Question 1 of 12
Question 1
How is your parent's mobility?
Consider their typical day, not their best day
Walks independently, no assistance needed
Walks with a cane or walker
Needs help with stairs or longer distances
Uses wheelchair or mostly chair/bed-bound
Question 2
Can they bathe and dress themselves?
Include showering, getting dressed, and grooming
Yes, completely independently
Needs some help (buttons, shower setup)
Needs significant help with most tasks
Cannot bathe or dress without full assistance
Question 3
How do they manage their medications?
Prescription and over-the-counter medications
Manages all medications independently
Needs reminders but takes them correctly
Often forgets or takes wrong doses
Cannot manage medications at all
Question 4
How is their memory and thinking?
Consider recent changes, not lifelong patterns
Sharp, no noticeable issues
Occasionally forgetful but manages fine
Noticeable memory problems affecting daily life
Significant confusion, gets lost, doesn't recognize people
Question 5
Can they prepare their own meals?
Simple meals, not gourmet cooking
Yes, prepares full meals independently
Can make simple meals (sandwiches, microwave)
Needs help with most meal preparation
Cannot prepare food safely
Question 6
How often do they need help during the night?
Bathroom trips, repositioning, medication, etc.
Never, sleeps through the night
Occasionally, once or twice a week
Most nights, at least once
Multiple times every night
Question 7
Can they be left alone safely?
For several hours during the day
Yes, for a full day without concern
Yes, but should check in by phone
Only for short periods (1-2 hours)
No, needs someone present at all times
Question 8
Do they have any behavioral concerns?
Wandering, aggression, sundowning, paranoia
Mild issues, easily redirected
Moderate issues requiring regular intervention
Severe issues, difficult to manage
Question 9
How complex are their medical needs?
Chronic conditions, treatments, monitoring
Generally healthy, few medications
Some chronic conditions, well-managed
Multiple conditions requiring monitoring
Complex medical needs (oxygen, wounds, tube feeding)
Question 10
How do they handle their finances?
Bills, banking, avoiding scams
Manages everything independently
Handles basics but needs help with complex matters
Makes mistakes, needs oversight
Cannot manage finances at all
Question 11
Have they had any falls in the past 6 months?
Include near-falls where they caught themselves
Multiple falls or one serious fall
Frequent falls, high fall risk
Question 12
What's your current caregiving situation?
Who provides care now?
They're independent, I just check in
Family helps a few hours per week
Family provides daily care, it's stressful
We're overwhelmed and need help urgently
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