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Questionnaires for Seniors

The following questionnaire is provided to allow the families to self asscess their own needs.

Ideally the best plan of action is to have a medical assessment done by a professional in your area, such as a physician, nurse, occupational therapist or local home care agency. This questionnaire is not intended to replace a professional assessment, but rather to assist you in determining if further help is actually needed. Bear in mind that implementing care can often be difficult and be met with resistance. It is important to involve the individual in question in any or all plans.
Is the Individual: YES NO

Independent Yes No
Somewhat dependent Yes No
Totally dependent Yes No
In need of minimal assistance Yes No
In need of maximum assistance Yes No
Forgetful Yes No
Able to walk independently Yes No
Lonely, calling you frequently at work Yes No
Recent surgery or major illness Yes No
Improving Yes No
Declining Yes No
Developing poor eating habits Yes No
Affected by a recent life altering event Yes No

If you answered yes to:

1-3 We are here to help.
4-7 Our services could be considered.
8-13 Call us today. We can help bring balance to your life.

For more information call 1-877-301-2092 or email us at ssartin@compassionateadvantage.ca

The Compassionate Advantage Inc.

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