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Assisted Living Needs Assessment

Assisted Living Needs Assessment

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Your personal Assessment is a tool that will help you determine the best type of senior living for you: Independent Living, Assisted Living, or Memory Care. If this is your first time searching for senior living, their differences may not be as apparent as you think. This short 2-minute survey will help you determine where to start your search. This does not guarantee accurate placement. It should be used as a guide in your decision-making process.

Upon completion of this tool, you can download your list of preferences as a reference during your search, save to your profile to access later and share, and download.

1. Cooking and Dining

I cook all my own meals.

True

False

I only prepare simple meals.

True

False

I no longer cook.

True

False

I never cooked.

True

False

I need assistance with feeding myself or ordering food.

True

False

I have left the stove or oven on.

True

False

I have forgotten to turn off running water.

True

False

I am aware of when I’m hungry or need to eat.

True

False

2. Medication Management

I organize all my own medications

True

False

A friend or family member helps me put my medications into a pill organizer.

True

False

I always remember to take my medications.

True

False

I need help or oversight with taking medications.

True

False

I have medications that need to be administered by someone else or a nurse.

True

False

I have an oxygen tank.

True

False

I need help with my oxygen tank (if you have one).

True

False

I have been diagnosed or suspect I have a condition that will eventually require memory care.

True

False

3. Mobility

I need someone to help me get into a chair or bed.

True

False

I often need two people to help me get into a chair or bed.

True

False

I would physically be able to evacuate a building independently.

True

False

If alarms were sounding in the building, I would understand what to do and evacuate if necessary.

True

False

I am able to move around my living space independently.

True

False

I have restless behavior during the day or night.

True

False

I am only mobile with a walker, cane, or wheelchair.

True

False

4. Personal Care

I manage my own bowel & bladder needs without assistance.

True

False

I am able to shower alone.

True

False

I can wash my own feet.

True

False

I always remember to bathe or change my clothes

True

False

I have a short temper and get frustrated easily.

True

False

I am able to comb my hair and/or shave myself.

True

False

I am able to manage my own dental hygiene.

True

False

I can manage my own hearing aids.

True

False

I am able to manage my morning routine of getting dressed and ready for the day,

True

False

I am able to manage my evening routine of getting undressed and ready for bed.

True

False

I need assistance with socks, shoes, or supports.

True

False

5. Lifestyle

I do all my own shopping and errands.

True

False

I am no longer allowed to have a driver’s license.

True

False

I can leave my home without getting lost or confused.

True

False

I am able to manage my own finances and cash.

True

False

I repeat myself or fixate on topics.

True

False

I use a cellular phone.

True

False

I have been the victim of fraud or other crimes.

True

False

I say or do things that are considered inappropriate.

True

False

I wash and fold my own laundry.

True

False

I require help with housekeeping.

True

False

I clean my refrigerator and remove my garbage regularly.

True

False

I am able to converse with others and be understood.

True

False

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