Homecare Questionnaire

At Capability Homecare we strive to help keep seniors safe and independent in the comfort of their own homes. We speak with a lot of clients and their loved ones each day to help them determine what support is needed. When contemplating homecare services, the first thing to do is to assess each individual’s abilities and needs. The following are some good questions to go through for yourself or your loved one.

Homecare Questionnaire

Yes No
Does the individual regularly skip meals?
Does the individual eat a lot of frozen or prepared meals?
Has the individual lost weight?
Is it difficult stand for more than a few minutes?
Has the individual had a fall?
Is it difficult to get in and out of bed?
Is it difficult to get in and out of a chair?
Does the individual ever feel unsteady or dizzy?
Does the individual have difficulty climbing up or down stairs?
Does the individual feel unsafe in their home?
Are there signs of loneliness or depression?
Has the individual stopped bathing on a daily basis?
Does the individual experience incontinence?
Does the individual need help getting dressed?
Is the individual keeping up with housekeeping?
Does the individual have past date food in their refrigerator and pantry?
Does the individual consistently take their medications?
Does the individual take the proper doses of their medications?
Does the individual show signs of confusion or disorientation?
Is the individual recovering from surgery?
Is there an illness or chronic condition?

If you answered yes to some of these questions, homecare might be a great option for you or your loved one.

Contact Us anytime for your free in-home assessment.

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