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OnLine Assessment Tool

At some point during the aging process, we begin to have more difficulty performing everyday activities. But at what point do we need to be concerned about the capabilities of an older adult and when do we consider putting services in place? To zero in on a person's abilities, one needs to make careful observations.

The following assessment tool can assist individuals in determining the appropriate resources to utilize as well as prepare families and seniors for the steps they may want to consider in planning proactively before a crisis occurs. This assessment tool is based on the functional abilities of the older adult. The questions are grouped around the activities of daily living (bathing dressing, grooming, eating, mobility, transferring and toileting) and the instrumental activities of daily living (shopping, transportation, meal preparation, equipment use, social participation and medication management).

This assessment should serve as a stepping stone and is not intended to make decisions for you. You may wish to consult your physician, a health care professional, geriatric care manager or County Social Service Department to personally evaluate your situation.

After completing the following assessment you will receive a score and a corresponding list of recommendations. Because an individual's specific situation is difficult to determine in a brief assessment, the recommendations should be considered in association with other forms of evaluation.

Client able to manage home/lawn maintenance?
Without assistance?
With some assistance?
Requires total assistance?
Client lives in apt. or other maintained environment
Housekeeping/Laundry?
Able to complete without assistance?
Able to complete with some assistance or reminding?
Requires total assistance?
Prefers to hire outside agency?
Client is vulnerable to outsiders/strangers
Able to recognize outsiders/strangers and seek assistance?
Unable to recognize strangers and unable to seek assistance?
Client is able to obtain help in the case of emergency?
Client is able to independently obtain emergency assistance?
Client requires guidance and instruction to obtain emergency assistance?
Client would be unable to obtain emergency assistance?
Driving
Client drives or able to access public transportation?
Client does not drive or needs assistance to with other forms of transportation?
Client requires special med-van for transport?
Activity programming
Client independently arranges for and attends social activity programs?
Client needs assistance with making arrangements and transporting?
Client unable to participate in social activities without direct assist?
Financial Management
Client independently manages financial matters?
Client needs some assistance with managing finances? (reminding, writing out checks, reviewing mail)
Client unable to manage finances?
Shopping
Client is able to independently access groceries?
Client requires assistance to access groceries?
Client is unable to access groceries?
Meal preparation
Client prepares meals without assistance?
Client requires some assistance to prepare meals? (could include meals on wheels)
Client unable to prepare meals?
Eating
Client can feed self with no assistance?
Client needs supervision during eating due to difficulty with choking or need for reminders?
Client unable to feed self?
Client is able to recognize surroundings?
Client is alert and oriented to date, time and place at all times?
Client intermittently is confused to time and place?
Client is consistently confused to time and place?
Client keeps appointments and commitments?
Client is able to set-up and attend to appointments independently?
Client needs reminding to keep appointments?
Client requires outside assistance to set appointments or keep commitments?
Client is able to understand and follow directions?
Client is able to understand and follow directions?
Client needs to check directions several times before understanding?
Client is unable to follow directions with direct supervision & guidance?
Wandering
Client does not wander?
Client wanders or has gotten lost?
Client cares for general appearance? (i.e. personal hygiene: brushing teeth, nail care, shaving, hair care)
Client independently manages their grooming?
Client needs reminders to maintain their grooming and appearance?
Client needs hands-on assistance to complete grooming tasks?
Clients ability to dress?
Client independently dresses self?
Client needs reminders to dress self and choose clothing?
Client needs assistance from another to dress?
Is client able to bathe or shower?
Client is able to independently bath or shower?
Client needs standby assistance or supervision during bathing?
Client requires physical assistance of caregiver to bath?
Continence
Client is continent of bowel and bladder and/or incontinence where client can use continence products independently?
Client requires reminding for toileting or assist with continence products?
Client unable to toilet independently?
Gait
Client ambulates (w/wo cane,walker,wheelchair) independently with no falling?
Client has unsteady gait and has had fall during past 6 months?
Client needs assistance of others to ambulate or maneuver wheelchair?
Transfer(i.e. standing to bed or wheelchair to toilet)
Client independently transfers from one place to another?
Client needs assistance to transfer?
Need for medical/rehabilitative therapies
Client has no medical or rehabilitative therapy needs?
Client has medical needs that they manage independently (i.e. insulin)?
Client has intermittent medical needs that require assistance?
Client requires regular medical monitoring?
Medications
Client requires no assistance with medications (able to identify medications properly and dispense accurately)?
Client needs some assistance with medications (someone needs to dispense medicines and/or remind)
Client is unable to manage medication regime?

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