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Check off the statements that you want to apply to your life now:

Housekeeping such as laundry and linen changes made for you
Yard work and maintenance provided all year round
Transportation services provided like running errands or doctor’s appointments
Fun activities with other seniors such as happy hours, exercise classes, walking groups, and recreational clubs like reading, gardening, or drawing
Scratch-made chef-inspired dining with snacks and beverages throughout the day
Minimal assistive services provided as needed

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Have they lost/gained weight recently?
Have they been taking their medications on time?
Has their grooming or hygiene changed?
Have they isolated themselves or do they lack social engagement with others?
Are there issues with mobility or access to medical care?

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Check off the questions that apply to your loved one:

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Have your loved one lost/gained weight recently?
Have they been taking their medications on time?
Have they gotten lost in an area that is normally familiar to them?
Do they have trouble reciting their address and/or phone number?
Can they perform personal care duties (grooming and hygiene)?
Have they isolated themselves or do they lack social engagement with others?
Are there issues with mobility or access to medical care?
Has their personality changed?
Are your care-taking duties adversely affecting your own life and daily activities?

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