Touching Hearts at Home > Resources > Self-Assessment Quiz

Self-Assessment Quiz

Is it time to consider in-home care?
Have you wondered if in-home care is the right option for yourself or someone you care about?

Place a check mark in the box for all the items that apply to yourself or someone that you are completing this questionnaire for. Total the points and the level of need will be explained in the chart below.

Questions

  1. Are you alone for several hours during the day and/or night?

Points

2

  1. In the past year, have you fallen, been anxious about falling, or otherwise been at risk for falling in your home or out in the community?

3

  1. Have you been hospitalized or been to the emergency room in the past year?

2

  1. Do you have at least one of these chronic ailments: heart disease, stroke, COPD, diabetes, arthritis, or osteoporosis?

2

  1. Do you use a wheelchair, walker, cane, stair lift, or any other device to help with balance or walking?

3

  1. Are you required to take several daily medications?

3

  1. Do you require assistance with at least one of the following activities? Bathing, toileting, meal preparation, errands, dressing, grooming, light housekeeping, etc.

3

  1. Would having a trained care provider to help you with your daily activities give you or your loved one comfort and peace of mind?

1

  1. Is it important to you or to live independently in your own home?

1

0-3 Points - Limited Need
In-home care is not likely to be recommended at this time for safety reasons, you may want to consider Companion Care as an option.

4-7 Points - Moderate Need
In-home care may be recommended and could be beneficial. Service may be recommended by hospital, doctor or nurse.

8-14 Points - Elevated Need
In-home care is likely to be recommended by hospitals, doctors, and nurses.

15-20 Points - Urgent Need
In-home care is likely to be recommended with some urgency by hospital, doctors, and nurses. May be required in order to be discharged to return home.