Personal Care Assessment Quiz

When physical or medical requirements begin to change, the need for adjustment in day-to-day living situations often follows. Many clients need a little extra help with personal care, meals or living activities to remain independent within their own homes. They may need care over and above what can be provided by staff during a hospital or rehab stay. Or loved ones and caregivers may need assistance with care or a break during the day or night.

This questionnaire can help you see whether in-home Personal Care might be the right option for you or a loved one. You'll receive a personalized report you can print or email to be used later. Please feel free to contact your nearest branch, as well. After an initial assessment over the phone or in person, a nurse will personally visit with you or family members to discuss the most beneficial and cost-effective services for you.

Question 1

Which (if any) of the following relate to the family member’s medical visits? (If none, please leave blank.)





Question 2

Which of the following relates to the family member’s household duties?








Question 3

Which of the following relates to the family member’s personal connections?





Question 4

Which of the following relates to the family member’s driving abilities?




Question 5

Which of the following relates to the family member’s medication management?




Question 6

Which of these services apply to the family member’s needs?










Question 7

Enter the family member’s zip code (required):

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