Checklist: - Assisted Daily Living, Inc
Checklist:
To help you determine the need for in-home Care Services:
Name:____________________________
Phone:____________________________
Email:____________________________
HOW’S THE ENVIRONMENT?
_ Is the home orderly and well kept?
_ Are necessary home repairs being performed?
_ Any unusual amount of clutter, dust, dirt or garbage?
_ Any unpleasant odors?
_ Do the cupboards or refrigerator smell?
_ Is the food in the refrigerator fresh and well stocked?
_ Are there safety hazards lurking, i.e., carpet tears, loose banister, no safety handles
in the bathroom, etc.
_ Are the house plants thriving?
_ Do the house pets look healthy and properly cared for?
TAKE A CLOSER LOOK AT THE YOUR LOVED ONE.
_ Do they appear healthy?
_ Have they lost or gained weight?
_ Do they call you by your name?
_ Are they speaking normally?
_ Do they show signs of irritability – mood changes?
_ Is there a lack of energy … increasing fatigue?
_ Are they up on the news?
_ Are they properly maintaining their checkbook and credit obligations?
_ Is there mail that is stacking up?
_ Have they continued their outside activities?
_ Do they stay in touch with friends and relatives?
_ Have there been recent or numerous auto mishaps/accidents?
_ Do they have future plans or goals?
_ Do you suspect depression?
_ How’s their vision and hearing?
_ Do you think they are in command of taking their prescriptions on time?
_ What about the expiration dates on their prescriptions and other meds?
_ What is the condition of their clothing? Are there stains, tears, etc?
_ Any unusual tearing or bruising of the skin?
_ Is their skin soft, supple and is the color normal?
_ Do their teeth appear clean?
_ Are they taking the time for proper grooming … hair, nails, makeup, etc?
_ Are they able to move around the home without concern?
_ Are there many different prescriptions? From various doctors?
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- core domain area checklist acvrep
- washington state department of social and health services
- checklist assisted daily living inc
- children first network 107 welcome
- staff orientation training checklist
- checklist of strategies for coping with grief
- home virginia department of behavioral health and
- optional long term care assessment and care planning tool
Related searches
- adult daily living printable activities
- free daily living skills printables
- adult daily living skills worksheets
- daily living skills checklist
- activities of daily living worksheets
- daily living skills worksheets pdf
- daily living skills checklist pdf
- activities of daily living pdf
- adult daily living skills curriculum
- daily living skills worksheets printable
- adult daily living skills checklist
- decreased activities of daily living icd 10