Assessing Your Loved One's Needs

Directions: This checklist is intended to identify areas of concern that you may want to monitor more closely or gather more information about.

Can your relative… Yes No Comments
Dress and undress without help?
Drive or use public transportation on own?
Shop for groceries or clothing on own?
Prepare meals?
Take a bath or shower without help?
Get in and out of bed without help?
Be left alone during day?
Pay bills and manage finances on own?
Clean the house or apartment?
Manage household duties?
Live alone comfortably and confidently?
Remain active and interested in life and hobbies?
Maintain a positive attitude?
Walk, climb stairs and can get around the house easily?
Care about own personal health and well-being?
Manage own medications?
Maintain a healthy weight?
Take care of themselves?

For any question where you answered ?no? to any question, you should monitor that activity more closely or he/she may need additional care.


  • Talk with your loved one about your concerns to problem solve together or to ask for permission to speak with his/her physician.
  • Consider meeting with a geriatric care manager to have a formal assessment performed.
  • Look into home modifications and products that could help your loved one get around more easily.


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