be multiple problems and to alert you to whether or not functioning seems to be declining instead of remaining stable. If things are becoming harder to handle and/or if your family member is getting worse, check out your options either with a professional or through resources identified within this website.

Caregiver Professionals are professionals that work with caregivers and are there to help. Contact them to discuss the results of your evaluation. If even that seems like too much to handle, they can assist you with getting help for your emotional and mental health needs as well. They will help you help both your family member and yourself. Remember to be completely honest with them. Don't be embarrassed to share with them how you are feeling and coping with your situation and any specific problems you may be having. Anything you share will be held in confidence and they will not judge you or the situation you find yourself in. They want to help you which is why they have chosen this career.