Elderwerks Senior Resource Directory 2025/2026

MINI QUICK ASSESSMENT FOR FAMILIES

MINI QUICK ASSESSMENT FOR FAMILIES

Is your loved one able to:

Yes ❏

No ❏

1. Dress and undress without help each day?

Yes ❏

No ❏

2. Ask for help when needed?

Yes ❏

No ❏

3. Maintain social contact with others?

Yes ❏

No ❏

4. Be left alone for 24 hours?

Yes ❏

No ❏

5. Shop for their own groceries and prepare meals?

Yes ❏

No ❏

6. Manage their own bills?

Yes ❏

No ❏

7. Manage stairs, laundry and home upkeep?

Yes ❏

No ❏

8. Remember to take medications?

Yes ❏

No ❏

9. Eat regular nutritious meals?

Yes ❏

No ❏

10. Bathe without assistance?

Yes ❏

No ❏

11. Drive or take public transportation?

Yes ❏

No ❏

12. Remembers to turn off/on stove, lights & TV, etc.?

*If you answer “No” to even one of the questions above you may need to provide more assistance or look into more supportive living arrangements for your loved one.

“ The great thing about getting older is that you don’t lose all the other ages you’ve been. ” Madeleine L’Engle

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