The purpose for this home care self-assessment worksheet is to help evaluate a senior’s ability to live safely and productively at home. Going through this worksheet will not only help identify ADLs (activities of daily living) they need help with, but also help them arrive to a decision they need help, which in the end is the toughest decision to make – accepting help in the home.
This information will be evaluated by a registered nurse as part of a formal assessment for home care. We recommend if the family is actively working with their loved one that both family members and the senior fill out this worksheet if the senior is not capable of going through the worksheet; a family member can go through the worksheet as a helpful aid prior to a discussion with Aware Senior Care.
Please rate the level of Assistance for each of the independent activities of daily living (IADLS) described below: