Home Caregivers [homecaregivers.com] ~ Home Health Needs Assessment

"It is comforting to know that Mom is not just being well cared for, but that she is truly loved..."

- Samantha

Can the individual bathe himself or herself without assistance?	YES NO
Can the individual dress himself or herself without assistance?	YES NO
Does the individual take more than 4 medicines per day?	YES NO
Can the individual list their medications and the schedule?	YES NO
Does the individual know the process to obtain medication refills?	YES NO
Can the individual describe the major side effects of their medications?	YES NO
Can the individual walk unassisted?	YES NO
Does the individual have pain that is not well managed?	YES NO
Can the individual prepare meals without assistance?	YES NO
Has the individual unintentionally lost or gained 10 lbs in the last 6 months?	YES NO
Does the individual have gait or balance problems?	YES NO
Does the individual have medical equipment in the home that needs to be managed?	YES NO