Home
What Is Home Care?
Is There A Need?
Services
Keeping in Touch
Consumer Protection
About Us
Contact Us
Is There A Need?
The following questions are designed to assist you in identifying the need for home care and the level of care necessary.
1. Please choose the best answer that describes the person needing care:
General Health
Frail
Poor
Fair
Good
Does the person needing help have a physical disability?
Yes
No
What is the person's age?
86 or older
85-71
70-60
59 or younger
Please select the statement that best describes the person's current living arrangement.
Alone without needed help
Alone, has help
With someone who can't help
With someone who can help
Self-sufficient
Please select the statement that best describes the person's current mental condition.
Diagnosis of Alzheimer's or other mental dysfunction
Frequent confusion and/or disorientation
Sometimes confused and forgetful
No Problem
2. How difficult is it for the individual needing care to perform the following activities of daily life:
Very
Moderately
No Difficulty
Personal care and Grooming
Ability to get around in the house
Managing the household tasks
Meal preparation and nutrition
Getting out of the home to shop, etc.
Socialize with others
Medication compliance
3. Does the person rely on others for these tasks?
Yes
No
4. Has there been deterioration in the physical or mental health of the individual or in the ability to manage daily activities within the past 6 months?
Yes
No
5. Does the need for care create stress for you or other family members?
Yes
No
6. Is your concern magnified by any of the following (check all that apply)
Family tension
Lack of knowledge
Inability to provide care due to personal commitments, distance, etc.
Feeling of being overwhelmed
7. Is the person in need of care able to handle an emergency in the home?
Yes
No
8. If something doesn't change, will it be difficult or impossible for this person to stay at home?
Yes
No
9. Are you worried about this individual?
Yes
No
Visiting Homemaker Services of Hudson County
(201)656-9012
586 Newark Avenue, Jersey City, New Jersey 07306
(201)656-6001