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